Novel Understanding on Thoracic Aortic Diseases from Bioengineering Concepts
Endovascular treatment modalities have decreased the mortality and morbidity of thoracic aortic diseases considerably in the past decades, due to the effectiveness of such interventions and the minimal invasive character. While endovascular treatment opti
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Novel Understanding on Thoracic Aortic Diseases from Bioengineering Concepts T. M. J. van Bakel, F. J. H. Nauta, Michele Conti, Rodrigo Romarowski, Simone Morganti, J. A. van Herwaarden, C. Alberto Figueroa, F. Auricchio, and Santi Trimarchi
9.1
Medical Imaging
Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are the most commonly used exams to analyze the morphology of the aorta and the surrounding strucT. M. J. van Bakel · F. J. H. Nauta Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy M. Conti · R. Romarowski · F. Auricchio Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy e-mail: [email protected]; rodrigomaximil. [email protected]; [email protected] S. Morganti Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, Pavia, Italy e-mail: [email protected] J. A. van Herwaarden Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands e-mail: [email protected] S. Trimarchi (*) Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy Department of Vascular Surgery, University of Milan, Milan, Italy e-mail: [email protected]; [email protected] C. A. Figueroa Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA e-mail: [email protected]
tures. According to the ESC Guidelines, CTA is the imaging modality of choice for the planning of thoracic endovascular aortic repair (TEVAR) [1]. CTA images provide information on aortic diameter and angulation and can be used to assess the length of landing zones. Importantly, basic CTA produces static images that can be obtained at any arbitrary point during the cardiac cycle (at diastole, systole, or somewhere in between) and does not give insight in the pulsatile changes of aortic diameter. Dynamic imaging modalities, such as electrocardiographic (ECG)-gated CTA, MRA, and ultrasonography imaging, have demonstrated significant changes in aortic dimensions during the cardiac cycle [2]. This lack of information, when using static CTA imaging, might lead to incorrect stent graft sizing which increases the risk of stent graft related failure [3]. In Fig. 9.1 an example is given of the measurements in aortic diameter and surface area measured on dynamic MRI data.
9.2
iomechanical Forces Acting B in the Thoracic Aorta
During the cardiac cycle, the aortic wall deforms due to the pulse pressure of each heartbeat and the velocity and orientation of the blood flow. These forces cause the thoracic aorta to change in diameter and size and make it move out of plane. The pulsatility of the aortic wall varies between the different segments of the aorta, being higher
© Springer-Verlag GmbH Austria, part of Springer Nature 2019 O. H. Stanger et al. (eds.), Surgical Management of Aortic Pathology, https://doi.org/10.1007/978-3-7091-4874-7_9
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