Jiang Xudong, Xiang Guangyuan, Du Guanting, Li Xiaoqiang, Wu Peng, Du Xiaolong
Department of Vascular Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, 321 Zhongshan Road, Nanjing, Jiangsu, China; Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China.
Department of Vascular Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu 210008, China.
Comput Methods Programs Biomed. 2023 Dec;242:107785. doi: 10.1016/j.cmpb.2023.107785. Epub 2023 Aug 30.
The aim of this study is to perform patient-specific hemodynamic simulations of the patients with complicated aortic dissection underwent Physician-modified endograft (PMEG) and evaluate the treatment outcome.
12 patient-specific models were reconstructed from computed tomography angiography (CTA) data of 6 patients with complicated aortic dissection before and after the PMEG. Hemodynamic simulations were conducted with the same time-varying volumetric flow rate extracted from the literature and 3-element Windkessel model (3 EWM) boundary conditions were applied at the aortic outlet. Hemodynamic indicators such as time-averaged wall shear stress (TAWSS), relative residence time (RRT) and endothelial cell activation potential (ECAP) were obtained to evaluate the postoperative effect of PMEG.
Comparing with the preoperative models, the flow rates of most visceral arteries were increased in the postoperative models (P = 0.012, P = 0.013, and P = 0.005). Pressure and TAWSS in visceral regions were significantly reduced (P = 0.003 and P = 0.017). With the false lumens (FL) covered by the stent grafts, the average TAWSS level increased in the regions of postoperative abdominal aorta (P = 0.002), and the average RRT and ECAP values decreased significantly (P = 0.02 and P = 0.003).
This study shows that PMEG, as a new technique for the treatment of complicated aortic dissection involving the distal tears in the visceral region, can effectively restore the abnormal blood supply of the visceral arteries, reduce the risk of aortic rupture, the formation of aortic dissection aneurysm (ADA), and thrombosis. This corresponds well with clinical retrospective studies and 1-year follow-up outcomes. The findings of this study are of great significance for the development of PMEG.
本研究旨在对接受医生改良型腔内移植物（PMEG）治疗的复杂主动脉夹层患者进行个体化血流动力学模拟，并评估治疗效果。
从6例复杂主动脉夹层患者接受PMEG治疗前后的计算机断层扫描血管造影（CTA）数据中重建12个个体化模型。采用从文献中提取的相同随时间变化的容积流量进行血流动力学模拟，并在主动脉出口处应用三元风箱模型（3 EWM）边界条件。获得时间平均壁面切应力（TAWSS）、相对停留时间（RRT）和内皮细胞激活潜能（ECAP）等血流动力学指标，以评估PMEG的术后效果。
与术前模型相比，术后模型中大多数内脏动脉的血流量增加（P = 0.012、P = 0.013和P = 0.005）。内脏区域的压力和TAWSS显著降低（P = 0.003和P = 0.017）。随着支架移植物覆盖假腔（FL），术后腹主动脉区域的平均TAWSS水平升高（P = 0.002），平均RRT和ECAP值显著降低（P = 0.02和P = 0.003）。
本研究表明，PMEG作为一种治疗涉及内脏区域远端撕裂的复杂主动脉夹层的新技术，可有效恢复内脏动脉的异常供血，降低主动脉破裂、主动脉夹层动脉瘤（ADA）形成和血栓形成的风险。这与临床回顾性研究和1年随访结果相符。本研究结果对PMEG的发展具有重要意义。
