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Abstract

Objectives

This study aimed to assess the relationship between wall shear stress (WSS), the curvature of the iliac vein, and iliac venous in-stent restenosis (ISR) using computational fluid dynamics (CFD) analysis.

Methods

Nine limbs in nine patients were enrolled, in which patients received stent placement for a de novo iliac venous lesion and developed non-occlusive ISR. Initial follow-up computed tomographic venography (CTV) occurred within 1 year after stent placement. Two venous models were created from the CTV: one based on the lumen visualized on CTV (ISR-included stenosis model) and one based on the underlying iliac vein stent free of any ISR (ISR-removed, virtual healthy model). CFD analysis was performed to obtain WSS on each model. WSS was assessed on the greater curve, lesser curve, a healthy stent wall (HS wall), and an intimal hyperplasia/mural thrombus-attaching stent wall (IH/MT wall).

Results

The median (interquartile) WSS on the greater curve was significantly higher than on the lesser curve: 0.179 (0.0686–0.266) versus 0.121 (0.0434–0.167) in the virtual healthy model, and 0.274 (0.153–0.557) versus 0.193 (0.116–0.367) in the stenosis model (both p < .001).

The WSS on the IH/MT wall and on the HS wall were 0.106 (0.0358–0.164) and 0.161 (0.0804–0.248) in the virtual healthy model and 0.253 (0.114–0.501) and 0.226 (0.131–0.432) in the stenosis model, respectively. The WSS was significantly lower on the IH/MT wall than on the HS wall in the virtual healthy model (p < .001), but it demonstrated no significant differences in the stenosis model (p = .838).

Conclusion

The iliac venous stent curvature could be a morphological risk factor of ISR, and WSS analysis could help predict future ISR. In the stenosis model, there were no significant differences in WSS between the IH/MT wall and the HS wall, implying that ISR builds up to a point of WSS equilibration.

Keywords

iliac stenting venous flow CT

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