Fluid structure interaction: Insights into biomechanical implications of endograft after thoracic endovascular aortic repair

TL;DR

This study introduces a patient-specific fluid-structure interaction computational framework to analyze the biomechanical effects of endograft implantation after thoracic endovascular aortic repair, revealing significant impacts on energy loss and wall deformation.

Contribution

The paper presents a novel, image-based, patient-specific FSI model that accurately predicts post-TEVAR biomechanics, emphasizing the importance of blood-endograft-wall interactions.

Findings

Endograft reduces the aorta's energy buffer function by 19.1%.

Rigid wall assumptions fail to predict blood flow waveforms accurately.

Blood flow energy is stored and released in four phases, captured by the FSI model.

Abstract

Thoracic endovascular aortic repair (TEVAR) has developed to be the most effective treatment for aortic diseases. This study aims to evaluate the biomechanical implications of the implanted endograft after TEVAR. We present a novel image-based, patient-specific, fluid-structure computational framework. The geometries of blood, endograft, and aortic wall were reconstructed based on clinical images. Patient-specific measurement data was collected to determine the parameters of the three-element Windkessel. We designed three postoperative scenarios with rigid wall assumption, blood-wall interaction, blood-endograft-wall interplay, respectively, where a two-way fluid-structure interaction (FSI) method was applied to predict the deformation of the composite stent-wall. Computational results were validated with Doppler ultrasound data. Results show that the rigid wall assumption fails to predict the waveforms of blood outflow and energy loss (EL). The complete storage and release process of blood flow energy, which consists of four phases is captured by the FSI method. The endograft implantation would weaken the buffer function of the aorta and reduce mean EL by 19.1%. The closed curve area of wall pressure and aortic volume could indicate the EL caused by the interaction between blood flow and wall deformation, which accounts for 68.8% of the total EL. Both the FSI and endograft have a slight effect on wall shear stress-related-indices. The deformability of the composite stent-wall region is remarkably limited by the endograft. Our results highlight the importance of considering the interaction between blood flow, the implanted endograft, and the aortic wall to acquire physiologically accurate hemodynamics in post-TEVAR computational studies and the deformation of the aortic wall is responsible for the major EL of the blood flow.