TY - JOUR
T1 - Hemodynamically motivated choice of patch angioplasty for the performance of carotid endarterectomy
AU - Kamenskiy, Alexey V.
AU - MacTaggart, Jason N.
AU - Pipinos, Iraklis I.
AU - Gupta, Prateek K.
AU - Dzenis, Yuris A.
N1 - Funding Information:
This work was supported in part by NIH grants K08HL079967 and R01AG034995 and by the grants from Nebraska Research Initiative Nanofiber Core Facility, National Science Foundation, and UNL/ UNMC Engineering for Medicine initiative.
PY - 2013/2
Y1 - 2013/2
N2 - Patch angioplasty is the most common technique used for the performance of carotid endarterectomy. A large number of materials are available, but little is known to aid the surgeon in choosing a patch while caring for a patient with carotid disease. The objective of this study was to investigate biomechanics of the carotid artery (CA) repaired with patch angioplasty, study the influence of patch width and location of closure on hemodynamics, and to select the optimal patch material from those commonly used. For this purpose, a mathematical model was built that accounts for fluid-structure interaction, three-dimensional arterial geometry, non-linear anisotropic mechanical properties, non-Newtonian flow and in vivo boundary conditions. This model was used to study disease-related mechanical factors in the arterial wall and blood flow for different types of patch angioplasty. Analysis indicated that patch closures performed with autologous vein and bovine pericardium were hemodynamically superior to carotid endarterectomy with synthetic patch angioplasty (polytetrafluoroethylene, Dacron) in terms of restenosis potential. Width of the patch and location of arteriotomy were found to be of paramount importance, with narrow patches being superior to wide patches, and anterior arteriotomy being superior to the lateral arteriotomy. These data can aid vascular surgeons in their selection of patch angioplasty technique and material for the care of patients undergoing open CA repair.
AB - Patch angioplasty is the most common technique used for the performance of carotid endarterectomy. A large number of materials are available, but little is known to aid the surgeon in choosing a patch while caring for a patient with carotid disease. The objective of this study was to investigate biomechanics of the carotid artery (CA) repaired with patch angioplasty, study the influence of patch width and location of closure on hemodynamics, and to select the optimal patch material from those commonly used. For this purpose, a mathematical model was built that accounts for fluid-structure interaction, three-dimensional arterial geometry, non-linear anisotropic mechanical properties, non-Newtonian flow and in vivo boundary conditions. This model was used to study disease-related mechanical factors in the arterial wall and blood flow for different types of patch angioplasty. Analysis indicated that patch closures performed with autologous vein and bovine pericardium were hemodynamically superior to carotid endarterectomy with synthetic patch angioplasty (polytetrafluoroethylene, Dacron) in terms of restenosis potential. Width of the patch and location of arteriotomy were found to be of paramount importance, with narrow patches being superior to wide patches, and anterior arteriotomy being superior to the lateral arteriotomy. These data can aid vascular surgeons in their selection of patch angioplasty technique and material for the care of patients undergoing open CA repair.
KW - Atherosclerosis
KW - Carotid artery
KW - Endarterectomy
KW - Finite element analysis
KW - Hemodynamics
KW - Patch angioplasty
KW - Restenosis
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U2 - 10.1007/s10439-012-0640-2
DO - 10.1007/s10439-012-0640-2
M3 - Article
C2 - 22923061
AN - SCOPUS:84878493493
SN - 0090-6964
VL - 41
SP - 263
EP - 278
JO - Annals of biomedical engineering
JF - Annals of biomedical engineering
IS - 2
ER -