Abstract
Recently, multilayer stents for type B aortic dissections (TBAD) have been proposed to decrease false lumen flow, increase and streamline true lumen flow, and retain branch vessel patency. We aimed to provide a protocol with standardized techniques to investigate aortic remodeling of TBAD by multilayer flow modulators (MFM) in static geometric and hemodynamic analyses. Combining existing literature and new insights, a standardized protocol was designed. Using pre- and postoperative CT scans, geometric models were constructed, lumen dimensions were calculated, computational fluid dynamics (CFD) models were composed, and velocity and pressures were calculated. Sixteen TBAD cases treated with MFM were included for analysis. For each case, aortic remodeling was analyzed using post-processing medical imaging software. After 3D models were created, geometrical anatomical measurements were performed, and meshes for finite element analysis were generated. MFM cases were compared pre- and postoperatively; true lumen volumes increased (p < 0.001), false lumen volumes decreased (p = 0.001), true lumen diameter at the plane of maximum compression (PMC) increased (p < 0.001), and false lumen index decreased (p = 0.008). True lumen flow was streamlined, and the overall fluid velocity and pressures decreased (p < 0.001 and p = 0.006, respectively). This protocol provided a standardized method to evaluate the effects of MFM treatments in TBAD on geometric analyses, PMC, and CFD outcomes.
Highlights
Medical treatment is still the preferred treatment option in many centers for the treatment of acute type aortic B dissection (TBAD)
Analysis using MIMICS software showed a median increase of true lumen volume from 71.09 cm3 (IQR 34.95–110.89 cm3 ) preoperatively to 83.26 cm3 (IQR 111.31–194.57 cm3 ) directly postoperatively (p < 0.001)
To traditional thoracic endovascular aortic repair (TEVAR) for type B aortic dissections (TBAD) using stent-grafts, this endovascular approach with multilayer stents has a low risk of paraplegia, renal failure, stent-graft-induced new entry tears, and distal progression of the dissection with aneurysm formation through stabilization of the entire aorta with no covered fabric [11,23,24,25]
Summary
Medical treatment is still the preferred treatment option in many centers for the treatment of acute type aortic B dissection (TBAD). According to the DISSECT criteria, thoracic endovascular aortic repair (TEVAR) has been advocated as standard care for acute TBAD [2]. Stent graft-induced new entry tears into the distal thoracic or abdominal aorta can arise as a complication of the TEVAR during the treatment of acute TBAD [3,4]. Aortic remodeling after TEVAR for TBAD is still questionable as aortic growth or new aneurysm occurs in 7% to 84% of the cases for the thoracic aorta and 10% to 54% of the cases for the abdominal aorta [5,6,7,8,9]. The latter therapies demonstrate prolonged learning curves, higher costs, and delays due to manufacturing, and the results of long-term follow-up are not available yet [10,11]
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