Qiao Yonghui, Mao Le, Wang Yan, Luan Jingyang, Chen Yanlu, Zhu Ting, Luo Kun, Fan Jianren
State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Biomech Model Mechanobiol. 2022 Apr;21(2):419-431. doi: 10.1007/s10237-021-01542-5. Epub 2022 Jan 7.
Thoracic endovascular aortic repair (TEVAR) has become the standard treatment of a variety of aortic pathologies. The objective of this study is to evaluate the hemodynamic effects of stent-graft introducer sheath during TEVAR. Three idealized representative diseased aortas were designed: aortic aneurysm, coarctation of the aorta, and aortic dissection. Computational fluid dynamics studies were performed in the above idealized aortic geometries. An introducer sheath routinely used in the clinic was virtually placed into diseased aortas. Comparative analysis was carried out to evaluate the hemodynamic effects of the introducer sheath. Results show that the blood flow to the supra-aortic branches would increase above 9% due to the obstruction of the introducer sheath. The region exposed to high endothelial cell activation potential (ECAP) expands in the scenarios of coarctation of the aorta and aortic dissection, which indicates that the probability of thrombus formation may increase during TEVAR. The pressure magnitude in peak systole shows an obvious rise, and a similar phenomenon is not observed in early diastole. The blood viscosity in the aortic arch and descending aorta is remarkably altered by the introducer sheath. The uneven viscosity distribution confirms the necessity of using non-Newtonian models, and high-viscosity region with high ECAP further promotes thrombosis. Our results highlight the hemodynamic effects of stent-graft introducer sheath during TEVAR, which may associate with perioperative complications.
胸主动脉腔内修复术（TEVAR）已成为多种主动脉病变的标准治疗方法。本研究的目的是评估TEVAR期间支架移植物导入鞘的血流动力学效应。设计了三种理想化的代表性病变主动脉：主动脉瘤、主动脉缩窄和主动脉夹层。对上述理想化的主动脉几何模型进行了计算流体动力学研究。将临床上常规使用的导入鞘虚拟置入病变主动脉中。进行对比分析以评估导入鞘的血流动力学效应。结果表明，由于导入鞘的阻塞，主动脉弓上分支的血流量将增加9%以上。在主动脉缩窄和主动脉夹层的情况下，暴露于高内皮细胞激活潜能（ECAP）的区域会扩大，这表明TEVAR期间血栓形成的可能性可能增加。收缩期峰值压力明显升高，舒张早期未观察到类似现象。导入鞘显著改变了主动脉弓和降主动脉中的血液粘度。粘度分布不均证实了使用非牛顿模型的必要性，且具有高ECAP的高粘度区域进一步促进血栓形成。我们的结果突出了TEVAR期间支架移植物导入鞘的血流动力学效应，这可能与围手术期并发症有关。
