Tupin Simon, Takase Kei, Ohta Makoto
Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan.
Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
Cardiovasc Intervent Radiol. 2021 Aug;44(8):1251-1259. doi: 10.1007/s00270-021-02835-z. Epub 2021 Apr 27.
The multilayer flow modulator (MFM) device has been used for the treatment of abdominal aortic aneurysm (AAA) for over a decade. Although several clinical studies have been published, criticism and concern over the device efficacy remain, as no quantitative analysis that describes its mechanism has been performed yet. The aim of this study was to experimentally evaluate the effect of MFM device deployment on aneurysmal pressure and branch perfusion.
An experimental flow and pressure monitoring system was developed to analyze the MFM deployment procedure performed by a qualified radiologist in AAA geometries with and without side branch. Particle image velocimetry experiments were then conducted on models with and without MFM device to evaluate and compare flow patterns and local flow velocity and vorticity in the aneurysm.
The experiments revealed no significant change in pressure and flow rate during and after deployment of the MFM device. The flow rate of the incorporated branch was fully preserved. On both models, the aneurysmal flow velocity was significantly reduced. In addition, the device modified local flow patterns, reducing vorticity and better feeding the incorporated branch.
This experimental study provides the basis for a better understanding of the mechanism of the MFM device, which allows intra-aneurysmal flow to decrease while preserving incorporated branch flow and reducing the risk of type II endoleak. The experimental system developed for this study was effective in simulating an endovascular procedure and studying the safety and effectiveness of endovascular devices.
多层血流调节器(MFM)装置用于治疗腹主动脉瘤(AAA)已有十多年。尽管已发表了多项临床研究,但对该装置的疗效仍存在批评和担忧,因为尚未进行描述其机制的定量分析。本研究的目的是通过实验评估MFM装置展开对动脉瘤压力和分支灌注的影响。
开发了一种实验性血流和压力监测系统,以分析由合格放射科医生在有和没有侧支的AAA模型中进行的MFM展开过程。然后在有和没有MFM装置的模型上进行粒子图像测速实验,以评估和比较动脉瘤中的血流模式、局部流速和涡度。
实验显示,MFM装置展开期间及之后,压力和流速均无显著变化。合并分支的流速得以完全保留。在两个模型上,动脉瘤内的流速均显著降低。此外,该装置改变了局部血流模式,降低了涡度,并更好地为合并分支供血。
本实验研究为更好地理解MFM装置的机制提供了依据,该装置可使动脉瘤内血流减少,同时保留合并分支的血流并降低II型内漏的风险。为本研究开发的实验系统在模拟血管内手术以及研究血管内装置的安全性和有效性方面是有效的。