Liu Ming-Yuan, Jiao Yang, Liu Junjun, Zhang Simeng, Li Wei
Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Beijing Center for Vascular Surgery, Beijing, China.
Front Cardiovasc Med. 2021 Apr 23;8:654412. doi: 10.3389/fcvm.2021.654412. eCollection 2021.
Branch vessel occlusion is reported in endovascular repair of aortic pathology. This study aimed to evaluate the hemodynamic indicators associated with in-stent thrombosis (IST) of a branched stent-graft (BSG) after endovascular aortic repair (EVAR) of a complex abdominal aortic aneurysm. A retrospective evaluation was performed based on the computed tomography (CT) scans and clinical data of three patients who underwent multi-branched endovascular repair. Patient-specific 3-dimensional models were reconstructed, and hemodynamic analysis was performed for IST. Hemodynamics-related parameters including time-averaged wall shear stress (TAWSS), oscillatory shear stress index (OSI), and relative residence time (RRT) were compared among the individual patients. The flow velocity, TAWSS, OSI, and RRT were radically changed in the area of the IST. In BSGs, IST tended to occur in the regions of hemodynamic alteration near the bends in the device, where a decreased flow velocity (<0.6 m/s) and TAWSS (<0.8 Pa) and an elevated OSI (>0.2) and RRT (>5 s) were consistently observed. Hemodynamic perturbations in BSGs cause a predisposition to IST, which can be predicted by a series of changes in the flow parameters. Early hemodynamic analysis might be useful for identifying and remediating IST after multibranched endovascular repair.
据报道，在主动脉病变的血管内修复中会出现分支血管闭塞。本研究旨在评估复杂腹主动脉瘤血管内修复（EVAR）后分支支架移植物（BSG）的支架内血栓形成（IST）相关的血流动力学指标。基于3例接受多分支血管内修复患者的计算机断层扫描（CT）图像和临床数据进行回顾性评估。重建了患者特异性三维模型，并对IST进行血流动力学分析。比较了个体患者之间包括时间平均壁面切应力（TAWSS）、振荡切应力指数（OSI）和相对停留时间（RRT）在内的血流动力学相关参数。在IST区域，流速、TAWSS、OSI和RRT发生了显著变化。在BSG中，IST倾向于发生在装置弯曲处附近血流动力学改变的区域，在这些区域持续观察到流速降低（<0.6 m/s）和TAWSS降低（<0.8 Pa）以及OSI升高（>0.2）和RRT升高（>5 s）。BSG中的血流动力学扰动会导致IST易感性增加，这可以通过血流参数的一系列变化来预测。早期血流动力学分析可能有助于识别和纠正多分支血管内修复后的IST。
