Aortic hemodynamics after thoracic endovascular aortic repair, with particular attention to the bird-beak configuration

Guido H W Van Bogerijen, Ferdinando Auricchio, Michele Conti, Adrien Lefieux, Alessandro Reali, Alessandro Veneziani, Jip L. Tolenaar, Frans L. Moll, Vincenzo Rampoldi, Santi Trimarchi

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To quantitatively evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic hemodynamics, focusing on the implications of a bird-beak configuration.

Methods: Pre- and postoperative CTA images from a patient treated with TEVAR for postdissecting thoracic aortic aneurysm were used to evaluate the anatomical changes induced by the stent-graft and to generate the computational network essential for computational fluid dynamics (CFD) analysis. These analyses focused on the bird-beak configuration, flow distribution into the supra-aortic branches, and narrowing of the distal descending thoracic aorta. Three different CFD analyses (A: preoperative lumen, B: postoperative lumen, and C: postoperative lumen computed without stenosis) were compared at 3 time points during the cardiac cycle (maximum acceleration of blood flow, systolic peak, and maximum deceleration of blood flow).

Results: Postoperatively, disturbance of flow was reduced at the bird-beak location due to boundary conditions and change of geometry after TEVAR. Stent-graft protrusion with partial coverage of the origin of the left subclavian artery produced a disturbance of flow in this vessel. Strong velocity increase and flow disturbance were found at the aortic narrowing in the descending thoracic aorta when comparing B and C, while no effect was seen on aortic arch hemodynamics.

Conclusion: CFD may help physicians to understand aortic hemodynamic changes after TEVAR, including the change in aortic arch geometry, the effects of a bird-beak configuration, the supra-aortic flow distribution, and the aortic true lumen dynamics. This study is the first step in establishing a computational framework that, when completed with patient-specific data, will allow us to study thoracic aortic pathologies and their endovascular management.

Original languageEnglish
Pages (from-to)791-802
Number of pages12
JournalJournal of Endovascular Therapy
Volume21
Issue number6
DOIs
Publication statusPublished - Dec 1 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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