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The heat transfer mechanism inside the human aorta may be related to the physiological function and lesion formation of the aortic wall. The objective of this study was to acquire the temperature distribution in the three-dimensional idealized aorta. An idealized healthy aortic geometry and three representative diseased aortas: aortic aneurysm, coarctation of the aorta, and aortic dissection were constructed. Advanced fluid-structure interaction (FSI) computational framework was applied to predict the aortic temperature distribution. The movement of the aortic root due to the heartbeat was also considered. The displacement distribution of the aortic vessel wall was consistent with clinical observation. The lesser curvature of the aortic arch, aneurysm body, coarctation region, and false lumen were all exposed to relatively high temperatures (over 310.006 K). We found that the rigid wall assumption slightly underestimated the magnitude of the whole aortic wall-averaged temperature while the changing trend and local temperature were like the results of the FSI method. Besides, the wall-averaged temperature would increase and the temperature inflection point would advance when the aortic vessel wall was loaded with a high heat flux. This pilot study revealed the aortic heat transfer mechanism and temperature distribution, and the findings may help to understand the physiological characteristics of the aortic vessel wall. [ABSTRACT FROM AUTHOR]

Thoracic endovascular aortic repair (TEVAR) has become the standard treatment of a variety of aortic pathologies. The objective of this study is to evaluate the hemodynamic effects of stent-graft introducer sheath during TEVAR. Three idealized representative diseased aortas were designed: aortic aneurysm, coarctation of the aorta, and aortic dissection. Computational fluid dynamics studies were performed in the above idealized aortic geometries. An introducer sheath routinely used in the clinic was virtually placed into diseased aortas. Comparative analysis was carried out to evaluate the hemodynamic effects of the introducer sheath. Results show that the blood flow to the supra-aortic branches would increase above 9% due to the obstruction of the introducer sheath. The region exposed to high endothelial cell activation potential (ECAP) expands in the scenarios of coarctation of the aorta and aortic dissection, which indicates that the probability of thrombus formation may increase during TEVAR. The pressure magnitude in peak systole shows an obvious rise, and a similar phenomenon is not observed in early diastole. The blood viscosity in the aortic arch and descending aorta is remarkably altered by the introducer sheath. The uneven viscosity distribution confirms the necessity of using non-Newtonian models, and high-viscosity region with high ECAP further promotes thrombosis. Our results highlight the hemodynamic effects of stent-graft introducer sheath during TEVAR, which may associate with perioperative complications. [ABSTRACT FROM AUTHOR]

• CFD methodology is firstly used to analyze hemodynamics after ISF-TEVAR. • There is a pressure difference between the inner and outer surfaces of the LSA stent. • The aortic arch and rebuild LCA and LSA are prone to thrombosis. • Double fenestrations have a great impact on hemodynamics. • The aortic arch and rebuilt branches should be closely watched during follow-up. The aortic major branches after thoracic endovascular aortic repair (TEVAR) could be preserved by in situ fenestration (ISF). This study aims to explore the hemodynamic consequences of ISF-TEVAR with double fenestrations. Two patients with aortic dissection and aneurysm, respectively, were treated by ISF-TEVAR and both the left carotid artery (LCA) and left subclavian artery (LSA) were reconstructed by fenestration technique. The blood was considered a non-Newtonian fluid and the Windkessel model was adopted at the aortic outlets. Simulations were performed in two postoperative models to analyze the effects of the double fenestration stents on the hemodynamics. The postoperative wall pressure of the LCA and LSA is relatively low and the pressure difference between the inner and outer walls of the protruding segment of the LSA stent is found. Acceleration occurs when blood flows around the fenestration stents and the shear-thinning rheological behavior is observed at the aortic arch. Moreover, regions susceptible to thrombosis are identified and the surface exposed to high relative residence time is located at the aortic arch after the LSA stent. The presence of the double fenestration stents has a profound impact on the postoperative hemodynamics, and the aortic arch and rebuilt branches should be closely watched during follow-up. [ABSTRACT FROM AUTHOR]

The inadequate landing zone during thoracic endovascular aortic repair (TEVAR) could be resolved by fenestration technology. The fenestration structure consists of a main endograft and a left subclavian artery (LSA) stent-graft. The purpose of this study is to assess the biomechanical implications of the protruding segment (PS) of the LSA stent-graft after TEVAR with in situ fenestration (ISF-TEVAR). The PS is characterized by the protruding length and centerline angle between the LSA and PS. An idealized three-dimensional geometric model of the human aorta was constructed as the reference benchmark. We designed nine postoperative aortic geometries with different protruding lengths (5, 10, 15 mm) and centerline angles (-20°, 0°, +20°). The blood was assumed to be non-Newtonian and the three-element Windkessel model was applied to reproduce physiological pressure waveforms. The interaction between the blood and vessel wall was captured by a two-way fluid-structure method. We also considered the impact of the fenestration structure on the vessel wall. Long protruding length (15 mm) and the retrograde angle (+20°) result in a markedly reduced LSA flow ratio (1.3%). There is a pressure difference between the inner and outer walls of the PS. The region around the PS is more prone to thrombosis. The flow stability and turbulence intensity of downstream blood of the PS gradually deteriorate. The largest deformed region moves from the aortic arch to the ascending aorta after ISF-TEVAR. The postoperative hemodynamics largely depends on the protruding length and angle of the LSA stent-graft. The configurations should be carefully controlled during ISF-TEVAR. [ABSTRACT FROM AUTHOR]