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Influence of Distal Re-entry Tears on False Lumen Thrombosis After Thoracic Endovascular Aortic Repair in Type B Aortic Dissection Patients: A Computational Fluid Dynamics Simulation

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Abstract

Purpose

Distal re-entry tears play a significant role in false lumen (FL) thrombosis, which will strongly affect the postoperative long-term survival of patients with type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). This study aimed to investigate the influence of a peculiar morphological parameter of the residual re-entry tears in TBAD patients after TEVAR on long-term FL thrombosis using the computational fluid dynamics.

Methods

Ideal population-based three-dimensional models of post-operative TBAD were established. Numerical simulation was performed to investigate the hemodynamic differences caused by different tear features, including the tear count, the maximum distance between tears, and the tear area.

Results

Although the low relative residence time (RRT) area did not change significantly when the tear distance was fixed, the area of oscillatory shear index (OSI) > 0.45 and endothelial cell activation potential (ECAP) > 1.5 decreased significantly with the tear count and area increased and a dramatic increase in blood flow into the FL was also observed. When tear count and total area were fixed, for each 10-mm increase in the maximum distance between tears, the area of low RRT in the FL increased significantly, while the average pressure difference increased by 10.85%.

Conclusion

The different morphology of the re-entry tears had different effects on the thrombosis-related hemodynamic parameters in FL following TEVAR. and the number of re-entry tears was most crucial to the potential thrombosis in the post-TEVAR FL of TBAD patients.

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Funding

National Natural Science Foundation of China [Grant Nos. 81770471,12072214,1802253]. Application Foundation Project of Sichuan Science and Technology Department [Grant Nos. 2018YYJC, 2019YJ0026].

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Authors and Affiliations

  1. Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China

    Da Li, Tinghui Zheng, Zhan Liu & Yan Li

  2. Department Vascular Surgery of West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China

    Ding Yuan

  3. Beijing Advanced Innovation Center of Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China

    Yubo Fan

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  1. Da Li
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  3. Zhan Liu
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  4. Yan Li
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Contributions

LD: Conceptualization, Software, Data Curation, Writing—Original Draft. YD: Resources, Software, Validation. LZ: Data curation, Software, Visualization. LY: Data Curation, Investigation. ZT: Conceptualization, Supervision, Writing - Review & Editing. FY: Project administration, Writing—Review & Editing.

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Correspondence to Ding Yuan or Yubo Fan.

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Li, D., Zheng, T., Liu, Z. et al. Influence of Distal Re-entry Tears on False Lumen Thrombosis After Thoracic Endovascular Aortic Repair in Type B Aortic Dissection Patients: A Computational Fluid Dynamics Simulation. Cardiovasc Eng Tech 12, 426–437 (2021). https://doi.org/10.1007/s13239-021-00532-z

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