Skip to main content
SpringerLink
Log in

Novel Understanding on Thoracic Aortic Diseases from Bioengineering Concepts

  • Chapter
  • First Online:
Surgical Management of Aortic Pathology

  • 1704 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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.

    Article  Google Scholar 

  2. Laskowski I, Verhagen HJ, Gagne PJ, Moll FL, Muhs BE. Current state of dynamic imaging in endovascular aortic aneurysm repair. J Endovasc Ther. 2007;14:807–12.

    Article  Google Scholar 

  3. Lin KK, Kratzberg JA, Raghavan ML. Role of aortic stent graft oversizing and barb characteristics on folding. J Vasc Surg. 2012;55:1401–9.

    Article  Google Scholar 

  4. van Keulen JW, van Prehn J, Prokop M, Moll FL, van Herwaarden JA. Dynamics of the aorta before and after endovascular aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg. 2009;38:586–96.

    Article  Google Scholar 

  5. Morbiducci U, Kok AM, Kwak BR, Stone PH, Steinman DA, Wentzel JJ. Atherosclerosis at arterial bifurcations: evidence for the role of haemodynamics and geometry. Thromb Haemost. 2016;115:484–92.

    Article  Google Scholar 

  6. Humphrey JD, Schwartz MA, Tellides G, Milewicz DM. Role of mechanotransduction in vascular biology: focus on thoracic aortic aneurysms and dissections. Circ Res. 2015;116:1448–61.

    Article  CAS  Google Scholar 

  7. Martufi G, Forneris A, Appoo JJ, Di Martino ES. Is there a role for biomechanical engineering in helping to elucidate the risk profile of the thoracic aorta? Ann Thorac Surg. 2016;101:390–8.

    Article  Google Scholar 

  8. Pasta S, Phillippi JA, Gleason TG, Vorp DA. Effect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta. J Thorac Cardiovasc Surg. 2012;143:460–7.

    Article  Google 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.

    Article  Google Scholar 

  10. Raaz U, Zollner AM, Schellinger IN, Toh R, Nakagami F, Brandt M, et al. Segmental aortic stiffening contributes to experimental abdominal aortic aneurysm development. Circulation. 2015;131:1783–95.

    Article  Google Scholar 

  11. Dong Z, Fu W, Wang Y, Wang C, Yan Z, Guo D, et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg. 2010;52:1450–7.

    Article  Google Scholar 

  12. Dong ZH, Fu WG, Wang YQ, Guo DQ, Xu X, Ji Y, et al. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation. 2009;119:735–41.

    Article  Google Scholar 

  13. Janosi RA, Tsagakis K, Bettin M, Kahlert P, Horacek M, Al-Rashid F, et al. Thoracic aortic aneurysm expansion due to late distal stent graft-induced new entry. Catheter Cardiovasc Interv. 2015;85:E43–53.

    Article  Google Scholar 

  14. Nauta FJ, Conti M, Kamman AV, van Bogerijen GH, Tolenaar JL, Auricchio F, et al. Biomechanical changes after thoracic endovascular aortic repair in type B dissection: a systematic review. J Endovasc Ther. 2015;22:918–33.

    Article  Google Scholar 

  15. Trimarchi S, Tolenaar JL, Jonker FH, Murray B, Tsai TT, Eagle KA, et al. Importance of false lumen thrombosis in type B aortic dissection prognosis. J Thorac Cardiovasc Surg. 2013;145:S208–12.

    Article  Google Scholar 

  16. Tolenaar JL, Kern JA, Jonker FH, Cherry KJ, Tracci MC, Angle JF, et al. Predictors of false lumen thrombosis in type B aortic dissection treated with TEVAR. Ann Cardiothorac Surg. 2014;3:255–63.

    PubMed  PubMed Central  Google Scholar 

  17. Kitamura T, Torii S, Oka N, Horai T, Nakashima K, Itatani K, et al. Key success factors for thoracic endovascular aortic repair for non-acute Stanford type B aortic dissection. Eur J Cardiothorac Surg. 2014;46:432–7.

    Article  Google Scholar 

  18. Conrad MF, Crawford RS, Kwolek CJ, Brewster DC, Brady TJ, Cambria RP. Aortic remodeling after endovascular repair of acute complicated type B aortic dissection. J Vasc Surg. 2009;50:510–7.

    Article  Google 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.

    Article  Google Scholar 

  20. Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Trialists A, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014;48:285–91.

    Article  CAS  Google Scholar 

  21. Investigators VR. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE registry. Eur J Vasc Endovasc Surg. 2014;48:363–71.

    Article  Google 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.

    CAS  Google Scholar 

  23. Fattori R, Montgomery D, Lovato L, Kische S, Di Eusanio M, Ince H, et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv. 2013;6:876–82.

    Article  Google Scholar 

  24. Nienaber CA, Kische S, Zeller T, Rehders TC, Schneider H, Lorenzen B, et al. Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept. J Endovasc Ther. 2006;13:738–46.

    Article  Google Scholar 

  25. Melissano G, Bertoglio L, Rinaldi E, Civilini E, Tshomba Y, Kahlberg A, et al. Volume changes in aortic true and false lumen after the “PETTICOAT” procedure for type B aortic dissection. J Vasc Surg. 2012;55:641–51.

    Article  Google Scholar 

  26. Steingruber IE, Chemelli A, Glodny B, Hugl B, Bonatti J, Hiemetzbeger R, et al. Endovascular repair of acute type B aortic dissection: midterm results. J Endovasc Ther. 2008;15:150–60.

    Article  Google Scholar 

  27. Doyle BJ, Norman PE. Computational biomechanics in thoracic aortic dissection: Today’s approaches and Tomorrow’s opportunities. Ann Biomed Eng. 2016;44:71–83.

    Article  Google Scholar 

  28. Sun Z, Chaichana T. A systematic review of computational fluid dynamics in type B aortic dissection. Int J Cardiol. 2016;210:28–31.

    Article  Google Scholar 

  29. Cheng SW, Lam ES, Fung GS, Ho P, Ting AC, Chow KW. A computational fluid dynamic study of stent graft remodeling after endovascular repair of thoracic aortic dissections. J Vasc Surg. 2008;48:303–9. discusion 9–10

    Article  Google Scholar 

  30. Figueroa CA, Taylor CA, Chiou AJ, Yeh V, Zarins CK. Magnitude and direction of pulsatile displacement forces acting on thoracic aortic endografts. J Endovasc Ther. 2009;16:350–8.

    Article  Google Scholar 

  31. Pasta S, Cho JS, Dur O, Pekkan K, Vorp DA. Computer modeling for the prediction of thoracic aortic stent graft collapse. J Vasc Surg. 2013;57:1353–61.

    Article  Google Scholar 

  32. Cheng Z, Riga C, Chan J, Hamady M, Wood NB, Cheshire NJ, et al. Initial findings and potential applicability of computational simulation of the aorta in acute type B dissection. J Vasc Surg. 2013;57:35–43.

    Article  Google Scholar 

  33. Karmonik C, Bismuth J, Shah DJ, Davies MG, Purdy D, Lumsden AB. Computational study of haemodynamic effects of entry- and exit-tear coverage in a DeBakey type III aortic dissection: technical report. Eur J Vasc Endovasc Surg. 2011;42:172–7.

    Article  CAS  Google Scholar 

  34. Beller CJ, Labrosse MR, Thubrikar MJ, Robicsek F. Role of aortic root motion in the pathogenesis of aortic dissection. Circulation. 2004;109:763–9.

    Article  Google Scholar 

  35. Nathan DP, Xu C, Gorman JH 3rd, Fairman RM, Bavaria JE, Gorman RC, et al. Pathogenesis of acute aortic dissection: a finite element stress analysis. Ann Thorac Surg. 2011;91:458–63.

    Article  Google Scholar 

  36. Auricchio F, Conti M, Marconi S, Reali A, Tolenaar JL, Trimarchi S. Patient-specific aortic endografting simulation: from diagnosis to prediction. Comput Biol Med. 2013;43:386–94.

    Article  CAS  Google Scholar 

  37. Pasta S, Rinaudo A, Luca A, Pilato M, Scardulla C, Gleason TG, et al. Difference in hemodynamic and wall stress of ascending thoracic aortic aneurysms with bicuspid and tricuspid aortic valve. J Biomech. 2013;46:1729–38.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy

    T. M. J. van Bakel, F. J. H. Nauta & Santi Trimarchi

  2. Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy

    Michele Conti, Rodrigo Romarowski & F. Auricchio

  3. Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy

    Simone Morganti

  4. Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    J. A. van Herwaarden

  5. Department of Vascular Surgery, University of Milan, Milan, Italy

    Santi Trimarchi

  6. Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    C. Alberto Figueroa

Authors
  1. T. M. J. van Bakel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. J. H. Nauta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michele Conti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rodrigo Romarowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simone Morganti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. A. van Herwaarden
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Alberto Figueroa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Auricchio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Santi Trimarchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Santi Trimarchi .

Editor information

Editors and Affiliations

  1. Fmr Royal Brompton Hospital, London, UK

    Olaf H. Stanger

  2. Royal Brompton Hospital, London, UK

    John R. Pepper

  3. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Lars G. Svensson

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer-Verlag GmbH Austria, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

van Bakel, T.M.J. et al. (2019). Novel Understanding on Thoracic Aortic Diseases from Bioengineering Concepts. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-4874-7_9

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-4872-3

  • Online ISBN: 978-3-7091-4874-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation