The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator
Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears,...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-03-01
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| Series: | Frontiers in Bioengineering and Biotechnology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fbioe.2022.831903/full |
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| author | Zhenfeng Li Zhenfeng Li Huanming Xu Chlöe Harriet Armour Yuze Guo Jiang Xiong Xiaoyun Xu Duanduan Chen Duanduan Chen |
| author_facet | Zhenfeng Li Zhenfeng Li Huanming Xu Chlöe Harriet Armour Yuze Guo Jiang Xiong Xiaoyun Xu Duanduan Chen Duanduan Chen |
| author_sort | Zhenfeng Li |
| collection | DOAJ |
| description | Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management. |
| first_indexed | 2024-12-13T07:57:44Z |
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| id | doaj.art-6cb778da3adf42afb0fed21120565336 |
| institution | Directory Open Access Journal |
| issn | 2296-4185 |
| language | English |
| last_indexed | 2024-12-13T07:57:44Z |
| publishDate | 2022-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Bioengineering and Biotechnology |
| spelling | doaj.art-6cb778da3adf42afb0fed211205653362022-12-21T23:54:30ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852022-03-011010.3389/fbioe.2022.831903831903The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic IndicatorZhenfeng Li0Zhenfeng Li1Huanming Xu2Chlöe Harriet Armour3Yuze Guo4Jiang Xiong5Xiaoyun Xu6Duanduan Chen7Duanduan Chen8School of Life Science, Beijing Institute of Technology, Beijing, ChinaWenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, ChinaSchool of Life Science, Beijing Institute of Technology, Beijing, ChinaDepartment of Chemical Engineering, Imperial College London, London, United KingdomSchool of Biomedical Engineering, University of Sydney, Sydney, NSW, AustraliaDepartment of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, ChinaDepartment of Chemical Engineering, Imperial College London, London, United KingdomSchool of Life Science, Beijing Institute of Technology, Beijing, ChinaWenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, ChinaThoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management.https://www.frontiersin.org/articles/10.3389/fbioe.2022.831903/fullaortic dissectionre-entry tearmodified modelshemodynamic indicatorre-intervention or surgery |
| spellingShingle | Zhenfeng Li Zhenfeng Li Huanming Xu Chlöe Harriet Armour Yuze Guo Jiang Xiong Xiaoyun Xu Duanduan Chen Duanduan Chen The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator Frontiers in Bioengineering and Biotechnology aortic dissection re-entry tear modified models hemodynamic indicator re-intervention or surgery |
| title | The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator |
| title_full | The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator |
| title_fullStr | The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator |
| title_full_unstemmed | The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator |
| title_short | The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator |
| title_sort | necessity to seal the re entry tears of aortic dissection after tevar a hemodynamic indicator |
| topic | aortic dissection re-entry tear modified models hemodynamic indicator re-intervention or surgery |
| url | https://www.frontiersin.org/articles/10.3389/fbioe.2022.831903/full |
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