Ascending aortic rupture after zone 2 endovascular repair: a multiparametric computational analysis

Abstract

A 74-year-old woman expired from ascending aortic rupture 3 months following branched zone 2 endovascular aortic repair. Multiparametric image-based computational evaluation of this case suggested that the stiffness mismatch between the endograft and the native aorta increased haemodynamic loads and likely led to the rupture of the ascending aorta. This under-recognized phenomenon should be considered in preoperative planning and presents suggestions for endograft development.

Keywords: Aortic aneurysm; Aortic rupture; Computational fluid dynamics; Thoracic endovascular aortic repair.

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Figures

Figure 1:

(A) Aortic wall outer diameters of the ascending and proximal descending aneurysms are reported over time. (B) Left: post-TEVAR infolding (black arrow) and bird beak (red arrow). Right: during autopsy, a 4.0-cm longitudinal tear was identified in the lesser curvature and 2.5 cm distal to the aortic valve. There was no associated dissection, and the tear did not extend to the proximal landing zone of the endograft. BCT: brachiocephalic trunk; LCCA: left common carotid artery; TEVAR: thoracic endovascular aortic repair.

Figure 2:

(A) Left: peak systolic pressure maps. Right: ascending aortic pressure waveforms. Pulse pressure increased by 35% post-TEVAR. VUED resulted in minimal changes compared to post-TEVAR. (B) Pre-TEVAR (left) and 30-day post-TEVAR (right) NID maps. NID: normalized index of distensibility; TEVAR: thoracic endovascular aortic repair; VUED: virtual uncomplicated endograft deployment.