Blood Flow after Endovascular Repair in the Aortic Arch: A Computational Analysis

Theodorus M. Van Bakel, Rodrigo M. Romarowski, Simone Morganti, Joost A. Van Herwaarden, Frans L. Moll, Hector W. De Beaufort, Massimiliano M. Marrocco-Trischitta, Francesco Secchi, Michele Conti, Ferdinando Auricchio, Santi Trimarchi*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)


Background The benefits of thoracic endovascular aortic repair (TEVAR) have encouraged stent graft deployment more proximally in the aortic arch. This study quantifies the hemodynamic impact of TEVAR in proximal landing zone 2 on the thoracic aorta and the proximal supra-aortic branches. Methods Patients treated with TEVAR in proximal landing zone 2 having available preoperative and 30-day postoperative computer tomography angiography and phase-contrast magnetic resonance imaging data were retrospectively selected. Blood flow was studied using patient-specific computational fluid dynamics simulations. Results Four patients were included. Following TEVAR in proximal landing zone 2, the mean flow in the left common carotid artery (LCCA) increased almost threefold, from 0.21 (0.12-0.41) L/min to 0.61 (0.24-1.08) L/min (+294%). The surface area of the LCCA had not yet increased commensurately and therefore maximum flow velocity in the LCCA increased from 44.9 (27.0-89.3) cm/s to 72.6 (40.8-135.0) cm/s (+62%). One of the patients presented with Type Ib endoleak at 1-year follow-up. The displacement force in this patient measured 32.1 N and was directed dorsocranial, perpendicular to the distal sealing zone. There was a linear correlation between the surface area of the stent graft and the resulting displacement force (p = 0.04). Conclusion TEVAR in proximal landing zone 2 alters blood flow in the supra-aortic branches, resulting in increased flow with high flow velocities in the LCCA. High displacement forces were calculated and related to stent graft migration and Type I endoleak during 1-year follow-up.

Original languageEnglish
Article number170063
Pages (from-to)81-87
Number of pages7
Issue number3
Publication statusPublished - 1 Jun 2018


  • blood flow
  • displacement force
  • thoracic endovascular aortic repair


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