Computational fluid analysis of symptomatic chronic type B aortic dissections managed with the Streamliner Multilayer Flow Modulator Florian Stefanov,

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Presentation transcript:

Computational fluid analysis of symptomatic chronic type B aortic dissections managed with the Streamliner Multilayer Flow Modulator Florian Stefanov, PhD, Sherif Sultan, MD, FRCSI, FACS, EBQS Vasc, Liam Morris, PhD, Ala Elhelali, Edel P. Kavanagh, PhD, Violet Lundon, Mohamed Sultan, BSc, Niamh Hynes, MB, BCh, BAO, MRCS, MMSc, MD Journal of Vascular Surgery Volume 65, Issue 4, Pages 951-963 (April 2017) DOI: 10.1016/j.jvs.2016.07.135 Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 1 Anatomic geometries of 12 symptomatic chronic type B aortic dissections (SCTBADs) segmented from computed tomography scans preoperatively. All geometries include aortic branches and true and false lumens. Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 2 Model development stages during computational analysis setup. A, Anatomic geometry segmentation process results in a fitted triangulated surface. B, Virtual Streamliner Multilayer Flow Modulator (SMFM) device generation and fitting of the segmented vessel based on postoperative computed tomography data. C, True and false lumen fluid domain discretization using tetrahedral mesh elements. D, Boundary conditions in terms of blood input velocity and output pressure for the transient analysis. Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 3 Dissection lumen analysis. A, False lumen index (FLI) mean and confidence interval (CI) plots comparison between the preoperative and postoperative states among all 12 cases. B, FLI drop trend before and after endovascular aneurysm repair. C, Accumulated percentage true lumen increase after endovascular aneurysm repair. D, Subgroup analysis showing a comparison of the mean volume reduction for the false lumen based on the device configuration used. Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 4 Velocity maps at peak systole shown as colored tridimensional streamlines for all 12 cases, a side-by-side comparison, before and after intervention. Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 5 Lumen wall pressure colored plots at peak systole in a side-by-side comparison for all cases, before and after intervention. Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 6 Dot charts of wall pressure distribution: primary vs secondary treatment. Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions

Fig 7 Perfusion increase bar charts. A, Overall comparison: primary vs secondary treatment (carotids, suprarenal and infrarenal arteries). Subgroup analysis regarding carotid perfusion percentage variation is based on (B). B, Dissection configuration: straight, aortouni-iliac, and aortobi-iliac. C, Streamliner Multilayer Flow Modulator (SMFM) proximal end position: ascending, transverse, and descending aorta. D, Endovascular aneurysm repair (EVAR) technique employed: provisional extension to induce complete attachment (PETTICOAT) and normal (only SMFM device). Journal of Vascular Surgery 2017 65, 951-963DOI: (10.1016/j.jvs.2016.07.135) Copyright © 2016 Society for Vascular Surgery Terms and Conditions