Computational Fluid Dynamics for the Prediction of Endograft Thrombosis in the Superficial Femoral Artery

Area of Science:

• Vascular Surgery
• Biomedical Engineering
• Medical Imaging

Background:

• Endograft thrombosis is a significant complication after superficial femoral artery (SFA) interventions.
• Current diagnostic tools like CTA and duplex ultrasound have limitations in predicting endograft thrombosis.
• Understanding the hemodynamic factors contributing to thrombosis is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the potential of image-based computational fluid dynamics (CFD) for predicting endograft thrombosis.
• To explore the relationship between hemodynamic parameters and endograft thrombosis in SFA occlusive disease.
• To assess if personalized CFD can identify patients at risk for endograft thrombosis.

Main Methods:

• Retrospective analysis of four patients treated with endografts for SFA occlusion.
• CFD simulations were performed using data from contrast-enhanced computed tomography angiography (CTA) and duplex ultrasound.
• Time-averaged wall shear stress (TAWSS) was computed to evaluate flow patterns within the endografts.

Main Results:

• CFD simulations revealed low TAWSS (<0.4 Pa) in patients who developed endograft thrombosis (Cases 3 and 4).
• Patients with normal TAWSS (>0.4 Pa) achieved primary patency for over two years (Cases 1 and 2).
• Recurrent endograft thrombosis occurred in patients with low TAWSS despite normal anatomical and ultrasound findings.

Conclusions:

• Low TAWSS, identified through CFD, is associated with recurrent endograft thrombosis.
• CFD offers a promising tool for predicting endograft thrombosis, especially when conventional assessments are normal.
• Personalized CFD analysis can enhance risk stratification for endograft thrombosis in SFA disease.