Abstract
Structural changes occurring to the aortic wall can result in vascular stiffening. This is represented by a loss of vascular compliance during pulsatile flow, resulting in increased systolic and pulse blood pressure, particularly in populations aged 50 and over. Aortic stiffness is thought to be permanent and an active de-stiffening strategy is yet to be developed. Extra aortic elastic wrapping has been proposed as a surgical technique to boost aortic distensibility and treat hypertension in the elderly. Previously, in-vivo and in-vitro testing have suggested a pulse-pressure reduction potential of elastic wrapping in the stiffened aortas. Herein, we explore the feasibility of elastic aortic wrapping to improve simulated aortic compliance across the age span. Detailed computational studies of the anisotropic aortic wall mechanics, using data from human subjects, were performed, evaluating key performance properties for the interaction between the aortic wall and elastic aortic wrap procedure. Main determinants of the procedure’s efficiency are identified using a pre-defined aortic stiffness and wrap elasticity. Finite element analysis predicts that segmental aortic distensibility can be increased if elastic wrapping is applied to a simulated stiff aorta. Elastic aortic wrapping is calculated to have little impact on the compliance of an initially distensible aorta.
Highlights
Structural changes occurring to the aortic wall can result in vascular stiffening
We implemented a sequential set of simulations, firstly modelling elastic wrapping of a stiffened human aorta, followed by a variation of the compression pressure imposed on the aortic wall and comparing these findings with a more compliant aorta
An aorta model representing the stiffened wall of an aging human subject (‘elderly’) associated with isolated systolic hypertension was used to demonstrate the feasibility of elastic wrapping to improve aortic compliance
Summary
Structural changes occurring to the aortic wall can result in vascular stiffening This is represented by a loss of vascular compliance during pulsatile flow, resulting in increased systolic and pulse blood pressure, in populations aged 50 and over. In-vivo and in-vitro testing have suggested a pulse-pressure reduction potential of elastic wrapping in the stiffened aortas. An elastically externally wrapped stiff aorta was demonstrated to distend more during systolic pressure rise (during normal pulsatile flow), increasing local distensibility. It is hypothesized that this is achieved by dampening of the primary pressure wave and delaying the returning secondary wave This concept of age-related aortic stiffness affecting hemodynamics is supported by multi-branched mathematical models that have indicated a reduced aortic impedance and pulse pressure[9]. To date elastic aortic wrapping has not been tested in humans
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