Computational Fluid Dynamics Predicting Intraprosthetic Thrombus Formation and Burden Following Endovascular Aortic...

Area of Science:

• Vascular Surgery
• Biomedical Engineering
• Medical Imaging

Background:

• Intraprosthetic thrombus (IPT) formation after endovascular aneurysm repair (EVAR) can lead to complications.
• Predicting IPT and its burden is crucial for effective postoperative surveillance.

Purpose of the Study:

• To assess the predictive capability of post-EVAR morphological and hemodynamic parameters for IPT formation and thrombus burden.
• To compare the efficacy of computed tomography angiography (CTA) and computational fluid dynamics (CFD) in predicting IPT.

Main Methods:

• Retrospective analysis of 76 patients post-EVAR (38 with IPT, 38 controls).
• Morphological data from CTA; hemodynamic metrics derived from CFD simulations.
• Logistic regression and ROC analyses identified predictors of IPT and thrombus burden.

Main Results:

• Elevated RRTmax, OSImax, RRTmean, OSImean, and reduced TAWSSmean were significantly associated with IPT.
• RRTmax showed the highest predictive value for IPT formation (AUC 0.8604) and correlated strongly with thrombus burden (R² = 0.63).
• Anatomical features alone were not independent predictors of IPT.

Conclusions:

• CFD-derived hemodynamic parameters, particularly RRTmax, are superior to anatomical indices for predicting IPT formation and burden post-EVAR.
• These hemodynamic metrics should be integrated into postoperative surveillance strategies for EVAR patients.