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Computational Fluid-Dynamic Analysis after Carotid Endarterectomy: Patch Graft versus Direct Suture Closure
Maurizio Domanin1, Adelaide Buora2, Francesco Scardulla3
1Department of Clinical Sciences and Community Health, Università di Milano, Milano, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.
Annals of Vascular Surgery
|May 9, 2017
Summary
Direct suture closure after carotid endarterectomy may offer better long-term outcomes than patch grafts, as indicated by computational fluid dynamics analysis of hemodynamic factors linked to restenosis.
Area of Science:
- Vascular surgery
- Biomedical engineering
- Hemodynamics
Background:
- The optimal closure technique following carotid endarterectomy (CEA) remains debated.
- Patch graft (PG) use is common to reduce restenosis and stroke, but evidence for long-term benefits, especially against late restenosis, is inconclusive.
- Computational fluid dynamics (CFD) can identify hemodynamic factors like oscillatory shear index (OSI) and relative residence time (RRT) that correlate with plaque formation.
Purpose of the Study:
- To compare the hemodynamic effects of patch graft (PG) versus direct suture (DS) closure after CEA using CFD.
- To identify specific carotid regions prone to restenosis based on flow patterns.
- To evaluate the correlation between closure technique and hemodynamic indices (OSI, RRT).
Main Methods:
- CFD modeling was performed on 13 carotid arteries from 12 patients who underwent CEA for >70% stenosis.
- Patient-specific geometries from magnetic resonance angiography and boundary conditions from Doppler ultrasound were utilized.
- Analysis focused on time-averaged OSI and RRT to assess flow recirculation and potential for plaque development.
Main Results:
- The PG group exhibited higher mean spatial averaged OSI (0.07 vs. 0.03) and a larger percentage of area with OSI > 0.2 (10.1% vs. 3.7%) compared to the DS group.
- Mean spatial averaged RRT values were significantly higher in the PG group (4.4 1/Pa vs. 1.6 1/Pa).
- The percentage of area with RRT > 4 1/Pa was substantially greater in the PG group (22.5% vs. 6.5%), indicating more disturbed flow.
Conclusions:
- Patch graft closure is associated with higher OSI and RRT values, suggesting more disturbed hemodynamics and wider areas of recirculation compared to direct suture.
- Indiscriminate use of PG, irrespective of carotid diameter, resulted in higher adverse hemodynamic values.
- Direct suture closure appears hemodynamically favorable, particularly for common carotid artery or bulb CEA, and when internal carotid artery diameter exceeds 5.0 mm, potentially reducing long-term adverse outcomes.
