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3 results for “bovine aortic arch variant”
Data set from Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Secchi F, Righini P, Glauber M, Nano G. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Eur J Vasc Endovasc Surg. 2020 May;59(5):808-816. doi: 10.1016/j.ejvs.2019.11.019. Epub 2019 Dec 27. PMID: 31889656.
<p>Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Secchi F, Righini P, Glauber M, Nano G. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Eur J Vasc Endovasc Surg. 2020 May;59(5):808-816. doi: 10.1016/j.ejvs.2019.11.019. Epub 2019 Dec 27. PMID: 31889656.</p> <p> </p> <p>This is the abstract:</p> <p><strong>Objective: </strong>The aim was to investigate whether the "bovine" aortic arch (i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)) is associated with a consistent geometric configuration of proximal landing zones for thoracic endovascular aortic repair (TEVAR).</p> <p><strong>Methods: </strong>Anonymised thoracic computed tomography (CT) scans of healthy aortas were reviewed to retrieve 100 cases of CILCA. Suitable cases were stratified according to type 1 and 2 CILCA, and also based on type of arch (I, II, and III). Further processing allowed calculation of angulation and tortuosity of the proximal landing zones. Centre lumen line lengths of each proximal landing zone were measured in a view perpendicular to the centre line. All geometric features were compared with those measured in healthy patients with a standard arch configuration (n = 60). Two senior authors independently evaluated the CT scans, and intra- and interobserver repeatability were assessed.</p> <p><strong>Results: </strong>The 100 selected patients (63% male) were 71.4 ± 7.7 years old. Type 1 CILCA (62/100) was more prevalent than type 2 CILCA (38/100), and the two groups were comparable in age (p = .11). Zone 3 presented a severe angulation (i.e. > 60°), which was greater than in Zone 2 (p < .001), and a consistently greater tortuosity than Zone 2 (p = .003). This pattern did not differ between type 1 and type 2 CILCA. A greater tortuosity was also observed in Zone 0, which was related to increased elongation of the ascending aorta (i.e. Zone 0), than the standard configuration. The CILCA had an overall greater elongation, and Zone 2 also was specifically longer. When stratifying by type of arch, reversely from Type III to Type I, the CILCA presented a gradual flattening of its transverse tract, which entailed a consistent progressive elongation (p = .03) and kinking of the ascending aorta, with a significant increase of Zone 0 angulation to even a severe degree (p = .001). Also, from Type III to Type I, Zone 2 presented a progressively shorter length (p = .004), which was associated with increased tortuosity (p < .05). Mean intra- and interobserver differences for angulation measurements were 1.4° ± 6.8° (p = .17) and 2.0° ± 10.1° (p = .19), respectively.</p> <p><strong>Conclusion: </strong>CILCA presents a consistent and peculiar geometric pattern compared with standard arch configuration, which provides relevant information for TEVAR planning, and may have prognostic implications.</p> <p> </p>
Computational Fluid Dynamics Modeling of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant.
<p>Dataset from the article Marrocco-Trischitta MM, Romarowski RM, Alaidroos M, Sturla F, Glauber M, Nano G. Computational Fluid Dynamics Modeling of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Ann Vasc Surg. 2020 Nov;69:413-417. doi: 10.1016/j.avsg.2020.05.024. Epub 2020 May 29. PMID: 32479874.</p> <p><strong>Abstract</strong></p> <p><strong>Background: </strong>To assess the endograft displacement forces (DF), which quantify the forces exerted by the pulsatile blood flow on the vessel wall and transmitted on the terminal fixation site of the endograft after its deployment in proximal landing zones (PLZs) of the bovine aortic arch variant.</p> <p><strong>Methods: </strong>Thirty healthy aortic computed tomographic angiographies of subjects with bovine arch configuration (10 per type of arch, I-III) were selected for the purpose of the study. A 3-dimensional model of the aortic arch lumen was reconstructed. Computational fluid dynamics modeling was then used to compute DF magnitude and orientation (i.e., x, y, and z axes) in PLZs of each case. DF values were normalized to the corresponding aortic wall area to estimate equivalent surface traction (EST).</p> <p><strong>Results: </strong>DF were highest in zone 0, consistently with the greater surface area. DF in zone 3 were much greater than in zone 2 because of a 3-fold greater upward component (z axis) (P < 0.001), being therefore mainly oriented orthogonally to the aortic blood flow and to the vessel longitudinal axis in that zone. EST progressively increased from zone 0 toward more distal PLZs, with EST in zone 3 being much greater than that in zone 2 (P < 0.001). The same pattern was observed after stratification by type of arch.</p> <p><strong>Conclusions: </strong>The bovine arch is associated with a consistent fluid dynamic pattern, which identifies in zone 3 an unfavorable biomechanical environment for endograft deployment.</p>
Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant
<p>Sturla F, Caimi A, Romarowski RM, Nano G, Glauber M, Redaelli A, Votta E, Marrocco-Trischitta MM. Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant. J Endovasc Ther. 2022 May 19:15266028221095403. doi: 10.1177/15266028221095403. Epub ahead of print. PMID: 35588222.</p> <p>Abstract</p> <p><strong>Purpose: </strong>Displacement forces (<strong><em>DF</em></strong>s) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of <strong><em>DF</em></strong>s merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure.</p> <p><strong>Materials and methods: </strong>We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the "bovine" aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute <strong><em>DF</em></strong>s within the aortic proximal landing zones. To quantify fast-approximate <strong><em>DF</em></strong>s, the wall shear stress contribution to the <strong><em>DF</em></strong> was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, <strong><em>DF</em></strong> values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction (<strong><em>EST</em></strong>).</p> <p><strong>Results: </strong>Fast-approximate approach consistently reflected (r<sup>2</sup>=0.99, p<0.0001) the <strong><em>DF</em></strong> pattern obtained by CFD, with a -1.1% and 0.7° bias in <strong><em>DF</em></strong>s magnitude and orientation, respectively. The normalized <strong><em>EST</em></strong> progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate <strong><em>EST</em></strong> was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. <strong><em>S</em></strong> showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of <strong><em>DF</em></strong> impact on the thoracic aortic wall.</p> <p><strong>Conclusion: </strong>Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.</p>
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