Forneris Arianna, Fatehi Hassanabad Ali, Appoo Jehangir J, Di Martino Elena S
Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada.
R&D Department, ViTAA Medical Solutions, Montreal, QC H2K 1M6, Canada.
Bioengineering (Basel). 2024 Jul 8;11(7):690. doi: 10.3390/bioengineering11070690.
The formation of an aneurysm in the false lumen (FL) is a long-term complication in a significant percentage of type B aortic dissection (AD) patients. The ability to predict which patients are likely to progress to aneurysm formation is key to justifying the risks of interventional therapy. The investigation of patient-specific hemodynamics has the potential to enable a patient-tailored approach to improve prognosis by guiding disease management for type B dissection. CFD-derived hemodynamic descriptors and geometric features were used to retrospectively assess individual aortas for a population of residual type B AD patients and analyze correlations with known outcomes (i.e., rapid aortic growth, death). The results highlight great variability in flow patterns and hemodynamic descriptors. A rapid aortic expansion was found to be associated with a larger FL. Time-averaged wall shear stress at the tear region emerged as a possible indicator of the dynamics of flow exchange between lumens and its effect on the evolution of individual aortas. High FL flow rate and tortuosity were associated with adverse outcomes suggesting a role as indicators of risk. AD induces complex changes in vessel geometry and hemodynamics. The reported findings emphasize the need for a patient-tailored approach when evaluating uncomplicated type B AD patients and show the potential of CFD-derived hemodynamics to complement anatomical assessment and help disease management.
在相当比例的B型主动脉夹层（AD）患者中，假腔（FL）内动脉瘤的形成是一种长期并发症。预测哪些患者可能进展为动脉瘤形成的能力是证明介入治疗风险合理性的关键。对患者特异性血流动力学的研究有可能通过指导B型夹层的疾病管理，实现针对患者的个性化方法以改善预后。利用计算流体动力学（CFD）得出的血流动力学描述符和几何特征，对一组残留B型AD患者的个体主动脉进行回顾性评估，并分析与已知结果（即主动脉快速生长、死亡）的相关性。结果突出了血流模式和血流动力学描述符的巨大变异性。发现主动脉快速扩张与较大的假腔相关。撕裂区域的时间平均壁面剪应力成为管腔间血流交换动态及其对个体主动脉演变影响的一个可能指标。高假腔流速和迂曲与不良结果相关，表明其作为风险指标的作用。AD会引起血管几何形状和血流动力学的复杂变化。报告的研究结果强调在评估无并发症的B型AD患者时需要采用针对患者的个性化方法，并显示了CFD得出的血流动力学在补充解剖学评估和帮助疾病管理方面的潜力。
