Changes in local hemodynamic forces associated with arch branched endografts

Area of Science:

• Vascular Surgery
• Biomedical Engineering
• Computational Fluid Dynamics

Background:

• Zone 0 endografts are used for complex aortic arch repair.
• Varied endograft designs with different side branch configurations exist.
• Assessing postimplantation hemodynamic changes is crucial for device selection and patient outcomes.

Purpose of the Study:

• To evaluate the hemodynamic impact of different zone 0 endograft designs with varying side branch configurations.
• To compare changes in peak flow rate, systolic blood pressure, and wall shear stress after endograft implantation.
• To analyze the influence of antegrade (A) and retrograde (R) branch configurations on hemodynamics.

Main Methods:

• Inclusion of 29 patients who underwent zone 0 endovascular repair with single-, double-, or triple-branched endografts.
• Utilizing patient-specific computational fluid dynamics (CFD) simulations.
• Assessing hemodynamic parameters including peak flow rate, systolic blood pressure (SBP), time-averaged wall shear stress (TAWSS), and displacement force (DF) at key aortic arch and supra-aortic vessels.

Main Results:

• Implantation of innominate artery (IA) side branches increased IA peak flow, significantly in single-branched devices.
• Peak flow decreased in the left common carotid artery (LCCA) and left subclavian artery (LSA) for single- and double-branched devices.
• Triple-branched endografts showed attenuated alterations in distal arch flow, with retrograde configurations demonstrating favorable characteristics.

Conclusions:

• Hemodynamic stability in the aortic arch improves with a higher number of endograft side branches.
• Retrograde branch orientation does not significantly affect flow rates or SBP in supra-aortic vessels.
• Triple-retrograde-branched configurations exhibited the most favorable hemodynamic characteristics.