Iwanaga Shoki, Kimura Naoyuki, Imada Shuta, Mizoguchi Mutsumi, Arakawa Mamoru, Akutsu Hirohiko, Kawahito Koji, Nakamura Masanori
Department of Surgery, Division of Cardiovascular Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, 329-0498, Japan.
Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Gokiso, Showa, Nagoya, 466-8555, Japan.
Gen Thorac Cardiovasc Surg Cases. 2025 Jun 17;4(1):28. doi: 10.1186/s44215-025-00212-7.
We report a computational fluid dynamics (CFD)-based analysis of an unsuccessful open fenestration for aortic dissection with mesenteric malperfusion.
A 75-year-old male was admitted for acute type B aortic dissection complicated by mesenteric malperfusion. He had a concomitant infrarenal abdominal aneurysm, prompting surgical infrarenal fenestration. Intraoperatively, the proximal intimal flap was resected near the renal arteries, and the aneurysm was replaced with a prosthetic graft. Despite the intervention, mesenteric malperfusion worsened, requiring additional endovascular aortic repair. CFD analysis revealed persistent false lumen flow and true lumen compression due to a large entry tear and residual proximal anastomotic stenosis.
CFD analysis suggests that a large entry tear and residual stenosis from insufficient fenestration may result in inadequate false lumen depressurization.
我们报告了一项基于计算流体动力学（CFD）对肠系膜灌注不良的主动脉夹层开窗术失败的分析。
一名75岁男性因急性B型主动脉夹层合并肠系膜灌注不良入院。他同时患有肾下腹主动脉瘤，因此进行了手术肾下开窗术。术中，在肾动脉附近切除近端内膜瓣，并用人工血管置换动脉瘤。尽管进行了干预，但肠系膜灌注不良仍恶化，需要额外的血管腔内主动脉修复。CFD分析显示，由于大的入口撕裂和近端吻合口残余狭窄，假腔血流持续存在且真腔受压。
CFD分析表明，大的入口撕裂和开窗不足导致的残余狭窄可能导致假腔减压不足。
