胸主动脉夹层是一种严重危及人类健康的心血管疾病,临床上的主要治疗方式为胸腔内修复术(TEVAR)。结合开窗技术的TEVAR(ISF-TEVAR)可用于治疗累及主动脉弓及其弓上分支血管的复杂病例。对一例主动脉夹层建立ISF-TEVAR术后的主动脉模型,开展血液两相流动数值模拟。通过考察血流动力学参数,定量探究ISF-TEVAR手术疗效;同时通过虚拟手术,缩短开窗支架在主动脉弓部的伸出长度,分别构建"半伸出"和"无伸出"两例术后模型,对比探究开窗支架的伸出长度对术后血液流动的影响。结果表明,开窗支架伸出段对血液动力学参数有显著影响,适当缩短伸出段长度有助于提升手术疗效。
Thoracic aortic dissection is a cardiovascular disease which seriously endangers human health. The main clinical treatment is thoracic endovascular aortic repair (TEAVR). TEVAR with in situ fenestration technique (ISF-TEVAR) can be used to treat complex cases involving the aortic arch and its branches. In this study, aortic geometry model of a patient suffering from aortic dissection treated by ISF-TEVAR was reconstructed, and two-phase blood flow simulation was carried out. The efficacy of ISF-TEVAR was quantitatively explored by assessing the hemodynamics. Meanwhile, the protruding length of the fenestration stent in the aortic arch was shortened by virtual surgery, and the "half protrusion" and "no protrusion" postoperative models were compared to reveal the effect of the protruding length on postoperative blood flow. Results show that appropriately shortening the protrusion length of the stent-graft improves the efficacy of ISF-TEVAR.
[1] Nienaber C A, Divchev D, Palisch H, et al. Early and late management of type B aortic dissection[J]. Heart, 2014, 100(19):1491-1497.
[2] Mcwilliams R G, Murphy M, Hartley D, et al. In situ stent-graft fenestration to preserve the left subclavian artery[J]. J Endovasc Ther, 2004, 11(2):170-174.
[3] Glorion M, Coscas R, Mcwilliams R G, et al. A comprehensive review of in situ fenestration of aortic endografts[J]. Eur J Vasc Endovasc Surg, 2016, 52(6):787-800.
[4] Kandail H, Hamady M, Xu X Y. Comparison of blood flow in branched and fenestrated stent-grafts for endovascular repair of abdominal aortic aneurysms[J]. J Endovasc Ther, 2015, 22(4):578-590.
[5] Jung J, Hassanein A, Lyczkowski R W. Hemodynamic computation using multiphase flow dynamics in a right coronary artery[J]. Ann Biomed Eng, 2006, 34(3):393.
[6] Schiller L. A drag coefficient correlation[J]. Zeit Ver Deutsch Ing, 1933, 77:318-320.
[7] 曾宇杰, 罗坤, 樊建人, 等. 主动脉夹层血液两相流动数值模拟分析[J]. 工程热物理学报, 2016, 37(4):780-784.
[8] Gallo D, Lefieux A, Morganti S, et al. A patient-specific follow up study of the impact of thoracic endovascular repair (TEVAR) on aortic anatomy and on post-operative hemodynamics[J]. Computers & Fluids, 2016, 141:54-61.
[9] Dill D B, Costill D L. Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration[J]. J Appl Physiol, 1974, 37(2):247-248.
[10] Pirola S, Cheng Z, Jarral O A, et al. On the choice of outlet boundary conditions for patient-specific analysis of aortic flow using computational fluid dynamics[J]. J Biomech, 2017, 60:15-21.
[11] Ansys C. Solver theory guide[J]. Ansys CFX Release, 2006, 11:1996-2006.
[12] Cheng Z, Riga C, Chan J, et al. Initial findings and potential applicability of computational simulation of the aorta in acute type B dissection[J]. J Vasc Surg, 2013, 57(2):35S-43S.
[13] Xie H, Zhang Y. The effect of red blood cells on blood heat transfer[J]. International Journal of Heat and Mass Transfer, 2017, 113:840-849.