Language
English
Publication Date
2-3-2026
Journal
Journal of the American Heart Association
DOI
10.1161/JAHA.125.044790
PMID
41614309
PMCID
PMC13055448
PubMedCentral® Posted Date
1-30-2026
PubMedCentral® Full Text Version
Post-print
Abstract
Background: Fenestrated and branched endovascular aneurysm repair can be complicated by branch vessel occlusion in the absence of structural stenosis. We hypothesized that computational flow simulation could identify adverse hemodynamic features associated with postfenestrated and branched endovascular aneurysm repair branch occlusion.
Methods: Patients undergoing 4-vessel fenestrated and branched endovascular aneurysm repair for Extent II to IV thoracoabdominal aortic aneurysms were retrospectively reviewed. Branches that occluded without identifiable kinking or stenosis on computed tomography were included, along with an equal cohort of anatomy-matched patent controls. Patient-specific pulsatile rigid-wall simulations were performed using SimVascular with individualized geometries and boundary conditions. Abnormal time-averaged wall shear stress (TAWSS) was defined as < 10 or >70 dynes/cm2.
Results: Nine patients (36 target vessels) experienced 10 branch occlusions. Postoperative pressure and flow did not differ significantly between occluded and patent renal or mesenteric branches. However, occluded renal and mesenteric branches demonstrated significantly larger postoperative areas of abnormal TAWSS compared with controls (renal: 14.5% versus 5.9%, P=0.003; mesenteric: 17.7% versus 9.9%, P=0.035). Logistic generalized estimating equation modeling showed abnormal TAWSS to be a significant predictor of renal branch occlusion (P=0.0085). Model estimates suggested occlusion probabilities of 1.1%, 31%, and 94% at 0%, 10%, and 20% abnormal TAWSS surface area, respectively. A cluster-bootstrapped receiver operating characteristic curve (area under the curve, 0.876) identified a >10.2% threshold that correctly classified 92% of renal occlusions. Abnormal TAWSS frequently localized to distal stent-artery interfaces.
Conclusions: Elevated abnormal TAWSS within stented renal branches is associated with subsequent branch occlusion after fenestrated and branched endovascular aneurysm repair. Computational flow simulation-derived TAWSS thresholds may help identify high-risk branches before failure, warranting prospective validation.
Keywords
Humans, Endovascular Aneurysm Repair, Retrospective Studies, Hemodynamics, Aortic Aneurysm, Thoracoabdominal, Aortic Aneurysm, Thoracic, Male, Female, Models, Cardiovascular, Blood Vessel Prosthesis Implantation, Aged, Aged, 80 and over, Computed Tomography Angiography, Computer Simulation, Treatment Outcome, Blood Vessel Prosthesis, Risk Factors, Graft Occlusion, Vascular, Stents, Endovascular Procedures, Patient-Specific Modeling, Aortography, computational fluid dynamics, fenestrated and branched EVAR, flow simulation, thoracoabdominal aortic aneurysm
Published Open-Access
yes
Recommended Citation
Tran, Kenneth; Chait, Jesse; Tenorio, Emmanuel; et al., "Patient-Specific Computational Flow Simulation Reveals Adverse Hemodynamic Factors Associated With Occlusion of Directional Branches After Fenestrated-Branched Endovascular Aneurysm Repair" (2026). Faculty, Staff and Students Publications. 7068.
https://digitalcommons.library.tmc.edu/baylor_docs/7068