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

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Thoracic aortic aneurysm undergoing thoracic endovascular aortic repair (TEVAR) (n=10). Intervention: Pre-operative hemodynamic risk factor R > 0.67 from fluid-structure interaction (FSI) simulations vs. Low to moderate risk factor R <= 0.67. Primary outcome: Post-TEVAR type I and III endoleak formation.

Q: What does this research mean for the field?

A pre-operative hemodynamic risk factor derived from fluid-structure interaction simulations and aortic tortuosity can identify landing zones at high risk for type I and III endoleaks after thoracic endovascular aortic repair. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Francesca Duca; Silvia Tavarone; Maurizio Domanin; Daniele Bissacco; Santi Trimarchi; Christian Vergara; Francesco Migliavacca

doi:10.1007/s10439-026-04337-w

October 27, 2026Annals of Biomedical EngineeringOpen Access

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

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Key result

Simulation-derived hemodynamic risk factor R > 0.67 identifies ~100% of post-TEVAR type I/III endoleaks.

n=10

Why the study?

Computational simulations can provide insights into TEVAR outcomes and complications before intervention, motivating the evaluation of pre-TEVAR hemodynamic data to predict post-TEVAR type I and III endoleaks.

Does a novel pre-operative hemodynamic risk factor (R) derived from patient-specific fluid-structure interaction simulations predict post-TEVAR type I and III endoleaks in patients with thoracic aortic aneurysm?

Key Points

To develop and evaluate a novel pre-operative hemodynamic risk factor (R) derived from fluid–structure interaction simulations to predict type I and III endoleaks following thoracic endovascular aortic repair.
Patient-specific fluid–structure interaction computational simulations were performed in N=10 pre-operative thoracic aortic aneurysm cases with known clinical follow-up outcomes.
Parallel and perpendicular hemodynamic drag forces on the aortic wall were combined with aortic tortuosity to calculate the landing zone risk factor R.
The cohort was divided into a calibration set (8 patients) to establish risk tier cutoffs and an independent test set (2 patients) to evaluate predictive agreement.
Landing zone risk thresholds were defined as low risk for R ≤ 0.33, moderate risk for 0.33 < R ≤ 0.67, and high risk for R > 0.67.
In the calibration set, all landing zones affected by endoleaks exhibited R > 0.9 except one at R = 0.71, yielding one false-positive and no false-negative cases.
In the test set, the risk factor correctly classified a type IB endoleak with high risk (R = 1.00 in the distal landing zone) and correctly assigned low risk across landing zones in an uncomplicated patient.

Study Design

Type

Observational (n=10)

Blinding

Single-blind

Multicenter

No

Structured PICO

Does a novel pre-operative hemodynamic risk factor (R) derived from patient-specific fluid-structure interaction simulations predict post-TEVAR type I and III endoleaks in patients with thoracic aortic aneurysm?

P

Population

10 patients (mean age 74.6 years, 30% female) with unruptured thoracic aortic aneurysm treated with TEVAR, followed for a mean of 1.5 years with serial CTA scans.

E

Exposure

Pre-operative patient-specific fluid-structure interaction (FSI) computational simulations using pre-TEVAR CTA scans to quantify hemodynamic drag forces (parallel and perpendicular components) and aortic tortuosity to calculate a novel hemodynamic risk factor (R).

O

Outcome

Post-TEVAR type I (IA and IB) and type III endoleak (EL) occurrence at a mean follow-up duration of 1.5 years (± 1.3 years), assessed via follow-up CTA scans.surrogate

This proof-of-concept study demonstrates that a novel pre-operative hemodynamic risk factor combining fluid-structure interaction-derived drag forces and aortic tortuosity successfully identified all analyzed post-TEVAR type I and III endoleak cases, offering a potential computational tool to aid pre-operative planning.

Limitations

Inlet pressure waveform and some outflow boundary conditions were derived from literature rather than being patient-specific due to the retrospective design.
Blood was modeled as a Newtonian fluid rather than accounting for non-Newtonian shear-thinning behavior.
The aortic wall was modeled as a linear elastic material rather than hyperelastic and viscoelastic.
The proposed risk factor is based solely on hemodynamics and does not incorporate structural characteristics such as von Mises stresses.
Small sample size (10 patients total: 8 in calibration set, 2 in test set) is insufficient to draw statistically significant conclusions or support definitive risk stratification.
Proof-of-concept study with a preliminary attempt to validate efficacy in a very small cohort (10 patients total, with only 2 patients in the test set).

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Implication

May aid pre-TEVAR endoleak risk stratification; leaves open need for prospective validation in larger cohorts.

Abstract

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: 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.

Discussion

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Cite This Study

Duca et al. (2026) conducted an observational in Thoracic aortic aneurysm undergoing thoracic endovascular aortic repair (TEVAR) (n=10). Pre-operative hemodynamic risk factor R > 0.67 from fluid-structure interaction (FSI) simulations vs. Low to moderate risk factor R <= 0.67 was evaluated on Post-TEVAR type I and III endoleak formation.

synapsesocial.com/papers/6aee6b6871a75948062208b1 https://doi.org/10.1007/s10439-026-04337-w

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

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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