Biomechanical Studies on Type B Aortic Dissection
- H.T.C. Veger
- Thursday 24 March 2022
2311 GJ Leiden
- Prof. J.F. Hamming
Uncomplicated Acute type B Aortic Dissection (ABAD) is still associated with a 30-day mortality of approximately 10%. Although the introduction of thoracic endovascular aneurysm repair (TEVAR) showed promising results in complicated ABAD, best medical treatment is still todays treatment for uncomplicated ABAD. Once complications occur the prognosis declines. Therefore, identification of predictors of poor prognosis in uncomplicated ABAD seems mandatory to select patients who will benefit from early TEVAR.
Several in vitro studies in a validated aorta dissection model were perfomed to study parameters that disadvantageous influence the false lumen in ABAD. We showed that different outflows from branch vessels originating from the false lumen in a ABAD result in expansion of the cross sectional false lumen area. Secondly we showed an aortic wall with reduced elasticity results in an increased false lumen diameter in the mid and distal part of the false lumen. Thirdly we showed that an increase in heart rate resulted in a significant increase of false lumen volume and wall shear stress (WSS) of the false lumen. This support that strict heart rate control is of major importance to reduce the mean and peak WSS in uABAD.
The final study was done on the impact of fenestration on the false lumen in ABAD. Fenestration is a minimally invasive alternative for the treatment of acute symptomatic aortic dissections because it may quickly decrease the pressure gradient of the false lumen. We showed that distal fenestration of the false lumen in aortic dissection will result in the largest false lumen reduction.
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