van Bakel Theodorus M, Romarowski Rodrigo M, Morganti Simone, van Herwaarden Joost A, Moll Frans L, de Beaufort Hector W, Marrocco-Trischitta Massimiliano M, Secchi Francesco, Conti Michele, Auricchio Ferdinando, Trimarchi Santi
Thoracic Aortic Research Center, IRCCS-Policlinico San Donato, University of Milan, Milan, Italy.
Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Aorta (Stamford). 2018 Jun;6(3):81-87. doi: 10.1055/s-0039-1683771. Epub 2019 Feb 22.
The benefits of thoracic endovascular aortic repair (TEVAR) have encouraged stent graft deployment more proximally in the aortic arch. This study quantifies the hemodynamic impact of TEVAR in proximal landing zone 2 on the thoracic aorta and the proximal supra-aortic branches.
Patients treated with TEVAR in proximal landing zone 2 having available preoperative and 30-day postoperative computer tomography angiography and phase-contrast magnetic resonance imaging data were retrospectively selected. Blood flow was studied using patient-specific computational fluid dynamics simulations.
Four patients were included. Following TEVAR in proximal landing zone 2, the mean flow in the left common carotid artery (LCCA) increased almost threefold, from 0.21 (0.12-0.41) L/min to 0.61 (0.24-1.08) L/min (+294%). The surface area of the LCCA had not yet increased commensurately and therefore maximum flow velocity in the LCCA increased from 44.9 (27.0-89.3) cm/s to 72.6 (40.8-135.0) cm/s (+62%). One of the patients presented with Type Ib endoleak at 1-year follow-up. The displacement force in this patient measured 32.1 N and was directed dorsocranial, perpendicular to the distal sealing zone. There was a linear correlation between the surface area of the stent graft and the resulting displacement force ( = 0.04).
TEVAR in proximal landing zone 2 alters blood flow in the supra-aortic branches, resulting in increased flow with high flow velocities in the LCCA. High displacement forces were calculated and related to stent graft migration and Type I endoleak during 1-year follow-up.
胸主动脉腔内修复术（TEVAR）的优势促使支架移植物在主动脉弓更靠近近端的位置展开。本研究量化了TEVAR在近端着陆区2对胸主动脉和近端主动脉弓上分支的血流动力学影响。
回顾性选取在近端着陆区2接受TEVAR治疗且有术前和术后30天计算机断层血管造影及相位对比磁共振成像数据的患者。使用个体化计算流体动力学模拟研究血流情况。
纳入4例患者。在近端着陆区2进行TEVAR后，左颈总动脉（LCCA）的平均血流量几乎增加了两倍，从0.21（0.12 - 0.41）L/分钟增至0.61（0.24 - 1.08）L/分钟（增加294%）。LCCA的表面积尚未相应增加，因此LCCA的最大流速从44.9（27.0 - 89.3）cm/秒增至72.6（40.8 - 135.0）cm/秒（增加62%）。1例患者在1年随访时出现Ib型内漏。该患者的移位力为32.1 N，方向为背颅侧，垂直于远端密封区。支架移植物的表面积与产生的移位力之间存在线性相关性（= 0.04）。
近端着陆区2的TEVAR改变了主动脉弓上分支的血流，导致LCCA血流增加且流速较高。计算出较高的移位力，并与1年随访期间的支架移植物迁移和I型内漏相关。
