Key result
Computational fluid dynamic analysis of aortoiliac bifurcations showed that a 30° angle had lower static pressure and Reynolds number compared to 45° and 70° angles, both before and after stenting.
Why the study?
How do bifurcation angle and stent configuration affect fluid dynamics in aortoiliac atherosclerotic disease?
How do bifurcation angle and stent configuration affect fluid dynamics in aortoiliac atherosclerotic disease?
Bifurcation angle significantly impacts the fluid dynamic profile of aortoiliac bifurcations before and after stenting, with 30° angles showing more favorable profiles and low kissing self-expandable stents showing the greatest deviation from physiology.
Answers are grounded in this paper and cite their sources.
Should not yet alter aortoiliac stenting practice; leaves open validation of angle-specific hemodynamics in clinical cohorts.
OBJECTIVES: To non-invasively evaluate by computational fluid dynamic (CFD) analysis the physiology and rheology of aortoiliac bifurcation disease at different angles and different stent configurations. MATERIAL AND METHODS: For the analysis, we considered a physiologic model of abdominal aorta with an iliac bifurcation set at 30°, 45° and 70° without stenosis. Subsequently, a bilateral ostial common iliac stenosis of 80% was considered for each type of bifurcation. For the stent simulation, we reconstructed Zilver vascular self-expanding (Zilver; Cook, Bloomington, MN) and Palmaz Genesis Peripheral (Cordis, Miami, FL) stents. RESULTS: The physiologic model, across the different angles, static pressure, Reynolds number and stream function, were lower for the 30° bifurcation angle with a gradient from 70° to 30° angles, whereas all the other parameters were inversely higher. After stenting, all the fluid parameters decreased homogenously independent of the stent type, maintaining a gradient in favour of 30° compared to 45° and 70° angles. The absolute greater deviation from physiology was observed for low kissing when self-expandable stents were used across all angles; in particular, the wall shear stress was high at at 45° angle. CONCLUSION: Bifurcation angle deeply impacts the physiology of aortoiliac bifurcations, which are used to predict the fluid dynamic profile after stenting. CFD, having the potential to be derived both from computed tomography scan or invasive angiography, appears to be an ideal tool to predict fluid dynamic profile before and after stenting in aortoiliac bifurcation.
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Rigatelli et al. (2018) studied Aortoiliac atherosclerotic disease. Stent simulation (Zilver self-expanding and Palmaz Genesis Peripheral stents) vs. Physiologic model without stenosis and different bifurcation angles was evaluated on Fluid dynamic parameters (static pressure, Reynolds number, stream function, wall shear stress). Computational fluid dynamic analysis of aortoiliac bifurcations showed that a 30° angle had lower static pressure and Reynolds number compared to 45° and 70° angles, both before and after stenting.
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