Liang Shichao, Jia Heyue, Zhang Xuehuan, Guo Wei, Zhou Guojing, Li Shilong, Yuan Panpan, Xiong Jiang, Chen Duanduan
School of Life Science, Beijing Institute of Technology, Beijing, China.
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Apr 5;9:828910. doi: 10.3389/fcvm.2022.828910. eCollection 2022.
Iliac branch devices (IBDs) are valid tools for internal iliac artery preservation during endovascular abdominal aortic aneurysm and iliac aneurysm repair. The purpose of this study was to evaluate the effectiveness of a novel IBD with an embedded branch configuration.
A typical iliac artery model was reconstructed, and two models were manufactured using three-dimensional printing technology. The novel IBD was deployed into one iliac artery model by an experienced vascular surgeon. A mock circulation loop (MCL) and a computational fluid dynamics (CFD) simulation were used to investigate the haemodynamic parameters of the iliac models without (Model A) and with (Model B) the IBD. A morphological analysis was conducted using computed tomography angiography and medical endoscopy. The flow distribution rate (FDR) and energy loss (EL) were used to quantify IBD performance.
The FDR of the right internal iliac artery in the MCL of Model A and Model B was 18.88 ± 0.12% and 16.26 ± 0.09%, respectively ( = 0.0013). The FDR of the right internal iliac artery in the CFD simulation of Model A and Model B was 17.52 and 14.49%, respectively. The EL of Model A was greater than Model B in both the MCL and the CFD simulation. Compared with Model A, Model B had a larger region (8.46 vs. 3.64%) with a relative residence time of >20 Pa at peak systole. Meanwhile, the area where the oscillatory flow index was >0.4 was significantly smaller in Model B than in Model A (0.46 vs. 0.043%). The region with an average wall shear stress of >4 Pa was greater in Model B than in Model A (0 vs. 0.22%).
The MCL and CFD simulation showed that the novel IBD had little impact on the FDR and EL of the iliac artery models. However, the IBD might be an effective tool for the treatment of abdominal aortic/iliac aneurysms that extend into branches. Further investigations are warranted to confirm whether this IBD could be useful in the clinic.
髂支装置（IBDs）是在血管腔内修复腹主动脉瘤和髂动脉瘤过程中保留髂内动脉的有效工具。本研究的目的是评估一种新型嵌入式分支构型IBD的有效性。
重建一个典型的髂动脉模型，并使用三维打印技术制造两个模型。一位经验丰富的血管外科医生将新型IBD植入其中一个髂动脉模型。使用模拟循环回路（MCL）和计算流体动力学（CFD）模拟来研究未植入IBD（模型A）和植入IBD（模型B）的髂动脉模型的血流动力学参数。使用计算机断层血管造影和医学内窥镜进行形态学分析。采用血流分布率（FDR）和能量损失（EL）来量化IBD的性能。
模型A和模型B的MCL中右侧髂内动脉的FDR分别为18.88±0.12%和16.26±0.09%（P = 0.0013）。模型A和模型B的CFD模拟中右侧髂内动脉的FDR分别为17.52%和14.49%。在MCL和CFD模拟中，模型A的EL均大于模型B。与模型A相比，模型B在收缩期峰值时相对停留时间>20 Pa的区域更大（8.46%对3.64%）。同时，模型B中振荡血流指数>0.4的区域明显小于模型A（0.46%对0.043%）。模型B中平均壁面剪应力>4 Pa的区域大于模型A（0对0.22%）。
MCL和CFD模拟表明，新型IBD对髂动脉模型的FDR和EL影响较小。然而，该IBD可能是治疗延伸至分支的腹主动脉/髂动脉瘤的有效工具。有必要进一步研究以确认这种IBD在临床上是否有用。
