Hostile Hemodynamics in Distal Stent Graft–Induced New Entry Prior to Aortic Rupture: A Comparison of Transient versus Steady-State CFD Simulations

Abstract

Background Computational fluid dynamics (CFD) simulations model blood flow in aortic pathologies. The aim of our study was to understand the local hemodynamic environment at the site of rupture in distal stent graft–induced new entry (dSINE) after frozen elephant trunk with a clinically time efficient steady-flow simulation versus transient simulations.

Methods Steady-state simulations were performed for dSINE, prior and after its development and prior to aortic rupture. To account for potential turbulences due geometric changes at the dSINE location, Reynolds-averaged Navier–Stokes equations with the realizable k-ε model for turbulences were applied. Transient simulations were performed for comparison. Hemodynamic parameters were assessed at various locations of the aorta.

Results Post-dSINE, jet-like flow due to luminal narrowing was observed which increased prior to rupture and resulted in focal neighbored regions of high and low wall shear stress (WSS). Prior to rupture, aortic diameter at the rupture site increased lowering WSS at the entire aortic circumference. Concurrently, WSS and turbulence increased locally above the entry tear at the inner aortic curvature. Turbulent kinetic energy and WSS elevation in the downstream aorta demonstrated enhanced stress on the native aorta. Results of steady-state simulations were in good qualitative agreement with transient simulations.

Conclusion Steady-flow CFD simulations feasible at clinical time scales prior to aortic rupture reveal a hostile hemodynamic environment at the dSINE rupture site in agreement with lengthy transient simulations. Consequently, our developed approach may be of value in treatment planning where a fast assessment of the local hemodynamic environment is essential.

Keywords

computational fluid dynamics - hemodynamics - turbulence - distal stent graft–induced new entry - frozen elephant trunk - rupture - risk

Publikationsverlauf

Eingereicht: 08. Mai 2023

Angenommen: 22. Juni 2023

Artikel online veröffentlicht:
28. Juli 2023

• References

• 1 Riambau V, Böckler D, Brunkwall J. et al; ESVS Guidelines Committee. Editor's choice - management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 53 (01) 4-52
• 2 Dong Z, Fu W, Wang Y. et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg 2010; 52 (06) 1450-1457
• 3 Czerny M, Eggebrecht H, Rousseau H. et al. Distal stent graft-induced new entry after TEVAR or FET: insights into a new disease from EuREC. Ann Thorac Surg 2020; 110 (05) 1494-1500
• 4 Czerny M, Schmidli J, Adler S. et al; EACTS/ESVS scientific document group. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55 (01) 133-162
• 5 Canaud L, Gandet T, Sfeir J, Ozdemir BA, Solovei L, Alric P. Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection. J Vasc Surg 2019; 69 (05) 1610-1614
• 6 Hiraoka A, Iida Y, Furukawa T. et al. Predictive factors of distal stent graft-induced new entry after frozen elephant trunk procedure for aortic dissection. Eur J Cardiothorac Surg 2022; 62 (01) ezac325
• 7 Hughes GC. Stent graft-induced new entry tear (SINE): intentional and NOT. J Thorac Cardiovasc Surg 2019; 157 (01) 101-106.e3
• 8 Zhu Y, Xu XY, Rosendahl U, Pepper J, Mirsadraee S. Prediction of aortic dilatation in surgically repaired type A dissection: a longitudinal study using computational fluid dynamics. JTCVS Open 2022; 9: 11-27
• 9 Ong CW, Wee I, Syn N. et al. Computational fluid dynamics modeling of hemodynamic parameters in the human diseased aorta: a systematic review. Ann Vasc Surg 2020; 63: 336-381
• 10 Midulla M, Moreno R, Negre-Salvayre A. et al. Impact of thoracic endografting on the hemodynamics of the native aorta: pre- and postoperative assessments of wall shear stress and vorticity using computational fluid dynamics. J Endovasc Ther 2021; 28 (01) 63-69
• 11 Urschel K, Tauchi M, Achenbach S, Dietel B. Investigation of wall shear stress in cardiovascular research and in clinical practice-from bench to bedside. Int J Mol Sci 2021; 22 (11) 5635
• 12 Karmonik C, Diaz O, Klucznik R. et al. Quantitative comparison of hemodynamic parameters from steady and transient CFD simulations in cerebral aneurysms with focus on the aneurysm ostium. J Neurointerv Surg 2015; 7 (05) 367-372
• 13 Moulakakis KG, Kadoglou NPE, Antonopoulos CN. et al. Changes in arterial stiffness and N-terminal pro-brain natriuretic peptide levels after endovascular repair of descending thoracic aorta. Ann Vasc Surg 2017; 38: 220-226
• 14 Osswald A, Karmonik C, Anderson JR. et al. Elevated wall shear stress in aortic type B dissection may relate to retrograde aortic type A dissection: a computational fluid dynamics pilot study. Eur J Vasc Endovasc Surg 2017; 54 (03) 324-330
• 15 Vorp DA, Schiro BJ, Ehrlich MP, Juvonen TS, Ergin MA, Griffith BP. Effect of aneurysm on the tensile strength and biomechanical behavior of the ascending thoracic aorta. Ann Thorac Surg 2003; 75 (04) 1210-1214
• 16 Osswald A, Weymann A, Tsagakis K. et al. First insights into the role of wall shear stress in the development of a distal stent graft induced new entry through computational fluid dynamics simulations. J Thorac Dis 2023; 15 (02) 281-290
• 17 Kwak BR, Bäck M, Bochaton-Piallat ML. et al. Biomechanical factors in atherosclerosis: mechanisms and clinical implications. Eur Heart J 2014; 35 (43) 3013-3020 , 3020a–3020d
• 18 Antiga L, Steinman DA. Rethinking turbulence in blood. Biorheology 2009; 46 (02) 77-81
• 19 Numata S, Itatani K, Kanda K. et al. Blood flow analysis of the aortic arch using computational fluid dynamics. Eur J Cardiothorac Surg 2016; 49 (06) 1578-1585
• 20 Kannojiya V, Das AK, Das PK. Simulation of blood as fluid: a review from rheological aspects. IEEE Rev Biomed Eng 2021; 14: 327-341
• 21 Affeld K, Schaller J, Wölken T, Krabatsch T, Kertzscher U. Role of flow for the deposition of platelets. Biointerphases 2016; 11 (02) 029804
• 22 Marsden A, Esmaily Moghadam M. Multiscale modeling of cardiovascular flows for clinical decision support. Appl Mech Rev 2015; 67: 030804
• 23 Vinoth R, Kumar D, Adhikari R. et al. Steady and transient flow CFD simulations in an aorta model of normal and aortic aneurysm subjects. In Quinto ET, Ida N, Louis AK, Jiang M, editors, Proceedings of the International Conference on Sensing and Imaging. Springer Verlag; 2019: 29-43