Novel Understanding on Thoracic Aortic Diseases from Bioengineering Concepts
Endovascular treatment modalities have decreased the mortality and morbidity of thoracic aortic diseases considerably in the past decades, due to the effectiveness of such interventions and the minimal invasive character. While endovascular treatment options have become more advanced, preoperative planning and follow-up outcomes are still mainly based on the measurement of the maximum diameter and growth rate of the thoracic aorta on static imaging. These measurements do not take into account the biomechanical aortic behavior over the cardiac cycle and do not visualize hemodynamic changes in blood flow.
In this chapter, we evaluate endovascular treatment options from a biomechanical point of view and assess how dynamic imaging and computational modeling may contribute to the understanding of thoracic aortic diseases and aid clinical decision-making.
KeywordsBioengineering Computational fluid dynamics Finite element analysis Thoracic aorta Aortic dissection Thoracic aortic aneurysm TEVAR
- 1.Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.CrossRefGoogle Scholar
- 9.van Prehn J, Bartels LW, Mestres G, Vincken KL, Prokop M, Verhagen HJ, et al. Dynamic aortic changes in patients with thoracic aortic aneurysms evaluated with electrocardiography-triggered computed tomographic angiography before and after thoracic endovascular aneurysm repair: preliminary results. Ann Vasc Surg. 2009;23:291–7.CrossRefGoogle Scholar
- 19.Nienaber CA, Kische S, Akin I, Rousseau H, Eggebrecht H, Fattori R, et al. Strategies for subacute/chronic type B aortic dissection: the investigation of stent grafts in patients with type B aortic dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg. 2010;140:S101–8.CrossRefGoogle Scholar
- 22.Mastroroberto P, Ciranni S, Indolfi C. Extensive endovascular repair of thoracic aorta: observational analysis of the results and effects on spinal cord perfusion. J Cardiovasc Surg. 2013;54:523–30.Google Scholar