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Article: A computational fluid dynamic study of stent graft remodeling after endovascular repair of thoracic aortic dissections

TitleA computational fluid dynamic study of stent graft remodeling after endovascular repair of thoracic aortic dissections
Authors
Issue Date2008
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/jvs
Citation
Journal Of Vascular Surgery, 2008, v. 48 n. 2, p. 303-310 How to Cite?
AbstractObjectives: Significant stent graft remodeling commonly occurs after endovascular repair of thoracic aortic dissections because of continuing expansion of the true lumen. A suboptimal proximal landing zone, minimal oversizing, and lack of a healthy distal attachment site are unique factors affecting long-term stent graft stability. We used computational fluid dynamic techniques to analyze the biomechanical factors associated with stent graft remodeling in these patients. Patients and Methods: A series of computational fluid dynamic models were constructed to investigate the biomechanical factors affecting the drag force on a thoracic stent graft. The resultant drag force as a net change of fluid momentum was calculated on the basis of varying three-dimensional geometry and deployment positions. A series of 12 patients with type B aortic dissections treated by thoracic stent graft and followed up for more than 12 months were then studied. Computed tomography transaxial images of each patient shortly after stent graft deployment and on subsequent follow-up were used to generate three-dimensional geometric models that were then fitted with a surface mesh. Computational fluid dynamic simulations were then performed on each stent graft model according to its geometric parameters to determine the actual change in drag force experienced by the stent graft as it remodels over time. Results: The drag force on the stent graft model increases linearly with its internal diameter and becomes highest when the deployment position is closer to the proximal arch. Aortic curvature is not a significant factor. Serial computed tomography scans of patients showed an increase in mean inlet area from 1030 mm2 to 1140 mm2, and mean outlet area from 586 mm2 to 884 mm2 (increase of 11% and 58%, respectively; P = .05, .01). These increases are associated with a change in resultant drag force on the stent graft from 21.0 N to 24.8 N (mean increase, 19.5%; range, 0%-63.2%; P = .002). There is a positive relationship between increase in drag force and increase in stent-graft area. Conclusion: The drag force on thoracic stent grafts is high. A significant change in stent-graft diameter occurs after endovascular repair for type B dissections, which is associated with an increase in hemodynamic drag force. These stent grafts may be subjected to a higher risk of distal migration, and continuing surveillance is mandatory. © 2008 The Society for Vascular Surgery.
Persistent Identifierhttp://hdl.handle.net/10722/58767
ISSN
2014 Impact Factor: 3.021
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorCheng, SWKen_HK
dc.contributor.authorLam, ESKen_HK
dc.contributor.authorFung, GSKen_HK
dc.contributor.authorHo, Pen_HK
dc.contributor.authorTing, ACWen_HK
dc.contributor.authorChow, KWen_HK
dc.date.accessioned2010-05-31T03:36:33Z-
dc.date.available2010-05-31T03:36:33Z-
dc.date.issued2008en_HK
dc.identifier.citationJournal Of Vascular Surgery, 2008, v. 48 n. 2, p. 303-310en_HK
dc.identifier.issn0741-5214en_HK
dc.identifier.urihttp://hdl.handle.net/10722/58767-
dc.description.abstractObjectives: Significant stent graft remodeling commonly occurs after endovascular repair of thoracic aortic dissections because of continuing expansion of the true lumen. A suboptimal proximal landing zone, minimal oversizing, and lack of a healthy distal attachment site are unique factors affecting long-term stent graft stability. We used computational fluid dynamic techniques to analyze the biomechanical factors associated with stent graft remodeling in these patients. Patients and Methods: A series of computational fluid dynamic models were constructed to investigate the biomechanical factors affecting the drag force on a thoracic stent graft. The resultant drag force as a net change of fluid momentum was calculated on the basis of varying three-dimensional geometry and deployment positions. A series of 12 patients with type B aortic dissections treated by thoracic stent graft and followed up for more than 12 months were then studied. Computed tomography transaxial images of each patient shortly after stent graft deployment and on subsequent follow-up were used to generate three-dimensional geometric models that were then fitted with a surface mesh. Computational fluid dynamic simulations were then performed on each stent graft model according to its geometric parameters to determine the actual change in drag force experienced by the stent graft as it remodels over time. Results: The drag force on the stent graft model increases linearly with its internal diameter and becomes highest when the deployment position is closer to the proximal arch. Aortic curvature is not a significant factor. Serial computed tomography scans of patients showed an increase in mean inlet area from 1030 mm2 to 1140 mm2, and mean outlet area from 586 mm2 to 884 mm2 (increase of 11% and 58%, respectively; P = .05, .01). These increases are associated with a change in resultant drag force on the stent graft from 21.0 N to 24.8 N (mean increase, 19.5%; range, 0%-63.2%; P = .002). There is a positive relationship between increase in drag force and increase in stent-graft area. Conclusion: The drag force on thoracic stent grafts is high. A significant change in stent-graft diameter occurs after endovascular repair for type B dissections, which is associated with an increase in hemodynamic drag force. These stent grafts may be subjected to a higher risk of distal migration, and continuing surveillance is mandatory. © 2008 The Society for Vascular Surgery.en_HK
dc.languageengen_HK
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/jvsen_HK
dc.relation.ispartofJournal of Vascular Surgeryen_HK
dc.rightsJournal of Vascular Surgery. Copyright © Mosby, Inc.en_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAneurysm, Dissecting - radiography - surgeryen_HK
dc.subject.meshAngioplasty - methodsen_HK
dc.subject.meshAortic Aneurysm, Thoracic - radiography - surgeryen_HK
dc.subject.meshBiomechanics - methodsen_HK
dc.subject.meshBlood Flow Velocity - physiologyen_HK
dc.subject.meshComputer Simulationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshModels, Cardiovascularen_HK
dc.subject.meshProbabilityen_HK
dc.subject.meshProsthesis Designen_HK
dc.subject.meshProsthesis Failureen_HK
dc.subject.meshSampling Studiesen_HK
dc.subject.meshSensitivity and Specificityen_HK
dc.subject.meshShear Strengthen_HK
dc.subject.meshStentsen_HK
dc.subject.meshStress, Mechanicalen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleA computational fluid dynamic study of stent graft remodeling after endovascular repair of thoracic aortic dissectionsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0741-5214&volume=48&issue=2&spage=303&epage=310&date=2008&atitle=A+computational+fluid+dynamic+study+of+stent+graft+remodeling+after+endovascular+repair+of+thoracic+aortic+dissectionsen_HK
dc.identifier.emailCheng, SWK: wkcheng@hkucc.hku.hken_HK
dc.identifier.emailChow, KW: kwchow@hku.hken_HK
dc.identifier.authorityCheng, SWK=rp00374en_HK
dc.identifier.authorityChow, KW=rp00112en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.jvs.2008.03.050en_HK
dc.identifier.pmid18644477en_HK
dc.identifier.scopuseid_2-s2.0-47249099917en_HK
dc.identifier.hkuros147926en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-47249099917&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume48en_HK
dc.identifier.issue2en_HK
dc.identifier.spage303en_HK
dc.identifier.epage310en_HK
dc.identifier.eissn1097-6809-
dc.identifier.isiWOS:000258035800008-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridCheng, SWK=7404684779en_HK
dc.identifier.scopusauthoridLam, ESK=24468571500en_HK
dc.identifier.scopusauthoridFung, GSK=7004213392en_HK
dc.identifier.scopusauthoridHo, P=24469553100en_HK
dc.identifier.scopusauthoridTing, ACW=7102858552en_HK
dc.identifier.scopusauthoridChow, KW=13605209900en_HK

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