Thoracic endovascular aortic repair (TEVAR) is an effective treatment method for Stanford type B aortic dissection (TB-AD). In the investigation of treatment methods of TEVAR, numerical simulation technologies play a pivotal role. However, current finite element simulations of AD often use overly simplified vascular models and fail to adequately consider the complex interactions between stents, vessels, and blood. In this study, a Boolean operation was adopted to establish 3D models of TB-AD based on patient-specific CT images. The 3D software was used to construct 5, 6, and 8-peak stent grafts. A finite element method was applied to simulate the compression and release processing of stent graft deployment. Finally, a fluid-solid interaction module was constructed for the multiphase fluid-solid interaction simulation. The results showed that after stent graft deployment, the cross-sectional area of the vessels in the aortic coarctation region increased by 60.0%–65.5%. The maximum blood flow velocity in the true lumen decreased from 1.585 m/s to 1.125–1.238 m/s. The maximum blood pressure increased from 1574 Pa (true lumen) and 1853 Pa (false lumen) to 2021–2165 Pa (true lumen). The distribution of wall equivalent stress was more uniform, and the maximum value decreased from 0.5475 MPa to 0.1667–0.1758 MPa. The maximum equivalent stress of the stent was 3.815–4.315 MPa. Comprehensive comparisons showed that the eight-peak stent graft exhibited lower equivalent stress and superior improvement in vascular morphology, blood flow, and vessel stress, providing an optimal stent graft option for the clinical treatment of TB-AD.
ZadrazilICorzoCVoulgaropoulosV, et al. A combined experimental and computational study of the flow characteristics in a Type B aortic dissection: effect of primary and secondary tear size. Chem Eng Res Des2020; 160: 240–253.
StrayerRJShearerPLHermannLK.Evaluation, and early management of acute aortic dissection in the ED. Curr Cardiol Rev2012; 8(2): 152–157.
4.
BonfantiMFranzettiGHomer-VanniasinkamS, et al. A combined in vivo, in vitro, in silico approach for patient-specific haemodynamic studies of aortic dissection. Ann Biomed Eng2020; 48(12): 2950–2964.
5.
DailyPOTruebloodHWStinsonEB, et al. Management of acute aortic dissections. Ann Thorac Surg1970; 10(3): 237–247.
6.
RamellaAMigliavaccaFRodriguez MatasJF, et al. Validation and verification of high-fidelity simulations of thoracic stent-graft implantation. Ann Biomed Eng2022; 50(12): 1941–1953.
7.
KanXMaTLinJ, et al. Patient-specific simulation of stent-graft deployment in type B aortic dissection: model development and validation. Biomech Model Mechanobiol2021; 20(6): 2247–2258.
8.
QiaoYFanJDingY, et al. A primary computational fluid dynamics study of pre- and Post-TEVAR with intentional left subclavian artery coverage in a Type B aortic dissection. J Biomech Eng2019; 141(11): 111002.
9.
GleasonTG.Endoleaks after endovascular aortic stent-grafting: impact, diagnosis, and management. Semin Thorac Cardiovasc Surg2009; 21(4): 363–372.
10.
FanelliFCannavaleAO’SullivanGJ, et al. Endovascular repair of acute and chronic aortic type B dissections: main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv2016; 9(2): 183–191.
11.
SayedAMunirMBahbahEI.Aortic dissection: a review of the pathophysiology, management and prospective advances. Curr Cardiol Rev2021; 17(4): e230421186875.
12.
MorrisLTierneyPHynesN, et al. 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. Front Cardiovasc Med2022; 9: 797829.
13.
WangSJiaHXiY, et al. The role of location, length, and thickness of the intimal flap in the propagation of Stanford type B aortic dissection based on ex vivo porcine aorta models. J Endovasc Ther2023. DOI: 10.1177/15266028231199930
14.
PanWKulisaPBousaïdB, et al. A proposal of risk indicators for pathological development from hemodynamic simulation: application to aortic dissection. J Cardiol Cardiovasc Med2023; 8(1): 029–038.
15.
XuHXiongJHanX, et al. Computed tomography-based hemodynamic index for aortic dissection. J Thorac Cardiovasc Surg2021; 162(2): e165–e176.
16.
ShahbazianNDoyleMGForbesTL, et al. A modeling framework for computational simulations of thoracic endovascular aortic repair. Int J Numer Methods Biomed Eng2023; 39(4): e3578.
17.
MorettiSTauroFOrricoM, et al. Comparative analysis of patient-specific aortic dissections through computational fluid dynamics suggests increased likelihood of degeneration in partially thrombosed false lumen. Bioengineering2023; 10(3): 316.
18.
DeryckeLAvrilSMillonA.Patient-specific numerical simulations of endovascular procedures in complex aortic pathologies: review and clinical perspectives. J Clin Med2023; 12(3): 766.
19.
KanXMaTJiangX, et al. Towards biomechanics-based pre-procedural planning for thoracic endovascular aortic repair of aortic dissection. Comput Methods Programs Biomed2024; 244: 107994.
20.
GirardinLStokesCThetMS, et al. Patient-specific haemodynamic analysis of virtual grafting strategies in Type-B aortic dissection: impact of compliance mismatch. Cardiovasc Eng Technol2024; 15: 290–304.
21.
LiuHZhaoGZhangGE, et al. Three-dimensional modelling and hemodynamic simulation of the closure of multiple entry tears in type B aortic dissection. Med Phys2024; 51(1): 42–53.
22.
ArmourCHMenichiniCMilinisK, et al. Location of reentry tears affects false lumen thrombosis in aortic dissection following TEVAR. J Endovasc Ther2020; 27(3): 396–404.
23.
LuanJQiaoYMaoL, et al. The role of aorta distal to stent in the occurrence of distal stent graft-induced new entry tear: a computational fluid dynamics and morphological study. Comput Biol Med2023; 166: 107554.
24.
JafariniaAMüllerTSWindbergerU, et al. Blood rheology influence on false lumen thrombosis in type B aortic dissection. J Biomed Eng Biosci2020; 7: 13–24.
25.
ChongMYGuBArmourCH, et al. An integrated fluid–structure interaction and thrombosis model for type B aortic dissection. Biomech Model Mechanobiol2022; 21(1): 261–275.
26.
LasherasJC.The biomechanics of arterial aneurysms. Annu Rev Fluid Mech2007; 39: 293–319.
27.
MengZMaTWangS, et al. Finite element analysis for type B aortic dissection treated with two types of stent grafts. Mol Cell Biomech2019; 16: 19–21.
28.
KleinstreuerCLiZBascianoCA, et al. Computational mechanics of nitinol stent grafts. J Biomech2008; 41(11): 2370–2378.
29.
MaTDongZHWangS, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg2018; 68(6S): 14S–21S.e2.
30.
KleinstreuerCLiZBascianoCA, et al. Computational mechanics of nitinol stent grafts. J Vasc Surg2008; 41(11): 2370–2378.
31.
ZarinsCKArkoFRCrabtreeT, et al. Explant analysis of AneuRx stent grafts: relationship between structural findings and clinical outcome. J Vasc Surg2004; 40(1): 1–11.
32.
WangSCaiYMengZ, et al. Finite element simulation of stent implantation and its applications in the interventional planning for hemorrhagic cardio-cerebrovascular diseases. J Biomed Eng2020; 37(6): 974–982.
33.
WangSWangLLinZ, et al. Hemodynamic study of personalized Stanford type B aortic dissection based on computational fluid dynamics. Chin J Clin Thorac Cardiovasc Surg2024; 31(4): 594–599.
34.
XiangYLiGTangJ, et al. Three-dimensional simulation of blood flow in human thoracic aorta. J Tongji Univ Med Sci2010; 31(4): 19–23.
35.
HazerDStollMSchmidtE, et al. Computational blood flow and vessel wall modeling in a CT-based thoracic aorta after stent-graft implantation. In: Proceedings of the SPIE 7626, medical imaging 2010: biomedical applications in molecular, structural, and functional imaging, 2010, p.76260K.
36.
ArokiarajMCDe BeuleMDe SantisG.A novel sax-stent method in treatment of ascending aorta and aortic arch aneurysms evaluated by finite element simulations. J Med Vasc2017; 42(1): 39–45.
37.
JayendiranRNourBRuimiA.Fluid-structure interaction (FSI) analysis of stent-graft for aortic endovascular aneurysm repair (EVAR): material and structural considerations. J Mech Behav Biomed Mater2018; 87: 95–110.
38.
KimuraNNakamuraMTakagiR, et al. False lumen/true lumen wall pressure ratio is increased in acute non-A non-B aortic dissection. Interact Cardiovasc Thorac Surg2022; 35(3): ivac138.
39.
KatohK.Effects of mechanical stress on endothelial cells in situ and in vitro. Int J Mol Sci2023; 24: 16518.
40.
SiemannDWChaplinDJHorsmanMR.Vascular-targeting therapies for treatment of malignant disease. Cancer2004; 100(12): 2491–2499.
41.
ZhouHLJiangXZVentikosY.Role of blood flow in endothelial functionality: a review. Front Cell Dev Biol2023; 11: 1259280.
