title: Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease.
abstract: In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta. Such information can also be combined with dedicated patient-specific computer-based simulations, to provide a further insight into the biomechanical aspects. In clinical practice, computational analysis might show the development of aortic disease, such as the aortic wall segments which experience higher stress in places where rupture and dissection may occur. In aortic dissections, the intimal tear is usually located at the level of the sino-tubular junction and/or at the origin of the left subclavian artery. Besides, computational models may potentially be used preoperatively to predict stent graft behavior, virtually testing the optimal stent graft sizing, deployment, and conformability, in order to provide the best endovascular treatment. The present study reviews the current literature regarding the use of computational tools for TEVAR biomechanics, highlighting their potential clinical applications.
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy;
authors.forename: Guido H W
authors.initials: GH
authors.lastname: van Bogerijen
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy;
authors.forename: Jip L
authors.initials: JL
authors.lastname: Tolenaar
authors.affiliation: Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Pavia, Italy;
authors.forename: Michele
authors.initials: M
authors.lastname: Conti
authors.affiliation: Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Pavia, Italy;
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Auricchio
authors.affiliation: Department of Radiology, Policlinico San Donato IRCCS, University of Milan, Milan, Italy; and.
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.affiliation: Department of Radiology, Policlinico San Donato IRCCS, University of Milan, Milan, Italy; and.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy;
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rampoldi
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy;
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
keywords: Computational analysis; Thoracic endovascular aortic repair (TEVAR); thoracic aortic disease