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The role of branch vessels in aortic type B dissection: an in vitro study
H T C Veger1, J J M Westenberg2, M J T Visser1
1Department of Vascular Surgery, Leiden University Medical Center, 2330 Leiden, The Netherlands.
Insights
Increased outflow from a false lumen in acute type B aortic dissection (ABAD) significantly expands the false lumen area. This finding is crucial for understanding ABAD progression and developing new treatment strategies.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Medical Imaging
Background:
- Acute type B aortic dissection (ABAD) is associated with poor outcomes when the false lumen remains patent.
- Patent branch vessels from the false lumen are hypothesized to maintain blood flow and patency.
- Understanding false lumen morphology changes is critical for managing ABAD.
Purpose of the Study:
- To investigate the morphologic changes of the false lumen in an in vitro model of ABAD.
- To assess the impact of varying outflow rates from false lumen branch vessels on false lumen dimensions.
Main Methods:
- An in vitro model using ex vivo porcine aortas with simulated dissections was created.
- A cannula in the false lumen mimicked a branch vessel with adjustable outflow (0%, 50%, 100%).
- Time-resolved magnetic resonance imaging assessed lumen areas and flow rates under physiological conditions.
Main Results:
- Increased antegrade outflow from the false lumen significantly increased mean false lumen area (p < .01).
- The distal false lumen expanded by up to 107% with high outflow rates.
- Results were reproducible in two separate porcine aorta models.
Conclusions:
- Antegrade outflow through false lumen branch vessels, without distal re-entry, leads to significant false lumen expansion.
- These findings highlight the role of outflow dynamics in ABAD progression.
- The study provides insights into the hemodynamics influencing false lumen patency and expansion.
Objectives:
In acute type B aortic dissection (ABAD) a patent false lumen portends a poor outcome. Patent branch vessels originating from the false lumen in a type B aortic dissection are assumed to contribute to persistent blood flow and patent false lumen. Therefore, the morphologic changes of the false lumen generated by different outflow rates in an in vitro model were investigated.
Methods:
An artificial dissection was created in two ex vivo porcine aortas. A thin cannula was placed in the false lumen, simulating a branch vessel originating from it. The aorta was positioned in a validated in vitro circulatory system with physiological pulsatile flow (1,500-2,700 mL/minute) and pressure characteristics (130/70 mm Hg). The cannula was attached to a small silicone tube with an adjustable valve mechanism. Three different valve settings were used for creating outflow from the false lumen (fully closed, opened at 50%, and fully opened at 100%). Measurements of lumen areas and flow rates were assessed with time-resolved magnetic resonance imaging. In order to study reproducibility, the experiment was performed twice in two different porcine aortas with a similar morphology.
Results:
Increasing antegrade outflow through the branch vessel of the false lumen resulted in a significant (p < .01) increase of the mean false lumen area at the proximal and distal location in both models. The distal false lumen expanded up to 107% in the case of high outflow via the false lumen through the branch vessel.
Conclusions:
Increasing antegrade outflow through a branch vessel originating from the false lumen when no distal re-entry tear is present results in an expansion of the cross sectional false lumen area.
