Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA; Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
Department of Radiology, University of Utah, Salt Lake City, UT, USA.
J Biomech. 2024 Nov;176:112320. doi: 10.1016/j.jbiomech.2024.112320. Epub 2024 Sep 12.
Splenic artery embolization (SAE) has become a favored alternative to splenectomy, offering a less invasive intervention for injured spleens while preserving spleen function. However, our understanding of the role that hemodynamics plays during embolization remains limited. In this study, we utilized patient-specific computational fluid dynamics (CFD) simulations to study distal and proximal embolization strategies commonly used in SAE. Detailed 3D computer models were constructed considering the descending aorta, various major visceral arteries, and the iliac arteries. Subsequently, the blood flow and pressure associated with different coil placement locations in proximal embolization were studied considering the collateral vessels. Coil induced variations in pressure fields were quantified and compared to baseline. The coil induced flow stagnation was also quantified with particle residence time. Distal embolization was modeled with Lagrangian particle tracking and the effect of particle size, release location, and timing on embolization outcome was studied. Our findings highlight the crucial role of collateral vessels in maintaining blood supply to the spleen following proximal embolization. It was demonstrated that coil location can affect distal pressure and that strategic coil placement guided by patient-specific CFD simulations can further reduce this pressure as desired. Additionally, the results point to the critical roles that particle size, release timing, and location play in distal embolization. Our study provides an early attempt to use patient-specific computer modeling for optimizing embolization strategies and ultimately improving patient outcomes during SAE procedures.
脾动脉栓塞术（SAE）已成为脾切除术的替代方法，为受伤的脾脏提供了一种侵入性较小的干预措施，同时保留脾脏功能。然而，我们对栓塞过程中血液动力学所起作用的理解仍然有限。在这项研究中，我们利用患者特定的计算流体动力学（CFD）模拟来研究 SAE 中常用的远端和近端栓塞策略。考虑到降主动脉、各种主要内脏动脉和髂动脉，构建了详细的 3D 计算机模型。随后，考虑到侧支血管，研究了近端栓塞中不同线圈放置位置的血流和压力。定量和比较了线圈引起的压力场变化与基线相比。还定量评估了线圈引起的流动停滞，并通过粒子停留时间进行比较。使用拉格朗日粒子跟踪对远端栓塞进行建模，并研究了粒子大小、释放位置和时间对栓塞结果的影响。我们的研究结果强调了侧支血管在近端栓塞后维持脾脏血液供应的关键作用。结果表明，线圈位置会影响远端压力，并且可以通过基于患者特定 CFD 模拟的策略性线圈放置来进一步降低所需的压力。此外，结果表明，粒子大小、释放时间和位置在远端栓塞中起着至关重要的作用。我们的研究为使用患者特定的计算机建模来优化栓塞策略并最终改善 SAE 手术中的患者结果提供了早期尝试。
