74 research outputs found
sj-docx-1-jet-10.1177_15266028231210228 – Supplemental material for Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study
No full textSupplemental material, sj-docx-1-jet-10.1177_15266028231210228 for Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study by Maria Katsarou, Tim J. Mandigers, Marton Berczeli, M. Mujeeb Zubair, Viony M. Belvroy, Daniele Bissacco, Joost A. van Herwaarden, Santi Trimarchi and Jean Bismuth in Journal of Endovascular Therapy</p
Utilizing numerical simulations to prevent stent graft kinking during thoracic endovascular aortic repair
No full textNumerical simulations of thoracic endovascular aortic repair (TEVAR) may be implemented in the preoperative workflow if credible and reliable. We present the application of a TEVAR simulation methodology to an 82-year-old woman with a penetrating atherosclerotic ulcer in the left hemiarch, that underwent a left common carotid artery to left subclavian artery bypass and consequent TEVAR in zone 2. During the intervention, kinking of the distal thoracic stent graft occurred and the simulation was able to reproduce this event. This report highlights the potential and reliability of TEVAR simulations to predict perioperative adverse events and short-term postoperative technical results. (J Vasc Surg Cases Innov Tech 2023;9:101269.
On the validation of patient-specific numerical simulations of the TEVAR procedure
No full textThe Thoracic Endovascular Aortic Repair (TEVAR) is becoming the first choice to treat thoracic aortic pathologies (e.g., aneurysms, ulcerations, and dissections) in a minimally invasive way. It consists of placing a self-expandable stent-graft into the pathological region to recreate a more physiological condition. When computational models are used in this clinical context to predict procedural results, their credibility should be validated and verified. This works applies a validated finite element methodology to four patient-specific anatomies. Different sizes of a commercial stent-graft model are recreated, and the TEVAR simulation results are validated by comparing them to post-operative Computed Tomography images. Errors between simulation and segmentation are lower than 10% for the stent struts opening area. This study also evaluates and discusses numerical quantities (contact pressures, device-to-vessel distances, and stress distributions) associated with potential TEVAR complications such as device migration and bird beak phenomenon. This work aims at demonstrating how a fully validated methodology is useful for clinicians to identify the best treatment for the patient before the intervention to avoid device-related complications
Five-year sex-related outcomes of thoracic endovascular aortic repair in the Global Registry for Endovascular Aortic Treatment
No full textObjective: The impact of sex on outcomes of thoracic endovascular aortic repair (TEVAR) represents an area of increased interest over the last decade, and long-term data are lacking. The aim of the present study was to investigate sex-related differences in long-term outcomes after TEVAR using real-world data from the Global Registry for Endovascular Aortic Treatment. Methods: Data were obtained retrospectively after querying the multicenter, sponsored Global Registry for Endovascular Aortic Treatment. Patients treated with TEVAR between December 2010 and January 2021 were selected regardless of the type of thoracic aortic disease. The primary outcome was sex-specific all-cause mortality at 5 years and maximum follow-up. Secondary outcomes were sex-specific all-cause mortality at 30 days and 1 year, and aorta-related mortality, major adverse cardiac events, neurological complications, and device-related complications or reinterventions at 30 days, 1 year, 5 years, and maximum follow-up. Results: A total of 805 patients were analyzed; 535 (66.5%) were males. Females were older (median, 66 years [interquartile range (IQR), 57-75 years] vs 69 years [IQR, 59-78 years], P < .001). Males had more frequently a history of coronary artery bypass grafting and renal insufficiency (8.7% vs 3.7% [P = .010] and 22.4% vs 11.6% [P < .001]). The median follow-up was 3.46 years (IQR, 1.49-4.99 years) for males and 3.18 years (IQR, 1.29-4.86 years) for females. Indications for TEVAR were mostly descending thoracic aortic aneurysms (n = 307 [38.1%]) type B aortic dissections (n = 250 [31.1%]) or others (n = 248 [30.8%]). Freedom from 5-year all-cause mortality was similar for males and females (67% [95% CI, 62.1-72.2] vs 65.9% [95% CI, 58.5-74.2]; P = .847), and there were no differences in secondary outcomes. Multivariable Cox regression showed females to have lower all-cause mortality rates; however, this difference did not reach statistical significance (hazard ratio, 0.97; 95% CI, 0.72-1.30; P = .834). Additional subgroup analyses based on the indication for TEVAR did not identify differences between both sexes for the primary and secondary outcomes except more endoleak type II in females with complicated type B aortic dissection (1.8% vs 12.1%; P = .023). Conclusions: The present analysis suggests that long-term outcomes of TEVAR performed irrespective of the type of aortic disease are similar for males and females. Further studies are needed to clarify existing controversies regarding the impact of sex on outcomes of TEVAR
Cardiac and Aortic Modifications After Endovascular Repair for Blunt Thoracic Aortic Injury: A Systematic Review
No full textObjective: Blunt thoracic aortic injury (BTAI) is a devastating condition that commonly occurs in healthy and young patients. Endovascular treatment is the first choice; however, it has also been demonstrated to alter cardiovascular haemodynamics. The aim of this systematic review was to describe the cardiovascular modifications after thoracic endovascular aortic repair (TEVAR) for BTAI. Data Sources: PubMed (MEDLINE), Scopus, and Web of Science were systematically searched for eligible studies reporting on modifications in aortic stiffness, blood pressure, cardiac mass, and aortic size. Review Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed. The Newcastle–Ottawa Scale was used to assess the methodological quality of included studies. Results: A total of 12 studies reporting on 265 patients were included. Severe heterogeneity existed among the included studies with regard to demographics, BTAI grade, endograft specifications, reported outcomes, and the method of evaluation. Regarding aortic stiffness, two studies found a significant increase in pulse wave velocity (PWV) in patients after TEVAR compared with a control group, while one did not find a significant increase in PWV and augmentation index after > 3 years of follow up. Five studies reported an increase in the incidence of post-TEVAR hypertension up to 55% (range 34.8% – 55.0%) vs. baseline. One study found a statistically significant increase in left ventricular mass and left ventricular mass index during follow up. Nine studies report data regarding aortic dilatation or remodelling after TEVAR. One found a 2.4 fold faster growth rate in ascending aortic diameter vs. controls, while other studies described significant changes in aortic size at different locations along the aorta and endograft after TEVAR. Conclusion: This systematic review highlights adverse cardiac and aortic modifications after TEVAR for BTAI. The results stress the need for lifelong surveillance in these patients and the necessity of developing a more compliant endograft to prevent cardiovascular complications in the long term
Type III aortic arch angulation increases aortic stiffness: Analysis from an ex vivo porcine model
No full textObjective: The relationship among increased aortic arch angulation, aortic fl ow dynamics, and vessel wall stiffness remains unclear. This experimental ex vivo study investigated how increased aortic arch angulation affects aortic stiffness and stent-graft induced aortic stiffening, assessed by pulse wave velocity (PWV). Methods: Porcine thoracic aortas were connected to a circulatory mock loop in a Type I and Type III aortic arch configuration. fi guration. Baseline characteristics and blood pressures were measured. Proximal and distal fl ow curves were acquired to calculate PWV in both arch configurations. fi gurations. After that, a thoracic stent-graft (VAMF2626C100TU) was deployed in aortas with adequate proximal landing zone diameters to reach 10% % t0 20% % oversizing. Acquisitions were repeated for both arch configurations fi gurations after stent-graft deployment. Results: Twenty-four aortas were harvested, surgically prepared, and mounted. Cardiac output was kept constant for both arch configurations fi gurations (Type I: 4.74 +/- 0.40 and Type III: 4.72 +/- 0.38 L/minute; P = .703). Compared with a Type I arch, aortic PWV increased significantly fi cantly in the Type III arch (3.53 +/- 0.40 vs 3.83 +/- 0.40 m/second; P < .001), as well as blood pressures. A stent-graft was deployed in 15 aortas. After deployment, Type I arch PWV increased (3.55 +/- 0.39 vs 3.81 +/- 0.44 m/second; P < .001) and Type III arch PWV increased although not significantly fi cantly (3.86 +/- 0.42 vs 4.03 +/- 0.46 m/second; P = .094). Type III arch PWV resulted the highest and significantly fi cantly higher compared with the Type I arch after stent-graft deployment (3.81 +/- 0.44 vs 4.03 +/- 0.46 m/second; P = .023). Conclusions: Increased aortic arch angulation-as - as in a Type III arch-is - is associated with higher aortic PWV and blood pressures and this may negatively influence fl uence cardiovascular health. (JTCVS Open 2024;17:37-46
Applicability assessment for in-silico patient-specific TEVAR procedures
No full text: Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive technique to treat thoracic aorta pathologies and consists of placing a self-expandable stent-graft into the pathological region to restore the vessel lumen and recreate a more physiological condition. Exhaustive computational models, namely the finite element analysis, can be implemented to reproduce the clinical procedure. In this context, numerical models, if used for clinical applications, must be reliable and the simulation credibility should be proved to predict clinical procedure outcomes or to build in-silico clinical trials. This work aims first at applying a previously validated TEVAR methodology to a patient-specific case. Then, defining the TEVAR procedure performed on a patient population as the context of use, the overall applicability of the TEVAR modeling is assessed to demonstrate the reliability of the model itself following a step-by-step method based on the ASME V&V40 protocol. Validation evidence sources are identified for the specific context of use and adopted to demonstrate the applicability of the numerical procedure, thereby answering a question of interest that evaluates the deployed stent-graft configuration in the vessel
Thoracic Stent Graft Numerical Models To Virtually Simulate Thoracic Endovascular Aortic Repair: A Scoping Review
No full textContains fulltext :
300938.pdf (Publisher’s version ) (Open Access)OBJECTIVE: Pre-procedural planning of thoracic endovascular aortic repair (TEVAR) may implement computational adjuncts to predict technical and clinical outcomes. The aim of this scoping review was to explore the currently available TEVAR procedure and stent graft modelling options. DATA SOURCES: PubMed (MEDLINE), Scopus, and Web of Science were systematically searched (English language, up to 9 December 2022) for studies presenting a virtual thoracic stent graft model or TEVAR simulation. REVIEW METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was followed. Qualitative and quantitative data were extracted, compared, grouped, and described. Quality assessment was performed using a 16 item rating rubric. RESULTS: Fourteen studies were included. Among the currently available in silico simulations of TEVAR, severe heterogeneity exists in study characteristics, methodological details, and evaluated outcomes. Ten studies (71.4%) were published during the last five years. Eleven studies (78.6%) included heterogeneous clinical data to reconstruct patient specific aortic anatomy and disease (e.g., type B aortic dissection, thoracic aortic aneurysm) from computed tomography angiography imaging. Three studies (21.4%) constructed idealised aortic models with literature input. The applied numerical methods consisted of computational fluid dynamics analysing aortic haemodynamics in three studies (21.4%) and finite element analysis analysing structural mechanics in the others (78.6%), including or excluding aortic wall mechanical properties. The thoracic stent graft was modelled as two separate components (e.g., graft, nitinol) in 10 studies (71.4%), as a one component homogenised approximation (n = 3, 21.4%), or including nitinol rings only (n = 1, 7.1%). Other simulation components included the catheter for virtual TEVAR deployment and numerous outcomes (e.g., Von Mises stresses, stent graft apposition, drag forces) were evaluated. CONCLUSION: This scoping review identified 14 severely heterogeneous TEVAR simulation models, mostly of intermediate quality. The review concludes there is a need for continuous collaborative efforts to improve the homogeneity, credibility, and reliability of TEVAR simulations.01 december 202
Thoracic Stent-Graft Models to Simulate Thoracic Endovascular Aortic Repair: A Scoping Review
No full textScoping Revie
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