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research-article

Abdominal aortic aneurysm endovascular repair: profiling post-implantation morphometry and hemodynamics with image-based computational fluid dynamics

[+] Author and Article Information
Paola Tasso

Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino 10129, Italy
paola.tasso@polito.it

Anastasios Raptis

Laboratory for Vascular Simulations, Institute of Vascular Diseases, Ioannina 45500, Greece
raptistasos@gmail.com

Miltiadis Matsagkas

Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, Larissa 41334, Greece
mimats@med.uth.gr

Maurizio Lodi Rizzini

Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino 10129, Italy
maurizio.lodirizzini@polito.it

Diego Gallo

Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino 10129, Italy
diego.gallo@polito.it

Michalis Xenos

Department of Mathematics, University of Ioannina, Ioannina 45500, Greece
mxenos@cc.uoi.gr

Umberto Morbiducci

Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino 10129, Italy
umberto.morbiducci@polito.it

1Corresponding author.

ASME doi:10.1115/1.4040337 History: Received January 25, 2018; Revised May 21, 2018

Abstract

Endovascular aneurysm repair (EVAR) has disseminated rapidly as an alternative to open surgical repair for the treatment of abdominal aortic aneurysms (AAAs), because of its reduced invasiveness, low mortality and morbidity rate. The effectiveness of the endovascular devices used in EVAR is always at question as postoperative adverse events can lead to re-intervention or to a possible fatal scenario for the circulatory system. Motivated by the assessment of the risks related to thrombus formation, here the impact of two different commercial endovascular grafts on local hemodynamics is explored through 20 image-based computational hemodynamic models of EVAR-treated patients (N=10 per each endograft model). Hemodynamic features, susceptible to promote thrombus formation, such as flow separation and recirculation, are quantitatively assessed and compared with the local hemodynamics established in image-based infrarenal abdominal aortic models of healthy subjects (N=10). The hemodynamic analysis is complemented by a geometrical characterization of the EVAR-induced reshaping of the infrarenal abdominal aortic vascular region. The findings of this study indicate that: (1) the clinically observed propensity to thrombus formation in devices used in EVAR strategies can be explained in terms of local hemodynamics by means of image-based computational hemodynamics approach; (2) reportedly pro-thrombotic hemodynamic structures are strongly correlated with the geometry of the aortoiliac tract postoperatively. In perspective, our study suggests that future clinical follow up studies could include a geometric analysis of the region of the implant, monitoring shape variations that can lead to hemodynamic disturbances of clinical significance.

Copyright (c) 2018 by ASME
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