Wang Jiabin, Fan Tingting, Zhang Hongpeng, Ge Yangyang, Lu Weihang, Liu Feng, Rong Dan, Guo Wei
The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Medical School of Chinese PLA, Beijing, China.
Front Physiol. 2023 Aug 4;14:1234989. doi: 10.3389/fphys.2023.1234989. eCollection 2023.
The G-Branch endograft is a novel multibranched "off-the-shelf" device used to repair thoracoabdominal aortic aneurysms (TAAAs). This report describes the hemodynamic and morphological performance of the G-Branch endograft in a human patient with TAAA. We retrospectively reviewed the computed tomography angiography scans and clinical data of a woman in whom TAAA was treated using a G-Branch endograft. Patient-specific three-dimensional models were reconstructed, and computational fluid dynamics and morphological and hemodynamic indicators were analyzed before and after implantation of the device. From a morphological perspective, there was an increase in cross-sectional area in the G-Branch endograft and all bridging stent grafts over time. Blood flow was redistributed among the renovisceral arteries, with a decrease in flow rate in the celiac artery and an increase in the left renal artery. Laminar blood flow was smoother and more rapid after implantation of the G-Branch device and remained stable during follow-up. In the bridging stent grafts, flow recirculation zones were found in the bridging zones of the celiac artery and superior mesenteric artery as well as the distal sealing zones of both renal arteries. Furthermore, higher time-averaged wall shear stress and a lower oscillatory index and relative resident time were found in the G-Branch endograft and bridging stent grafts. Quantitative analysis showed obvious reduction in the surface area ratio of the elevated time-averaged wall shear stress area and surface area ratio of the relative resident time after G-branch implantation. The revascularization of branch vessels occurred following G-branch implantation, with improvements arising not only from morphological changes but also from hemodynamic alterations. The long-term performance of the G-Branch endograft needs further investigation and clinical validation.
G型分支腔内移植物是一种新型的多分支“现货供应”装置，用于修复胸腹主动脉瘤（TAAA）。本报告描述了G型分支腔内移植物在一名TAAA患者中的血流动力学和形态学表现。我们回顾性分析了一名使用G型分支腔内移植物治疗TAAA的女性患者的计算机断层血管造影扫描和临床数据。重建了患者特异性三维模型，并分析了该装置植入前后的计算流体动力学以及形态学和血流动力学指标。从形态学角度来看，随着时间的推移，G型分支腔内移植物和所有桥接支架移植物的横截面积均有所增加。肾周动脉之间的血流重新分布，腹腔干动脉血流速度降低，左肾动脉血流速度增加。植入G型分支装置后，层流更加平滑且速度更快，并且在随访期间保持稳定。在桥接支架移植物中，在腹腔干动脉和肠系膜上动脉的桥接区域以及双侧肾动脉的远端密封区域发现了血流再循环区。此外，在G型分支腔内移植物和桥接支架移植物中发现了更高的时间平均壁面切应力、更低的振荡指数和相对驻留时间。定量分析显示，G型分支植入后，时间平均壁面切应力升高区域的表面积比和相对驻留时间的表面积比明显降低。G型分支植入后分支血管发生了血运重建，不仅形态学改变带来了改善，血流动力学改变也产生了积极影响。G型分支腔内移植物的长期性能需要进一步研究和临床验证。
