Li Da, Ma Jinman, Wei Chijun, Zhao Jichun, Yuan Ding, Zheng Tinghui
Department of Applied Mechanics, Sichuan University, Chengdu, China.
Department of Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China.
Ann Vasc Surg. 2019 Aug;59:308.e1-308.e8. doi: 10.1016/j.avsg.2019.02.049. Epub 2019 May 7.
Pancreaticoduodenal artery aneurysms (PDAAs) with occlusion of the superior mesenteric artery (SMA) are extremely rare. In the present study, we used computational fluid dynamics (CFD) to analyze the hemodynamics of a patient-specific PDAA with occlusion of the SMA preoperatively and then decide the treatment strategy in terms of the potential postoperative hemodynamics.
A 3D model of a 69-old-year female with PDAA was reconstructed based on CT images. The virtual postoperative models of the aneurysmectomy with or without revascularization were numerically simulated in terms of hemodynamics including the flow field and wall shear stress (WSS).
Aneurysmectomy with revascularization would result in the original aneurysm site experiencing abnormally high WSS and pressure, which may possibly lead to the recurrence of PDAA. However, aneurysmectomy without revascularization would lead to stagnant flow in the blocked posterior-inferior pancreaticoduodenal artery (PIPDA). As a result, the PIPDA may soon be completely occluded after surgery and the SMA perfusion would be guaranteed. Finally, aneurysmectomy without revascularization was performed in this patient. The postoperative six-month computed tomography angiography result finely matched to the preoperative CFD simulation result.
This study gained insights into hemodynamics of PDAA. In addition, it demonstrated that utilization of CFD analysis also possibly helps assist the operation strategies for vascular diseases.
肠系膜上动脉（SMA）闭塞的胰十二指肠动脉瘤（PDAA）极为罕见。在本研究中，我们术前使用计算流体动力学（CFD）分析了一名患有SMA闭塞的特定患者的PDAA血流动力学情况，然后根据潜在的术后血流动力学情况确定治疗策略。
基于CT图像重建了一名69岁患有PDAA的女性的三维模型。对动脉瘤切除并重建血管或未重建血管的虚拟术后模型进行了血流动力学数值模拟，包括流场和壁面剪应力（WSS）。
切除动脉瘤并重建血管会导致原动脉瘤部位出现异常高的WSS和压力，这可能会导致PDAA复发。然而，未重建血管的动脉瘤切除术会导致阻塞的胰十二指肠下后动脉（PIPDA）血流停滞。结果，PIPDA可能在手术后很快完全闭塞，并且SMA灌注将得到保证。最后，该患者接受了未重建血管的动脉瘤切除术。术后六个月的计算机断层血管造影结果与术前CFD模拟结果高度吻合。
本研究深入了解了PDAA的血流动力学。此外，它还表明利用CFD分析可能有助于辅助血管疾病的手术策略。
