Hemodynamic effects of stent-graft introducer sheath during thoracic endovascular aortic repair. 2022

Yonghui Qiao, and Le Mao, and Yan Wang, and Jingyang Luan, and Yanlu Chen, and Ting Zhu, and Kun Luo, and Jianren Fan
State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.

Thoracic endovascular aortic repair (TEVAR) has become the standard treatment of a variety of aortic pathologies. The objective of this study is to evaluate the hemodynamic effects of stent-graft introducer sheath during TEVAR. Three idealized representative diseased aortas were designed: aortic aneurysm, coarctation of the aorta, and aortic dissection. Computational fluid dynamics studies were performed in the above idealized aortic geometries. An introducer sheath routinely used in the clinic was virtually placed into diseased aortas. Comparative analysis was carried out to evaluate the hemodynamic effects of the introducer sheath. Results show that the blood flow to the supra-aortic branches would increase above 9% due to the obstruction of the introducer sheath. The region exposed to high endothelial cell activation potential (ECAP) expands in the scenarios of coarctation of the aorta and aortic dissection, which indicates that the probability of thrombus formation may increase during TEVAR. The pressure magnitude in peak systole shows an obvious rise, and a similar phenomenon is not observed in early diastole. The blood viscosity in the aortic arch and descending aorta is remarkably altered by the introducer sheath. The uneven viscosity distribution confirms the necessity of using non-Newtonian models, and high-viscosity region with high ECAP further promotes thrombosis. Our results highlight the hemodynamic effects of stent-graft introducer sheath during TEVAR, which may associate with perioperative complications.

UI MeSH Term Description Entries
D011474 Prosthesis Design The plan and delineation of prostheses in general or a specific prosthesis. Design, Prosthesis,Designs, Prosthesis,Prosthesis Designs
D001807 Blood Vessel Prosthesis Device constructed of either synthetic or biological material that is used for the repair of injured or diseased blood vessels. Vascular Prosthesis,Blood Vessel Prostheses,Tissue-Engineered Vascular Graft,Graft, Tissue-Engineered Vascular,Grafts, Tissue-Engineered Vascular,Prostheses, Blood Vessel,Prostheses, Vascular,Prosthesis, Blood Vessel,Prosthesis, Vascular,Tissue Engineered Vascular Graft,Tissue-Engineered Vascular Grafts,Vascular Graft, Tissue-Engineered,Vascular Grafts, Tissue-Engineered,Vascular Prostheses,Vessel Prostheses, Blood,Vessel Prosthesis, Blood
D006439 Hemodynamics The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM. Hemodynamic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001013 Aorta, Thoracic The portion of the descending aorta proceeding from the arch of the aorta and extending to the DIAPHRAGM, eventually connecting to the ABDOMINAL AORTA. Aorta, Ascending,Aorta, Descending,Aortic Arch,Aortic Root,Arch of the Aorta,Descending Aorta,Sinotubular Junction,Ascending Aorta,Thoracic Aorta,Aortic Roots,Arch, Aortic,Ascending Aortas,Junction, Sinotubular,Root, Aortic,Sinotubular Junctions
D015607 Stents Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. Stent
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017545 Aortic Aneurysm, Thoracic An abnormal balloon- or sac-like dilatation in the wall of the THORACIC AORTA. This proximal descending portion of aorta gives rise to the visceral and the parietal branches above the aortic hiatus at the diaphragm. Aneurysm, Thoracic Aorta,Thoracic Aorta Aneurysm,Thoracic Aortic Aneurysm,Aneurysm, Thoracic Aortic,Aorta Aneurysm, Thoracic,Thoracic Aorta Aneurysms,Thoracic Aortic Aneurysms
D057510 Endovascular Procedures Minimally invasive procedures, diagnostic or therapeutic, performed within the BLOOD VESSELS. They may be perfomed via ANGIOSCOPY; INTERVENTIONAL MAGNETIC RESONANCE IMAGING; INTERVENTIONAL RADIOGRAPHY; or INTERVENTIONAL ULTRASONOGRAPHY. Endovascular Techniques,Intravascular Procedures,Intravascular Techniques,Endovascular Procedure,Endovascular Technique,Intravascular Procedure,Intravascular Technique,Procedure, Endovascular,Procedure, Intravascular,Procedures, Endovascular,Procedures, Intravascular,Technique, Endovascular,Technique, Intravascular,Techniques, Endovascular,Techniques, Intravascular
D019917 Blood Vessel Prosthesis Implantation Surgical insertion of BLOOD VESSEL PROSTHESES to repair injured or diseased blood vessels. Implantation, Blood Vessel Prosthesis,Vascular Prosthesis Implantation,Implantation, Vascular Prosthesis,Prosthesis Implantation, Vascular

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