Abstract
Uncomplicated acute type B aortic dissections are usually treated medically, but they can become acutely complicated by rapid expansion, rupture and malperfusion syndromes and in the longer term by chronic dilatation and aortic aneurysm formation. The objective of this study is to use computational fluid dynamics reconstructions of type B aortic dissections to compare geometric and haemodynamic factors between the cases selected for medical treatment and the cases selected for thoracic endovascular aortic repair (TEVAR), and to examine whether any of these factors are associated with the outcome of the medically treated group. This study includes eight type B dissection cases, with four in each group. Aortic flow analyses were carried out based on patient-specific anatomy at initial presentation before treatment. Comparisons between the two groups show that the false lumen to true lumen volume ratio is considerably higher in patients selected for TEVAR. Results from the four medically treated cases indicate that the size of the primary entry tear is the key determinant of the false lumen flow rate, which may influence the long-term outcome of medically treated patients. Potential relations between flow related parameters based on initial anatomy and subsequent anatomical changes in the medically treatment group were examined. Our initial findings based on the limited cases are that high relative residence time is a strong predictor of subsequent false lumen thrombosis, whereas pressure difference between the true and false lumen as well as the location of the largest pressure difference may be associated with the likelihood of subsequent aortic expansion.
Similar content being viewed by others
References
Barth, T. J. and D. C. Jesperson. The design and application of upwind schemes on unstructured meshes. AIAA Paper. 89-0366, 1989.
Cheng, Z., F. P. Tan, C. V. Riga, C. D. Bicknell, M. S. Hamady, R. G. Gibbs, N. B. Wood, and X. Y. Xu. Analysis of flow patterns in a patient-specific aortic dissection model. J. Biomech. Eng. 132(5):051007, 2010.
Cheng, Z., C. V. Riga, J. Chan, M. S. Hamady, N. B. Wood, N. J. W. Cheshire, X. Y. Xu, and R. G. J. Gibbs. Computational simulation of the aorta in acute Type B dissection: initial findings and potential applicability. J. Vasc. Surg. 57:35S–43S, 2013.
Cheng, Z. C. Juli, N. B. Wood, R. G. J Gibbs, X. Y. Xu. Predicting flow in aortic dissection: comparison of computational model with PC-MRI velocity measurements. Med. Eng. Phys. 2014. doi:10.1016/j.medengphy.2014.07.006.
Dailey, P. O., H. Trueblood, and E. B. Stinson. Management of acute aortic dissection. Ann. Thorac. Surg. 10:237–246, 1970.
Eggebrecht, H., U. Herold, O. Kuhnt, A. Schmermund, T. Bartel, S. Martini, A. Lind, C. K. Naber, P. Kienbaum, H. Kuhl, J. Peters, H. Jakob, R. Erbel, and D. Baumgart. Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional outcome. Eur. Heart. J. 26:489–497, 2005.
Ferziger, J. H., and M. Peric. Computational Methods for Fluid Dynamics. Berlin: Springer, 1999.
Hagan, P. G., C. A. Nienaber, E. M. Isselbacher, D. Bruckman, D. J. Karavite, P. L. Russman, A. Evangelista, R. Fattori, T. Suzuki, J. K. Oh, A. G. Moore, J. F. Malouf, L. A. Pape, C. Gaca, U. Sechtem, S. Lenferink, H. J. Deutsch, H. Diedrichs, J. Marcosy Robles, A. Llovet, D. Gilon, S. K. Das, W. F. Armstrong, G. M. Deeb, and K. A. Eagle. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA J. Am. Med. Assoc. 283:897–903, 2000.
Himburg, H. A., D. M. Grzybowski, A. Hazel, J. A. LaMack, X. M. Li, and M. H. Friedman. Spatial comparison between wall shear stress measures and porcine arterial endothelial permeability. Am. J. Physiol. Heart Circ. Physiol. 286(5):H1916–H1922, 2004.
Hutchinson, B. R., and G. D. Raithby. A multigrid method based on the additive correction strategy. Numer. Heat Transf. 9:511–537, 1986.
Karmonik, C., S. Partovi, M. Müller-Eschner, J. Bismuth, M. G. Davies, D. J. Shah, M. Loebe, D. Böckler, A. B. Lumsden, and H. von Tengg-Kobligk. Longitudinal computational fluid dynamics study of aneurysmal dilatation in a chronic DeBakey type III aortic dissection. J. Vasc. Surg. 56:260–2633, 2012.
Langtry, R., and F. Menter. Correlation-based transition modeling for unstructured parallelized computational fluid dynamics codes. AIAA J. 47(12):2894–2906, 2009.
Marui, A., T. Mochizuki, N. Mitsui, T. Koyama, F. Kimura, and M. Horibe. Toward the best treatment for uncomplicated patients with type B acute aortic dissection. Circulation 100(suppl. 2):II275–280, 1999.
Menter, F. R., R. Langtry, and S. Völker. Transition modelling for general purpose CFD codes. Flow Turbul. Combust. 77:277–303, 2006.
Nienaber, C., H. Rousseau, H. Eggebrect, S. Kische, R. Fattori, T. C. Rehders, G. Kundt, D. Scheinert, M. Czerny, T. Kleinfeldt, B. Zipfel, L. Labrousse, and H. Ince. Randomized comparison of strategies for Type B aortic dissection; the Investigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation 120:2519–2528, 2009.
Resnick, N., S. Einav, L. Chen-Konak, M. Zilberman, H. Yahav, and A. Shay-Salit. Hemodynamic forces as a stimulus for arteriogenesis. Endothelium 10(4–5):197–206, 2003.
Shirali, A. S., M. S. Bischoff, H. M. Lin, I. Oyfe, R. Lookstein, R. B. Griepp, and G. D. Luozzo. Predicting the risk for acute type B aortic dissection in hypertensive patients using anatomic variables. JACC Cardiovasc. Imaging 6(3):349–357, 2013.
Slater, E. E., and R. W. DeSanctis. The clinical recognition of dissecting aortic aneurysm. Am. J. Med. 60(5):625–633, 1976.
Spittell, P. C., J. A. Spittell, Jr., J. W. Joyce, A. J. Tajik, W. D. Edwards, H. V. Schaff, and A. W. Stanson. Clinical features and differential diagnosis of aortic dissection: experience with 236 Cases (1980 through 1990). Mayo. Clin. Proc. 68(7):642–651, 1993.
Sueyoshi, E., I. Sakamoto, K. Hayashi, T. Yamagichi, and T. Imada. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation 110(Suppl 1):II256–261, 2004.
Tan, F. P. P., R. Torii, A. Borghi, R. H. Mohiaddin, N. B. Wood, and X. Y. Xu. Fluid-structure interaction analysis of wall stress and flow patterns in a thoracic aortic aneurysm. Int. J. Appl. Mech. 1(1):179–199, 2009.
Tan, F. P. P., X. Y. Xu, R. Torii, N. B. Wood, N. Delahunty, M. Mullen, N. Moat, and R. Mohiaddin. Comparison of aortic flow patterns before and after transcatheter aortic valve implantation. Cardiovasc. Eng. Technol. 3(1):123–135, 2011.
Tozer, E. C., and T. E. Carew. Residence time of low-density lipoprotein in the normal and atherosclerotic rabbit aorta. Circ. Res. 80(2):208–218, 1997.
Tse, K. M., P. Chiu, H. P. Lee, and P. Ho. Investigation of hemodynamics in the development of dissecting aneurysm within patient-specific dissecting aneurismal aortas using computational fluid dynamics (CFD) simulations. J. Biomech. 44:827–836, 2011.
Wilcox, D. C. Turbulence Modelling for CFD (3rd ed.). La Canada: DCW Industries, 2006.
Zamir, M., P. Sinclair, and T. H. Wonnacott. Relation between diameter and flow in major branches of the arch of the aorta. J. Biomech. 25(11):1303–1310, 1992.
Conflict of interest
The authors have no conflict of interests to declare.
Author information
Authors and Affiliations
Corresponding author
Additional information
Associate Editor Umberto Morbiducci oversaw the review of this article.
Rights and permissions
About this article
Cite this article
Cheng, Z., Wood, N.B., Gibbs, R.G.J. et al. Geometric and Flow Features of Type B Aortic Dissection: Initial Findings and Comparison of Medically Treated and Stented Cases. Ann Biomed Eng 43, 177–189 (2015). https://doi.org/10.1007/s10439-014-1075-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10439-014-1075-8