Comparison of the Haemodynamic Performance of Various Treatment Options for Aorto-Iliac Occlusive Disease
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Nikolaos Kontopodis1, Konstantinos Tzirakis2, Ifigeneia Tzartzalou1
1Vascular Surgery Department, Medical School, University of Crete, Heraklion, Crete, Greece.
Insights
Aortobifemoral bypass (AoBFB) shows superior hemodynamic performance compared to other treatments for aorto-iliac occlusive disease. This standard of care offers better pressure and limb perfusion, despite other methods not showing significantly worse thrombogenic markers.
Area of Science:
- Vascular Surgery
- Biomedical Engineering
- Computational Fluid Dynamics
Background:
- Aorto-iliac occlusive disease requires various surgical and endovascular treatments.
- Aortobifemoral bypass (AoBFB) is the established standard of care.
- Alternative treatments include axillobifemoral bypass (AxBFB), aorto-iliac kissing stents (KS), and covered endovascular reconstruction of aortic bifurcation (CERAB).
Purpose of the Study:
- To computationally compare the hemodynamic performance of four treatment modalities for aorto-iliac occlusive disease.
- To evaluate pressure drop and thrombogenic markers across different configurations.
Main Methods:
- Utilized patient-specific anatomies from CT angiograms.
- Performed numerical simulations using a finite volume solver.
- Assessed pressure drop (ΔP), Time Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), and Relative Residence Time (RRT).
Main Results:
- Aortobifemoral bypass (AoBFB) demonstrated the lowest pressure drop across all models.
- Axillobifemoral bypass (AxBFB) exhibited the highest pressure drop.
- All configurations showed thrombogenic potential based on TAWSS, OSI, and RRT, with AoBFB having the lowest percentage of surface area with high RRT.
Conclusions:
- Aortobifemoral bypass (AoBFB) offers favorable hemodynamic performance compared to AxBFB, KS, and CERAB.
- Lower patency rates of alternative modalities may not be solely explained by the investigated hemodynamic indices.
Introduction:
Several surgical and endovascular techniques are used during the treatment of aorto-iliac occlusive disease. Aortobifemoral bypass (AoBFB) is the standard of care, but other options such as axillobifemoral (AxBFB) bypass, aorto-iliac kissing stents (KS), and covered endovascular reconstruction of aortic bifurcation (CERAB) are also available. This study aimed to perform a computational comparison of these four modalities to investigate their haemodynamic performance.
Report:
Eight patient specific anatomies were analysed, with each of the abovementioned techniques used to treat two anatomies. The CT angiograms were segmented from the renal (or axillary) to common femoral arteries and the 3D geometries were exported. A commercial finite volume solver was implemented for numerical simulations. Outcomes that were assessed were pressure drop (ΔP) between the inlet and the outlet for every configuration and haemodynamic indices of Time Average Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), and Relative Residence Time (RRT) as markers of a thrombogenic environment. The results indicate that maximum ΔP was observed at peak systole for all models, with values ranging between 12 mmHg and 21 mmHg for the AoBFB, 64 mmHg and 96 mmHg for the AxBFB, 31 mmHg and 46 mmHg for the KS, and 43 mmHg and 46 mmHg for the CERAB configuration. TAWSS, OSI, and RRT varied among different configurations, mostly presenting values well above thrombogenic thresholds. Regarding RRT, the percentage of total surface area presenting such values is 2.5%, 3.2%, 2%, and 4.3% for the AoBFB, AxBFB, KS, and CERAB configurations, respectively.
Discussion:
Computational modelling indicates a favourable haemodynamic performance of AoBFB compared with the other configurations. This leads to a smaller pressure drop and sconsequently a higher pressure in the outlet of the conduit, which is the perfusion pressure of the limb. Notably, lower patency rates of the latter modalities cannot be explained based on haemodynamic indices.
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