胸腔内血管主动脉修复术去支路造成的椎动脉流速相位变化:流道和局部血管硬度对椎动脉搏动的影响

Naoki Takeishia, Li Jialongb, Naoto Yokoyamac, Hisashi Tanakad, Takasumi Gotoe, Shigeo Wada
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引用次数: 0

摘要

尽管对脑动脉血流进行了大量研究,但对主动脉弓动脉瘤有望采用的手术选择--主动脉弓动脉瘤去分支胸腔内血管主动脉修复术(dTEVAR)--患者的血流动力学尚未有全面的描述。实验观察到,与术前相比,接受 dTEVAR 术后患者左侧椎动脉(LVA)的流速相位延迟,而右侧椎动脉(RVA)的流速相位在手术前后几乎保持不变。由于该手术干预包括支架移植植入和体外搭桥,预计 dTEVAR 引起的颅内血流动力学变化与脑动脉中的流体流动和脉搏波有关。为了澄清这一问题,我们使用一维模型(1D)对 VA 流速对相位差的影响(即局部血管硬度和流道变化)进行了数值研究。数值结果表明,相对于术前患者,术后接受 dTEVAR 的患者 LVA 流速相位延迟,而 RVA 流速相位不延迟。结果进一步表明,与术前相比,影响术后 LVA 流速相位延迟的主要因素是分流,即流径的改变,而不是支架移植,即局部血管僵硬度的改变。
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Phase changes of the flow rate in the vertebral artery caused by debranching thoracic endovascular aortic repair: effects of flow path and local vessel stiffness on vertebral arterial pulsation
Despite numerous studies on cerebral arterial blood flow, there has not yet been a comprehensive description of hemodynamics in patients undergoing debranching thoracic endovascular aortic repair (dTEVAR), a promising surgical option for aortic arch aneurysms. A phase delay of the flow rate in the left vertebral artery (LVA) in patients after dTEVAR compared to those before was experimentally observed, while the phase in the right vertebral artery (RVA) remained almost the same before and after surgery. Since this surgical intervention included stent graft implantation and extra-anatomical bypass, it was expected that the intracranial hemodynamic changes due to dTEVAR were coupled with fluid flow and pulse waves in cerebral arteries. To clarify this issue, A one-dimensional model (1D) was used to numerically investigate the relative contribution (i.e., local vessel stiffness and flow path changes) of the VA flow rate to the phase difference. The numerical results demonstrated a phase delay of flow rate in the LVA but not the RVA in postoperative patients undergoing dTEVAR relative to preoperative patients. The results further showed that the primary factor affecting the phase delay of the flow rate in the LVA after surgery compared to that before was the bypass, i.e., alteration of flow path, rather than stent grafting, i.e., the change in local vessel stiffness. The numerical results provide insights into hemodynamics in postoperative patients undergoing dTEVAR, as well as knowledge about therapeutic decisions.
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