Research Papers

Abdominal Aortic Aneurysm Endovascular Repair: Profiling Postimplantation 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
e-mail: paola.tasso@polito.it

Anastasios Raptis

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

Mitiadis Matsagkas

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

Maurizio Lodi Rizzini

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

Diego Gallo

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

Michalis Xenos

Department of Mathematics,
University of Ioannina,
Ioannina 45500, Greece
e-mail: mxenos@cc.uoi.gr

Umberto Morbiducci

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

Manuscript received January 25, 2018; final manuscript received May 21, 2018; published online August 20, 2018. Assoc. Editor: Giuseppe Vairo.

J Biomech Eng 140(11), 111003 (Aug 20, 2018) (12 pages) Paper No: BIO-18-1052; doi: 10.1115/1.4040337 History: Received January 25, 2018; Revised May 21, 2018

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). Moreover, the durability of endovascular devices is investigated analyzing the displacement forces (DFs) acting on them. 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 prothrombotic hemodynamic structures are strongly associated with the geometry of the aortoiliac tract postoperatively; and (3) DFs are associated with cross-sectional area of the aortoiliac tract postoperatively. In perspective, our study suggests that future clinical followup studies could include a geometric analysis of the region of the implant, monitoring shape variations that can lead to hemodynamic disturbances of clinical significance.

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Fig. 1

Workflow of the methodology applied to characterize hemodynamic and geometric alterations induced by the implanted endografts

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Fig. 2

Image-based models of the investigated iliac bifurcation for (a) healthy subjects, (b) patients treated with Endurant, and (c) patients treated with Excluder

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Fig. 3

Geometric segments for healthy and treated subjects in which the hemodynamic and morphometric analysis is performed: body (identified by the segment upstream of the bifurcation point), left branch, and right branch

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Fig. 4

Three-dimensional visualization of centerlines, colored by curvature values for (a) healthy subjects, (b) endurant and (c) excluder patients. Red and black dots represent, respectively, positive and negative torsion peaks along the centerlines.

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Fig. 5

Peak and mean values of torsion and curvature for the three analyzed groups. Statistical significant differences between groups are indicated: *p-value < 0.05; **p-value < 0.01.

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Fig. 6

Peak and mean values of cross-sectional area and area variation rate for the three analyzed groups. Statistically significant differences between groups are indicated: *p-value < 0.05, **p-value < 0.01.

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Fig. 7

Distribution of TAWSS values at the luminal surface for (a) healthy subjects, (b) endurant and (c) excluder patients. In panel (d), the reported average values of TAWSS over the luminal surface highlight that AWSS is significantly different between endurant and excluder patients (p-value < 0.05).

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Fig. 8

Visualization of recirculation volumes by using negative vmeanax isosurfaces for (a) healthy subjects, (b) endurant and (c) excluder patients. In the insets, axial views are shown, demonstrating protrusion of the recirculation volume into the lumen for Endurant cases. In panel (d), the reported values of mean %VolRec highlight that the volume of recirculation is significantly different in the three groups. Statistically significant difference between groups is indicated: *p-value < 0.05, **p-value < 0.01.

Grahic Jump Location
Fig. 9

Visualization of intravascular LNH isosurfaces for (a) healthy subjects, (b) endurant and (c) excluder patients. Counter-rotating structures are evident in the entire volume of all models: Right-handed helical structures are associated with positive LNH values (blue color) and left-handed helical structures are associated with negative LNH values (red color). In panel (d), the reported helicity intensity values for the three groups highlight that patients treated with the excluder present h2 values statistically different (p-value < 0.05) from both Endurant patients and healthy subjects.

Grahic Jump Location
Fig. 10

Representative examples of wall shear and pressure stresses acting on endograft's wall due to the action of streaming blood at peak systole: (a) Endurant patient EN1 in Fig. 2 and (b) Excluder patient EX9 in Fig. 2. The mapped stresses are integrated over the endograft surface to calculate the total DF.



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