Department of Surgery, University of Nebraska-Medical Center, 985182 Nebraska-Medical Center, Omaha, NE 68198-5182, USA.
Ann Biomed Eng. 2013 Feb;41(2):263-78. doi: 10.1007/s10439-012-0640-2. Epub 2012 Aug 25.
Patch angioplasty is the most common technique used for the performance of carotid endarterectomy. A large number of materials are available, but little is known to aid the surgeon in choosing a patch while caring for a patient with carotid disease. The objective of this study was to investigate biomechanics of the carotid artery (CA) repaired with patch angioplasty, study the influence of patch width and location of closure on hemodynamics, and to select the optimal patch material from those commonly used. For this purpose, a mathematical model was built that accounts for fluid-structure interaction, three-dimensional arterial geometry, non-linear anisotropic mechanical properties, non-Newtonian flow and in vivo boundary conditions. This model was used to study disease-related mechanical factors in the arterial wall and blood flow for different types of patch angioplasty. Analysis indicated that patch closures performed with autologous vein and bovine pericardium were hemodynamically superior to carotid endarterectomy with synthetic patch angioplasty (polytetrafluoroethylene, Dacron) in terms of restenosis potential. Width of the patch and location of arteriotomy were found to be of paramount importance, with narrow patches being superior to wide patches, and anterior arteriotomy being superior to the lateral arteriotomy. These data can aid vascular surgeons in their selection of patch angioplasty technique and material for the care of patients undergoing open CA repair.
补片血管成形术是进行颈动脉内膜切除术最常用的技术。有大量的材料可供选择，但在为颈动脉疾病患者护理的同时，很少有医生了解如何选择补片。本研究的目的是研究用补片血管成形术修复颈动脉（CA）的生物力学，研究补片的宽度和缝合位置对血流动力学的影响，并从常用的补片材料中选择最佳材料。为此，建立了一个数学模型，该模型考虑了流固耦合、三维动脉几何形状、非线性各向异性力学特性、非牛顿流和体内边界条件。该模型用于研究不同类型的补片血管成形术的动脉壁和血流中的与疾病相关的力学因素。分析表明，与使用合成补片血管成形术（聚四氟乙烯、涤纶）相比，自体静脉和牛心包补片缝合在再狭窄潜力方面具有更好的血流动力学效果。补片的宽度和血管切开的位置非常重要，窄补片优于宽补片，前侧血管切开优于外侧血管切开。这些数据可以帮助血管外科医生选择补片血管成形术技术和材料，以护理接受开放颈动脉修复的患者。
