Comparison of Hemodynamics After Fenestrated, Branched, and Chimney Endovascular Aneurysm Repair Employing Computational Fluid Dynamics

TL;DR

This study compares blood flow patterns after three types of aortic aneurysm repair procedures using computer simulations to evaluate their effectiveness.

Contribution

The study provides a detailed computational comparison of hemodynamic outcomes for FEVAR, BEVAR, and chEVAR in complex aortic aneurysm repair.

Findings

chEVAR showed marked hemodynamic deviations compared to FEVAR and BEVAR.

BEVAR had higher time-averaged wall shear stress (TAWSS) values than other methods.

All methods improved blood flow toward near-physiological conditions and preserved visceral artery perfusion.

Abstract

Background/Objectives: This study compared the hemodynamic performance of fenestrated (FEVAR), branched (BEVAR), and chimney endovascular aortic aneurysm repair (chEVAR) in patients with complex aortic aneurysms. Methods: The pre- (native) and post-endovascular repair (endograft-defined) blood lumen was reconstructed from computed tomography angiographies of nine (9) elective patients treated with FEVAR (n = 3), BEVAR (n = 3), and chEVAR (n = 3). Computational fluid dynamics (CFD) simulations obtained blood flow properties. Velocity magnitude, wall shear stress (WSS), time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and local normalized helicity (LNH) were computed at peak systole and mid-diastole. The hemodynamic data were statistically analyzed to evaluate correlations between FEVAR, BEVAR, and chEVAR, focusing on targeted visceral arteries. Results: Only slight differences were observed regarding RRT, OSI, and TAWSS between FEVAR and BEVAR, whereas the chEVAR group demonstrated a marked deviation from both. In FEVAR, the postoperative helical flow structures appeared more compact, while in BEVAR they were more developed and exhibited a more rotational configuration. The LNH of the visceral vessel patterns exhibited similar qualitative features across groups. Regarding TAWSS, higher values were found in BEVAR, whereas chEVAR showed the lowest. Conclusions: FEVAR, BEVAR, and chEVAR improved postoperative blood flow characteristics toward near-physiological conditions, reducing undesired flow patterns and recirculation zones. FEVAR showed more stable visceral flow, and BEVAR demonstrated higher flow rates and fewer recirculation zones, while chEVAR exhibited more streamlined visceral artery flow with reduced regurgitation at bridging stent entries. Despite variations, all approaches effectively preserved visceral artery perfusion.

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