Why the study?
To assess the influence of the distance between the distal end of a thoracic stent-graft and the first reentry tear on false lumen thrombosis progression after TEVAR.
Does the distance between the distal end of a thoracic stent-graft and the first reentry tear affect false lumen thrombosis progression following TEVAR?
Does the distance between the distal end of a thoracic stent-graft and the first reentry tear affect false lumen thrombosis progression following TEVAR?
Computational fluid dynamics modeling suggests that a more distal reentry tear (larger SG-FRT distance) promotes false lumen thrombosis following TEVAR.
Should not change TEVAR planning; hypothesis-generating in animal models and requires clinical validation.
Purpose: To report a study that assesses the influence of the distance between the distal end of a thoracic stent-graft and the first reentry tear (SG-FRT) on the progression of false lumen (FL) thrombosis in patients who underwent thoracic endovascular aortic repair (TEVAR). Materials and Methods: Three patient-specific geometrical models were reconstructed from postoperative computed tomography scans. Two additional models were created by artificially changing the SG-FRT distance in patients 1 and 2. In all 5 models, computational fluid dynamics simulations coupled with thrombus formation modeling were performed at physiological flow conditions. Predicted FL thrombosis was compared to follow-up scans. Results: There was reduced false lumen flow and low time-averaged wall shear stress (TAWSS) in patients with large SG-FRT distances. Predicted thrombus formation and growth were consistent with follow-up scans for all patients. Reducing the SG-FRT distance by 30 mm in patient 1 increased the flow and time-averaged wall shear stress in the upper abdominal FL, reducing the thrombus volume by 9.6%. Increasing the SG-FRT distance in patient 2 resulted in faster thoracic thrombosis and increased total thrombus volume. Conclusion: The location of reentry tears can influence the progression of FL thrombosis following TEVAR. The more distal the reentry tear in the aorta the more likely it is that FL thrombosis will occur. Hence, the distal landing zone of the stent-graft should be chosen carefully to ensure a sufficient SG-FRT distance.
No takes yet. Share an insight, caveat, or question.
Armour et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: