Predicting Post-TEVAR Endoleaks: A Pre-operative Hemodynamic Risk Factor from Patient-Specific Fluid–Structure Interaction Simulations

Purpose Thoracic endovascular aortic repair (TEVAR) is a minimally invasive treatment for thoracic aortic pathologies, including thoracic aortic aneurysm (TAA). Computational simulations can provide valuable insights into TEVAR outcomes and complications before intervention. This proof-of-concept study proposes a novel risk factor R as a potential predictor of post-TEVAR type I and III endoleaks (ELs) using pre-TEVAR hemodynamic data. Methods Fluid–structure interaction (FSI) computational simulations are performed in ten pre-TEVAR patient-specific TAA cases, with known follow-up TEVAR outcomes. Hemodynamic drag forces acting on the aortic wall are quantified and used to define R , which combines parallel and perpendicular drag force components with aortic tortuosity. The patient cohort is divided into a calibration set, used to associate specific R values with three different risk levels, and a test set, used to preliminarily assess the agreement between the predictions derived from R and the post-TEVAR follow-up outcomes. Results Based on the R values obtained for the calibration set, R ≤ ≤ 0.33 is associated with low risk of EL formation, 0.33 < R ≤ ≤ 0.67 with moderate risk, and R > 0.67 with high risk. Once it is applied to the test set, the risk factor is able to correctly identify a type I EL. Conclusion The risk factor proposed in this work is capable of identifying all the EL cases analyzed. This study represents a preliminary attempt to determine whether pre-TEVAR hemodynamics can effectively predict post-TEVAR complications and therefore aid clinicians in the pre-operative planning.