Dissection Flap Research Articles

Abstract 10419: Mechanical Properties of Flap and Adventitia in Type B Aortic Dissection

Introduction: Type B Aortic Dissection (TBAD) is a lethal disease. The tissue mechanical property is of great importance for estimating TBAD rupture risk. This study sought to characterize the mechanical properties of stiffness and strength of dissection flap and adventitia tissues from patients with chronic TBAD. Methods: Aortic tissue removed from 23 patients undergoing open repair of thoracoabdominal aortic aneurysms secondary to chronic TBAD was analyzed. Uniaxial testing was performed on the flap (circumferential [Circ] n=11, axial n=8) and on the adventitia (Circ n=7, axial n=6 ). The uniaxial lower tangent modulus (uLTM), uniaxial higher tangent modulus (uHTM) and ultimate tensile strength (UTS) were obained for each sample from stress-strain relation (Fig. 1a). We also perfromed biaxial tension testing (BTT, in Circ and Axial) of the flap (n=7) and adventitia (n=9). BTT is closer to the in vivo loading condition than uniaxial testing. Since BTT usually achieves lower maximum stress, here only the biaxial lower tangent modulus (bLTM, Fig. 1b) was obtained. Result: The uLTM of the dissection flap (Fig. 1c), and bLTM of the flap and adventitia (Fig. 1d) in Circ are significantly larger than those in Axial (p=0.006, 0.011, and 0.008, repsectively). In Circ (Fig. 1d), the bLTM of the adventitia is larger than that of the flap (p=0.027). The flap UTS in Circ is larger than that in Axial (Fig. 1f, p<0.001). In Axial, adventitia UTS is larger than flap UTS (Fig. 1f, p=0.001). Conclusions: The adventitia is stiffer and stronger than the dissection flap in patients with cTBAD. These biomechanical data corroborate the surgical axiom of including the adventitia in surgical repair of aortic dissections. Furthermore, the flap and adventitia in Circ are stiffer than those in Axial. These findings may provide insight into the ability of the aorta to maintain its wall integrity in the setting of hypertension and aneurysmal disease, and provide foundations for estimating the risk of TBAD.

Abstract 12644: Multiple Spontaneous Coronary Artery Dissections in a Middle-Aged Man With Acute Chest Pain

Introduction: Previously considered rare, spontaneous coronary artery dissection (SCAD) has emerged as an important cause of chest pain, acute coronary syndrome, and sudden cardiac death. Due to hormonal factors, SCAD often affects seemingly healthy women. SCAD in men remains little understood and under-recognized. We report a case of a 61-year-old gentleman who presented with NSTE-ACS and was found to have SCAD. Patient Presentation: A 61-year-old male with history of untreated hyperlipidemia presented with acute substernal chest pressure radiating to bilateral arms and back. On presentation, vitals and physical examination was normal.His labs showed troponin I at 0.015 ng/mL which later up trended to 21.7 ng/ml. ECG demonstrated sinus bradycardia with no ischemic changes. Decision was made to take him for cardiac catheterization.It demonstrated right coronary artery (RCA) was ecstatic. Distally, there was a a right conus branch fistula draining into pulmonary artery. There was evidence of microvascular dysfunction. An echocardiogram showed mid and basal inferolateral akinesis, normal EF.He was started on dual anti platelets (DAPT) and GDMT. At the time of discharge, he started having recurrence of his chest pain with exertion. Cardiac CT showed multiple spontaneous coronary artery dissections with healing dissections and remodeling throughout the ecstatic RCA and its distal branches with additional contour irregularities and non-obstructive dissection flaps in the diagonal branch of the left anterior dissecting artery. He was enrolled into cardiac rehabilitation. Conclusion: SCAD occurs by the formation of an intramural hematoma or intimal disruption causing a coronary obstruction. Coronary angiography remains the primary tool in the diagnosis. Alternative imaging modalities, such as intravascular ultrasound and optical coherence tomography, CT coronary angiography can be used to confirm the diagnosis. It is managed medically with DAPT and adequate control of blood pressure. Cardiac rehabilitation appears to be beneficial in preventing recurrence. We would also like to emphasize that SCAD can occur in any age group and gender, it’s crucial to recognize it early and is a condition that can be managed conservatively.

Abstract 12977: Combined Coronary Stenting and Cutting Balloon Angioplasty in the Management of a Postpartum Spontaneous Coronary Artery Dissection

Introduction: Spontaneous coronary artery dissection (SCAD), whilst documented in the peripartum period, has limited data in regard to management with cardiac intervention. SCAD is typically managed conservatively; however, in cases of hemodynamic instability and persistent ischemia, cardiac intervention with percutaneous coronary intervention (PCI) or coronary artery bypass grafting can be considered. Case: We present the case of a 34-year-old G2P2 female, without significant past medical history, who initially presented with severe substernal chest pain, five days following a spontaneous vaginal delivery. Initial electrocardiogram revealed sinus bradycardia without ischemic changes. Troponin I was elevated to 0.22 and 0.24. Heparin infusion, Aspirin loading, and Metoprolol were initiated. Coronary catheterization was performed and revealed dissection of a large left circumflex artery dissecting distally into the first obtuse marginal (OM1). A drug eluting stent (DES) was placed to the OM1. However, this worsened the dissection hematoma, propagating distally to the second obtuse marginal (OM2), also treated with a DES. Cutting balloon angioplasty was performed on the proximal circumflex to fenestrate the dissection flap and prevent proximal propagation of the dissection. A third DES was placed to the proximal circumflex artery. The patient continued dual anti-platelet therapy (DAPT) for one year, without complication. Conclusions: SCAD, in a young postpartum female, is a rare and potentially catastrophic condition. We present a case of SCAD, managed with PCI. This case demonstrates both the risk of dissection propagation with coronary stenting, as well as potential risk mitigation with cutting balloon angioplasty. Figure 1. Coronary Catheterization with PCI. A , SCAD of Lateral Circumflex to OM1. B , Post-DES to OM1 with dissection propagation to OM2 . C , Post-DES to OM2. D , Post-Balloon angioplasty and DES to proximal lateral circumflex

Putative computed tomography scan-negative type A dissection

ObjectivesComputed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm. MethodsWe report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate–severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022. ResultsThe diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation. ConclusionsSurgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required.

Application of anterolateral thigh flap preforming tongue in patients with total glossectomy

Objective: To investigate the efficacy of anterolateral thigh flap preforming tongue in patients with total glossectomy. Methods: A total of 27 patients with tongue cancer who underwent total glossectomy, neck lymph node dissection and anterolateral thigh flap transfer were collected from January 2019 to April 2021 in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital. All patients were males, the age ranged from 35-73 years. The patients were divided into experimental (14 cases) and control (13 cases) groups, based on whether the tongue was reconstructed. The clinical parameters of two groups were analyzed by independent sample t test or Fisher exact probability method. Results: The success rate of free flap was 100%, of the patients, 2 patients had cervical hematoma and 1 patient had wound infection postoperatively. There was no difference in speech (6.69±3.42 vs. 5.50±3.01, t=0.96, P=0.346) or swallowing (χ2=0.46, P=0.793) function between two groups at 1 month after surgery. However, the speech (24.94±7.43 vs. 18.44±6.30, t=2.48, P=0.020) and swallowing (χ2=6.97, P=0.008) functions in experimental group were significantly better than those in control group. No case was lost to follow-up. All patients were extubated after operation, with average time of 7.2 days in the experimental group and 7.7 days in the control group. The overall survival rate was 71.4% in the experimental group and 61.5% in the control group. Conclusion: The use of anterolateral thigh flap preforming tongue can improve the speech and swallowing functions in patients with total glossectomy and offer a novel method for tongue construction.

Gluteal And Thigh Compartment Syndrome After Open Abdominal Aortic Aneurysm Repair

A 55-year-old male underwent elective aorto-bi-iliac bypass for asymptomatic abdominal aortic aneurysm (AAA) and left common iliac artery (LCIA) ectasia. Intraoperative assessment of the left foot revealed persistent ischemia after reperfusion, and this was thought to be related to a dissection flap or technical issue at the left limb anastomosis. To address this, a jump bypass to the left internal iliac and left common femoral artery was performed, requiring re-clamping of the left iliac system.

Coronary artery involvement in type A aortic dissection: Fate of the coronaries.

Type A aortic dissection (TAAD) involves a tear in the intimal layer of the thoracic aorta proximal to the left subclavian artery, and hence, carries a high risk of mortality and morbidity and requires urgent intervention. This dissection can extend into the main coronary arteries. Coronary artery involvement in TAAD can either be due to retrograde extension of the dissection flap into the coronaries or compression and/or blockage of these vessels by the dissection flap, possibly causing myocardial ischemia. Due to the emergent nature of TAAD, coronary involvement is often missed during diagnosis, thereby delaying the required intervention. The main scope of this review is to summarize the literature on the incidence, mechanism, diagnosis, and treatment of coronary artery involvement in TAAD. A comprehensive literature search was performed using multiple electronic databases, including PubMed, Ovid, Scopus and Embase, to identify and extract relevant studies. Incidence of coronary artery involvement in TAAD was seldom reported in the literature, however, some studies have described patients diagnosed either preoperatively, intraoperatively following aortic clamping, or even during autopsy. Among the few studies that reported on this matter, the treatment choice for coronary involvement in TAAD was varied, with the majority revascularizing the coronary arteries using coronary artery bypass grafting or direct local repair of the vessels. It is well-established that coronary artery involvement in TAAD adds to the already high mortality and morbidity associated with this disease. Lastly, the right main coronary artery was often more implicated than the left. This review reiterates the significance of an accurate diagnosis and timely and effective interventions to improve prognosis. Finally, further large cohort studies and longer trials are needed to reach a definitive consensus on the best approach for coronary involvement in TAAD.

OA18 A rare presentation of Polyarteritis Nodosa

OA18 A rare presentation of Polyarteritis Nodosa

Intra-operative Transoesophageal Echocardiography Detecting Intramural Haematoma During Thoracic Endovascular Aortic Repair

A 49 year old man with type B aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with left carotid and subclavian artery fenestrations. After stent graft deployment, intra-operative transoesophageal echocardiography detected hypoechoic, well defined, crescent shaped wall thickening without a dissection flap in the ascending aorta via the short axis (A, white arrow). The M mode showed that the aortic wall thickening remained constant during the cardiac cycle. Doppler mode showed no communication between the aortic lumen and the thickening aortic wall (B).

The Importance of TEE Examination in Patients with Pseudoaneurysm of Arch of Aorta Post-TEVAR Procedure

AbstractA 57-year-old male patient presented to the emergency department with acute onset severe and tearing pain in the back. He was a chronic smoker and was a known hypertensive. He was admitted in view of type B aortic dissection with entry tear distal to left subclavian artery (LSCA) and underwent thoracic endovascular aortic repair (TEVAR) procedure for the same. Two stents (34–30–200mm size, Ankura, Lifetech, Nanshan District, Shenzhen, China) were placed overlapping each other to cover the dissection flap starting from distal end of left common carotid artery to proximal part of celiac artery. Post-stenting, patient developed recurrent episodes of melena, abdominal distension, and fever that were managed conservatively. Two months later, a routine follow-up computed tomographic aortic angiography revealed a focal contrast filled outpouching (2.1*1.9cm) extending from the proximal part of endovascular stent with surrounding thrombosis from anterior wall of the aortic arch. On inspecting the arch vessels, an ostial occlusion of LSCA was also discovered. Routine blood investigations were all within normal limits. Two-dimensional echocardiography showed a normal biventricular function with concentric left ventricular hypertrophy. All valves were normal.

Isolated posterior inferior cerebellar artery dissection with ischaemic stroke: evaluating the radiological features and diagnostic feasibility of high-resolution vessel wall imaging

To evaluate the radiological features of isolated posterior inferior cerebellar artery dissection (PICAD) and the feasibility of using high-resolution vessel-wall imaging (HR-VWI) for diagnosing PICAD. Three hundred and nine patients with arterial dissection involving the posterior cerebral circulation, who underwent HR-VWI between March 2012 and July 2019 were reviewed retrospectively. Among them, 44 patients (14.2%) were diagnosed with isolated PICAD in consensus among a neuroradiologist, a neurointerventionist, and a neurologist. Two neuroradiologists reviewed the vessel wall images independently for evidence of dissection (dissection flap, outer diameter enlargement on T2-weighted imaging [WI], mural haematoma). Diagnostic confidence was also scored on a five-point scale. Intra- and interobserver agreement for diagnosing PICAD and detecting evidence of dissection were evaluated. Dissection flaps were seen on T2WI in all cases (100%) and on contrast-enhanced T1WI in 34 patients (79.1%). Outer diameter enlargement of the steno-occlusive lesions on angiography was detected in most cases (97.7%). A mural haematoma was detected on three-dimensional (3D) contrast-enhanced motion-sensitised driven-equilibrium T1WI in 97.1% of the cases. The mean diagnostic confidence score derived by two neuroradiologists was 4.72. The two reviewers showed substantial to almost perfect agreement (weighted kappa coefficient: 0.62-0.97). Use of HR-VWI as a diagnostic tool for PICAD is feasible, and a dissection flap with outer wall enlargement on HR-T2WI allows confident dissection diagnosis. The present data suggest that PICAD might be considered as a stroke aetiology in patients with unexplained ischaemic stroke in the PICA territory, and that PICA evaluation with HR-VWI is both necessary and feasible.

Axillary Arch (Langer’s Arch) in an 80 year-old White Male Cadaver

Recognizing the presence of an Axillary arch (Langer’s arch or muscle) can be important for clinical associations, such as when patients present with compression neuropathies and syndromes related to the upper extremity. Its presence is also relevant during surgical interventions involving the axillary fossa, such as sentinel node biopsy axillary lymph node dissection and pectoralis muscle flaps. While neglecting to identify variations rarely leads to an increase in mortality, it is essential to identify for clinical relevance. It is similarly important to anatomical instructors in the education of future medical providers. During cadaveric dissection of fifty cadavers, we observed a unilateral Axillary arch (Langer’s arch or muscle) found on the left side of an 80 year-old White Male cadaver inserting onto the tendon of the pectoralis major muscle. This anatomical variation is commonly referenced in the literature for its clinical significance. Operating surgeons, vascular interventionalists, and oncologists should be aware of this anatomical variant as it occurs while treating diverse patient populations.

P178 TYPE–A AORTIC DISSECTION IN MARFANOID HABITUS

Abstract Aortic dissection (AD) is the tearing of the tunica intima of the aortic wall with creation of a false lumen. Type–A AD, in which the intimal flaps originates in the aortic tract proximal to the left subclavian artery, is a surgical emergency because – if left untreated – it has mortality rates as high as 1–2% every hour, from the onset of symptoms. Certain collagenopathies, such as Marfan Syndrome, are a predisposing condition for AD. We describe the case of a 25–year–old man with Marfanoid habitus who came to the Emergency Room of our facility, with acute pulmonary oedema. He had been complaining about thoraco–abdominal pain, bloody mucus and worsening dyspnoea since the week before. Upon cardiology consultation, a transthoracic echocardiogram showed an aneurysm of the aortic root (70 mm) and the ascending aorta (90 mm), with dissection flap extended beneath the aortic valvular plane, with torrential aortic valve insufficiency and eccentric jet, a left ventricle severely dilated and a severe systolic dysfunction (EF 25%). On urgent CT angiography the dissection flap was observed to extend cranially to the right common carotid artery and caudally to the renal arteries. The patient then underwent cardiac surgery to replace the aortic valve with a mechanical prosthesis and the ascending aorta as per the Bentall procedure and to replace the aortic arch with reimplantation and debranching of the supra–aortic trunks. Four months after discharge, the patient presented again due to sustained ventricular tachycardia (SVT) which was interrupted by electric cardioversion. On this occasion, an ICD implant was indicated as a secondary prevention measure. After one month, recurrence of SVT was observed, which was successfully treated by the implanted ICD, and therefore indication was given for an electrophysiologic study and subsequent transcatheter radiofrequency ablation of the ventricular arrhythmia. The case presented is of particular interest as it highlights the crucial role of a rapid echocardiographic assessment focussed on making a diagnosis and directing treatment, despite a misleading clinical picture due to duration and atypicality of symptoms. It should also be stressed that an overall assessment of the patient, based on habitus and age, plays a major role in establishing a suspected diagnosis and guiding the patient towards the most appropriate treatment.

Axillary Arch (Langer’s Arch) in an 80‐Year‐Old White Male Cadaver

Recognizing the presence of an Axillary arch (Langer’s arch or muscle) can be important for clinical associations, such as when patients present with compression neuropathies and syndromes related to the upper extremity. Its presence is also relevant during surgical interventions involving the axillary fossa, such as sentinel node biopsy axillary lymph node dissection and pectoralis muscle flaps. While neglecting to identify variations rarely leads to an increase in mortality, it is essential to identify for clinical relevance. It is similarly important to anatomical instructors in the education of future medical providers. During cadaveric dissection of fifty cadavers, we observed a unilateral Axillary arch (Langer’s arch or muscle) found on the left side of an 80‐year‐old White Male cadaver inserting onto the tendon of the pectoralis major muscle. This anatomical variation is commonly referenced in the literature for its clinical significance. Operating surgeons, vascular interventionalists, and oncologists should be aware of this anatomical variant as it occurs while treating diverse patient populations.

Evaluation of Remodeling of Visceral Arteries and Impact on Renal Function Post-endovascular Repair of Type B Aortic Dissection Vis-A-Vis Baseline Visceral Artery Morphology.

To evaluate the remodeling of visceral arteries post-endovascular repair (TEVAR) of type B aortic dissection and to investigate interval change in renal volume and estimated glomerular filtration rate (eGFR) vis-a-vis baseline visceral artery morphology. All patients of type B aortic dissection who underwent TEVAR with a baseline and follow-up CT during the study period were included. Baseline morphology of visceral arteries (celiac, superior, and inferior mesenteric artery and bilateral renal artery) were classified into 7 patterns depending upon the origin of the artery (from true/false lumen) and the extension of dissection flap, while occluded vessels were categorized as pattern 8. One hundred and thirty-two branches were analyzed in 25 patients (23 males; mean age: 50.1years) with a mean follow-up of 386days. 51 visceral branches were arising from the true lumen without any stenosis. Of the remaining 81 branches, 48 showed favorable remodeling (P = .0001). The highest incidence of favorable remodeling was observed in arteries arising from the true lumen (pattern 2,3: 44/48; 91.6%) whereas only one thrombosed and artery arising from the false lumen each (pattern 5 and 8) showed favorable remodeling. Kidneys perfused by false lumen or occluded renal artery suffered statistically significant volume loss compared to kidneys perfused by true or both lumens (-16.5% vs .2%; P = .01); however, the change in eGFR failed to reach statistical significance. Visceral arteries arising from the true lumen are more likely to undergo favorable remodeling. The kidneys supplied by false lumen or by occluded renal artery suffer significantly more volume loss after TEVAR.

A dissection … of the Dacron?

A dissection … of the Dacron?

Pulmonary Artery Dissection In A Patient With Heartmate 3 Left Ventricular Assist Device

Pulmonary Artery Dissection In A Patient With Heartmate 3 Left Ventricular Assist Device

Mechanical and histological characteristics of aortic dissection tissues

Aims: This study investigated the association between the macroscopic mechanical response of aortic dissection (AoD) flap, its fibre features, and patient physiological features and clinical presentations.Methods: Uniaxial test was performed with tissue strips in both circumferential and longitudinal directions from 35 patients with (AoD:CC) and without (AoD:w/oCC) cerebral/coronary complications, and 19 patients with rheumatic or valve-related heart diseases (RH). A Bayesian inference framework was used to estimate the expectation of material constants (C1, D1, and D2) of the modified Mooney-Rivlin strain energy density function. Histological examination was used to visualise the elastin and collagen in the tissue strips and image processing was performed to quantify their area percentages, fibre misalignment and waviness.Results: The elastin area percentage was negatively associated with age (p = 0.008), while collagen increased about 6% from age 40 to 70 (p = 0.03). Elastin fibre was less dispersed and wavier in old patients and no significant association was found between patient age and collagen fibre dispersion or waviness. Features of fibrous microstructures, either elastin or collagen, were comparable between AoD:CC and AoD:w/oCC group. Elastin and collagen area percentages were positively correlated with C1 and D2, respectively, while the elastin and collagen waviness were negatively correlated with C1 and D2, respectively. Elastin dispersion was negatively correlated to D2. Multivariate analysis showed that D2 was an effective parameter which could differentiate patient groups with different age and clinical presentations, as well as the direction of tissue strip.Conclusion: Fibre dispersion and waviness in the aortic dissection flap changed with patient age and clinical presentations, and these can be captured by the material constants in the strain energy density function. Statement of significanceAortic dissection (AoD) is a severe cardiovascular disease. Understanding the mechanical property of intimal flap is essential for its risk evaluation. In this study, mechanical testing and histology examination were combined to quantify the relationship between mechanical presentations and microstructure features. A Bayesian inference framework was employed to estimate the expectation of the material constants in the modified Mooney-Rivlin constitutive equation. It was found that fibre dispersion and waviness in the AoD flap changed with patient age and clinical presentations, and these could be captured by the material constants. This study firstly demonstrated that the expectation of material constants can be used to characterise tissue microstructures and differentiate patients with different clinical presentations.

Aortic dissection with cerebral infarction

Aortic dissection is a fatal cardiovascular health problem. Chest and back pain are among the common complaints of the patients, and they may also apply with atypical clinics. It is very difficult to diagnose with examination and anamnesis, especially in patients who present with poor consciousness and stroke symptoms. In this study, we wanted to present a 62-year-old female patient who had syncope at home and was unconscious for about 1 hour, has stroke symptoms, and aortic dissection was detected in her examinations. When no hemorrhage was detected in non-contrast brain CT, neck and brain contrast-enhanced CT angiography imaging was performed. Aortic dissection flap extending to the right carotid communis was detected in the imaging. Clinicians should pay attention to detailed examination and be alert for further examinations in order not to harm the patient in terms of underlying causes, especially in unconscious patients who have a stroke clinic and cannot express their complaints in a healthy way.

An in vitro Assessment of the Haemodynamic Features Occurring Within the True and False Lumens Separated by a Dissection Flap for a Patient-Specific Type B Aortic Dissection.

One of the highest mortality rates of cardiovascular diseases is aortic dissections with challenging treatment options. Currently, less study has been conducted in developing in vitro patient-specific Type B aortic dissection models, which mimic physiological flow conditions along the true and false lumens separated by a dissection flap with multiple entry and exit tears. A patient-specific Stanford Type B aortic dissection scan was replicated by an in-house manufactured automatic injection moulding system and a novel modelling technique for creating the ascending aorta, aortic arch, and descending aorta incorporating arterial branching, the true/false lumens, and dissection flap with entry and exit intimal tears. The physiological flowrates and pressure values were monitored, which identified jet stream fluid flows entering and exiting the dissection tears. Pressure in the aorta’s true lumen region was controlled at 125/85 mmHg for systolic and diastolic values. Pressure values were obtained in eight sections along the false lumen using a pressure transducer. The true lumen systolic pressure varied from 122 to 128 mmHg along the length. Flow patterns were monitored by ultrasound along 12 sections. Detailed images obtained from the ultrasound transducer probe showed varied flow patterns with one or multiple jet steam vortices along the aorta model. The dissection flap movement was assessed at four sections of the patient-specific aorta model. The displacement values of the flap varied from 0.5 to 3 mm along the model. This model provides a unique insight into aortic dissection flow patterns and pressure distributions. This dissection phantom model can be used to assess various treatment options based on the surgical, endovascular, or hybrid techniques.