Magnitude and Direction of Pulsatile Displacement Forces Acting on Thoracic Aortic Endografts

Purpose: To assess 3-dimensional (3D) pulsatile displacement forces (DF) acting on thoracic endografts using 3D computational techniques. Methods: A novel computational method to quantitate the pulsatile 3D flow and pressure fields and aortic wall dynamics in patient-specific anatomical models based on cardiac-gated computed tomography (CT) scans was used to construct simulations of the proximal and mid-descending thoracic aorta. Endografts of varying lengths and diameters were implanted in these patient-specific models. The magnitude and direction of the DF vector were calculated and expressed in Newtons (N). This DF included the effects of both the pressure and shearing stresses of blood. Results: The magnitude of DF increased with endografts of increasing diameter and length. A 36-mm endograft in the mid-descending aorta had a mean DF of 21.7 N with a peak systolic DF of 27.8 N and an end-diastolic DF of 16.7 N. Conversely, a 30-mm endograft in the proximal descending aorta had a mean DF of 14.9 N, with peak systolic and end-diastolic DFs of 18.9 and 11.5, respectively. The orientation of the DF acting on the endograft varied depending on aortic angulation and tortuosity; in general, the vector was perpendicular to the greater curvature of the endograft rather than along the downstream longitudinal centerline axis of the aorta as is commonly believed. The DF vector pointed primarily in the cranial direction for the proximal descending endograft and in the sideways direction for the mid-descending endograft simulation. Furthermore, it was shown that elevated pressure plays an important role in the magnitude and direction of DF; an increase in mean blood pressure resulted in an approximately linearly proportional increase in DF. Conclusion: The orientation of the DF varies depending on curvature and location of the endograft, but in all instances, it is in the cranial rather than caudal direction on axial imaging. This is counter to the intuitive notion that displacement forces act in the downward direction of blood flow. Therefore, we postulate that migration of thoracic endografts may be different from abdominal endografts since it may involve upward rather than downward movement of the graft. Computational methods can enhance the understanding of the magnitude and orientation of the loads experienced in vivo by thoracic aortic endografts and therefore improve their design and performance. J Endovasc Ther. 2009;16:350-358