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research-article

A primary computational fluid dynamics study of pre- and post-TEVAR with intentional left subclavian artery coverage in a type B aortic dissection

[+] Author and Article Information
Yonghui Qiao

State Key Laboratory of Clean Energy Utilization, Zhejiang University, 38 Zheda Road, Hangzhou, China, 310027
yhqiao@zju.edu.cn

Jianren Fan

State Key Laboratory of Clean Energy Utilization, Zhejiang University, 38 Zheda Road, Hangzhou, China, 310027
fanjr@zju.edu.cn

Ying Ding

Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032
ding.ying@zs-hospital.sh.cn

Professor Kun Luo

State Key Laboratory of Clean Energy Utilization, Zhejiang University, 38 Zheda Road, Hangzhou, China, 310027
zjulk@zju.edu.cn

Ting Zhu

Department of Vascular Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China, 200032
zhu_ting@126.com

1Corresponding author.

ASME doi:10.1115/1.4043881 History: Received April 28, 2018; Revised May 20, 2019

Abstract

The impact of left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR) on the circulatory system is not fully understood. Here we coupled single-phase non-Newtonian model and fluid-structure interaction (FSI) technique to simulate blood flow in an acute type B aortic dissection. Additionally, three-element Windkessel model was implemented to reproduce physiological pressure waves, where a new workflow was used to determine model parameters with the absence of measured data. Simulations were carried out in three models to demonstrate the efficacy of TEVAR with the LSA coverage; case A: pre-TEVAR aorta; case B: post-TEVAR aorta with the disappearance of LSA; case C: post-TEVAR aorta with virtually adding LSA. Results show that the blood flow through the compressed true lumen is only 8.43%, which may lead to ischemia in related organs. After TEVAR, the wall pressure on the stented segment increases and blood flow in the supra-aortic branches and true lumen is improved. Meantime, the average deformation of the aorta is significantly reduced due to the implantation of the stent-graft. After virtually adding LSA, significant changes in the distribution of blood flow and two indices based on wall shear stress are observed. Moreover, the movement of residual false lumen becomes stable which could contribute to patient recovery. Overall, this study quantitatively evaluates the efficacy of TEVAR for acute type B aortic dissection and demonstrates that the coverage of LSA has a considerable impact on the important hemodynamic parameters.

Copyright (c) 2019 by ASME
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