Key result
ISF-TEVAR with double fenestrations of the LCA and LSA altered postoperative hemodynamics, causing flow acceleration around stents and creating regions susceptible to thrombosis at the aortic arch.
Why the study?
To explore the hemodynamic consequences of in situ fenestration thoracic endovascular aortic repair (ISF-TEVAR) with double fenestrations to preserve aortic major branches.
What are the hemodynamic consequences of TEVAR with in situ double fenestrations of the LCA and LSA?
Case Report (n=2)
What are the hemodynamic consequences of TEVAR with in situ double fenestrations of the LCA and LSA?
Computational simulations of TEVAR with double in situ fenestrations reveal altered hemodynamics and potential regions of thrombosis susceptibility, highlighting the need for close follow-up of the aortic arch and rebuilt branches.
May increase arch thrombosis risk after double-fenestrated ISF-TEVAR; hypothesis-generating and requires prospective clinical validation.
The aortic major branches after thoracic endovascular aortic repair (TEVAR) could be preserved by in situ fenestration (ISF). This study aims to explore the hemodynamic consequences of ISF-TEVAR with double fenestrations. Two patients with aortic dissection and aneurysm, respectively, were treated by ISF-TEVAR and both the left carotid artery (LCA) and left subclavian artery (LSA) were reconstructed by fenestration technique. The blood was considered a non-Newtonian fluid and the Windkessel model was adopted at the aortic outlets. Simulations were performed in two postoperative models to analyze the effects of the double fenestration stents on the hemodynamics. The postoperative wall pressure of the LCA and LSA is relatively low and the pressure difference between the inner and outer walls of the protruding segment of the LSA stent is found. Acceleration occurs when blood flows around the fenestration stents and the shear-thinning rheological behavior is observed at the aortic arch. Moreover, regions susceptible to thrombosis are identified and the surface exposed to high relative residence time is located at the aortic arch after the LSA stent. The presence of the double fenestration stents has a profound impact on the postoperative hemodynamics, and the aortic arch and rebuilt branches should be closely watched during follow-up.
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Qiao et al. (2019) conducted a case report in Aortic dissection and aneurysm (n=2). ISF-TEVAR with double fenestrations of LCA and LSA was evaluated on Hemodynamic consequences (wall pressure, flow acceleration, and thrombosis susceptibility). ISF-TEVAR with double fenestrations of the LCA and LSA altered postoperative hemodynamics, causing flow acceleration around stents and creating regions susceptible to thrombosis at the aortic arch.
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