Mandigers Tim J, Ramella Anna, Bissacco Daniele, Domanin Maurizio, van Herwaarden Joost A, Heijmen Robin, Luraghi Giulia, Migliavacca Francesco, Trimarchi Santi
Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, Milan, Italy.
Eur J Vasc Endovasc Surg. 2023 Dec;66(6):784-796. doi: 10.1016/j.ejvs.2023.06.006. Epub 2023 Jun 15.
Pre-procedural planning of thoracic endovascular aortic repair (TEVAR) may implement computational adjuncts to predict technical and clinical outcomes. The aim of this scoping review was to explore the currently available TEVAR procedure and stent graft modelling options.
PubMed (MEDLINE), Scopus, and Web of Science were systematically searched (English language, up to 9 December 2022) for studies presenting a virtual thoracic stent graft model or TEVAR simulation.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed. Qualitative and quantitative data were extracted, compared, grouped, and described. Quality assessment was performed using a 16 item rating rubric.
Fourteen studies were included. Among the currently available in silico simulations of TEVAR, severe heterogeneity exists in study characteristics, methodological details, and evaluated outcomes. Ten studies (71.4%) were published during the last five years. Eleven studies (78.6%) included heterogeneous clinical data to reconstruct patient specific aortic anatomy and disease (e.g., type B aortic dissection, thoracic aortic aneurysm) from computed tomography angiography imaging. Three studies (21.4%) constructed idealised aortic models with literature input. The applied numerical methods consisted of computational fluid dynamics analysing aortic haemodynamics in three studies (21.4%) and finite element analysis analysing structural mechanics in the others (78.6%), including or excluding aortic wall mechanical properties. The thoracic stent graft was modelled as two separate components (e.g., graft, nitinol) in 10 studies (71.4%), as a one component homogenised approximation (n = 3, 21.4%), or including nitinol rings only (n = 1, 7.1%). Other simulation components included the catheter for virtual TEVAR deployment and numerous outcomes (e.g., Von Mises stresses, stent graft apposition, drag forces) were evaluated.
This scoping review identified 14 severely heterogeneous TEVAR simulation models, mostly of intermediate quality. The review concludes there is a need for continuous collaborative efforts to improve the homogeneity, credibility, and reliability of TEVAR simulations.
胸主动脉腔内修复术（TEVAR）的术前规划可采用计算辅助手段来预测技术和临床结果。本综述的目的是探讨目前可用的TEVAR手术和支架移植物建模选项。
对PubMed（MEDLINE）、Scopus和Web of Science进行系统检索（检索截至2022年12月9日的英文文献），以查找呈现虚拟胸主动脉支架移植物模型或TEVAR模拟的研究。
遵循系统评价和Meta分析扩展版的范围综述的首选报告项目（PRISMA-ScR）。提取、比较、分组并描述定性和定量数据。使用16项评分标准进行质量评估。
纳入14项研究。在目前可用的TEVAR计算机模拟中，研究特征、方法细节和评估结果存在严重异质性。10项研究（71.4%）在过去五年内发表。11项研究（78.6%）纳入了异质性临床数据以从计算机断层血管造影成像重建患者特异性主动脉解剖结构和疾病（如B型主动脉夹层、胸主动脉瘤）。3项研究（21.4%）利用文献输入构建理想化主动脉模型。应用的数值方法包括三项研究（21.4%）中用于分析主动脉血流动力学的计算流体动力学，以及其他研究（78.6%）中用于分析结构力学的有限元分析，包括或不包括主动脉壁力学特性。10项研究（71.4%）将胸主动脉支架移植物建模为两个独立组件（如移植物、镍钛合金），三项研究（21.4%）建模为一个组件的均匀近似，一项研究（7.1%）仅包括镍钛合金环。其他模拟组件包括用于虚拟TEVAR部署的导管，并评估了众多结果（如冯·米塞斯应力、支架移植物贴合度、阻力）。
本范围综述确定了14个严重异质性的TEVAR模拟模型，大多质量中等。综述得出结论，需要持续的合作努力来提高TEVAR模拟的同质性、可信度和可靠性。
