Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation

Christopher Tossas-Betancourt; Theodorus M.J. van Bakel; Christopher J. Arthurs; Dawn M. Coleman; Jonathan L. Eliason; C. Alberto Figueroa; James C. Stanley

doi:10.1016/j.jvs.2019.02.063

Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation

Christopher Tossas-Betancourt, Theodorus M.J. van Bakel, Christopher J. Arthurs, Dawn M. Coleman, Jonathan L. Eliason, C. Alberto Figueroa^*, James C. Stanley

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective:Suprarenal abdominal aortic coarctation (SAAC) alters flow and pressure patterns to the kidneys and is often associated with severe angiotensin-mediated hypertension refractory to drug therapy. SAAC is most often treated by a thoracoabdominal bypass (TAB) or patch aortoplasty (PA). It is currently unclear what effect these interventions have on renal flow and pressure waveforms. This study, using retrospective data from a patient with SAAC subjected to a TAB, undertook computational modeling to analyze aortorenal blood flow preoperatively as well as postoperatively after a variety of TAB and PA interventions. Methods:Patient-specific anatomic models were constructed from preoperative computed tomography angiograms of a 9-year-old child with an isolated SAAC. Fluid-structure interaction (FSI) simulations of hemodynamics were performed to analyze preoperative renal flow and pressure waveforms. A parametric study was then performed to examine the hemodynamic impact of different bypass diameters and patch oversizing. Results:Preoperative FSI results documented diastole-dominated renal perfusion with considerable high-frequency disturbances in blood flow and pressure. The postoperative TAB right and left kidney volumes increased by 58% and 79%, respectively, reflecting the increased renal artery blood flows calculated by the FSI analysis. Postoperative increases in systolic flow accompanied decreases in high-frequency disturbances, aortic pressure, and collateral flow after all surgical interventions. In general, lesser degrees of high-frequency disturbances followed PA interventions. High-frequency disturbances were eliminated with the 0% PA in contrast to the 30% and 50% PA oversizing and TAB interventions, in which these flow disturbances remained. Conclusions:Both TAB and PA dramatically improved renal artery flow and pressure waveforms, although disturbed renal waveforms remained in many of the surgical scenarios. Importantly, only the 0% PA oversizing scenario eliminated all high-frequency disturbances, resulting in nearly normal aortorenal blood flow. The study also establishes the relevance of patient-specific computational modeling in planning interventions for the midaortic syndrome. Clinical Relevance:We performed computational fluid dynamics modeling to assess aortorenal blood flow in a child with a suprarenal abdominal aortic coarctation and to test the performance of different surgical interventions. We discovered high-frequency disturbances in the renal arteries that could potentially trigger excessive renin release. Thoracoabdominal bypass and patch aortoplasty with oversizing did not remove these disturbances completely. This could explain why the hypertension cure rates of surgical repair of suprarenal abdominal aortic coarctation are suboptimal. In addition, this study establishes the relevance of computational fluid dynamics modeling as a valuable tool to analyze complex hemodynamics and to test the performance of different surgical interventions.

Original language	English
Pages (from-to)	505-516.e4
Journal	Journal of Vascular Surgery
Volume	71
Issue number	2
Early online date	29 May 2019
DOIs	https://doi.org/10.1016/j.jvs.2019.02.063
Publication status	Published - 1 Feb 2020

Keywords

CFD
High-frequency disturbances
Optimal surgical repair
Patient-specific modeling

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jvs.2019.02.063

Computational analysis of renal_TOSAS BETANCOURT_Published Online 29 May 2019_GREEN AAM(CC BY NC ND)Accepted author manuscript, 188 KBLicence: CC BY-NC-ND

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Tossas-Betancourt, C., van Bakel, T. M. J., Arthurs, C. J., Coleman, D. M., Eliason, J. L., Figueroa, C. A., & Stanley, J. C. (2020). Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation. Journal of Vascular Surgery, 71(2), 505-516.e4. https://doi.org/10.1016/j.jvs.2019.02.063

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title = "Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation",

abstract = "Objective:Suprarenal abdominal aortic coarctation (SAAC) alters flow and pressure patterns to the kidneys and is often associated with severe angiotensin-mediated hypertension refractory to drug therapy. SAAC is most often treated by a thoracoabdominal bypass (TAB) or patch aortoplasty (PA). It is currently unclear what effect these interventions have on renal flow and pressure waveforms. This study, using retrospective data from a patient with SAAC subjected to a TAB, undertook computational modeling to analyze aortorenal blood flow preoperatively as well as postoperatively after a variety of TAB and PA interventions. Methods:Patient-specific anatomic models were constructed from preoperative computed tomography angiograms of a 9-year-old child with an isolated SAAC. Fluid-structure interaction (FSI) simulations of hemodynamics were performed to analyze preoperative renal flow and pressure waveforms. A parametric study was then performed to examine the hemodynamic impact of different bypass diameters and patch oversizing. Results:Preoperative FSI results documented diastole-dominated renal perfusion with considerable high-frequency disturbances in blood flow and pressure. The postoperative TAB right and left kidney volumes increased by 58% and 79%, respectively, reflecting the increased renal artery blood flows calculated by the FSI analysis. Postoperative increases in systolic flow accompanied decreases in high-frequency disturbances, aortic pressure, and collateral flow after all surgical interventions. In general, lesser degrees of high-frequency disturbances followed PA interventions. High-frequency disturbances were eliminated with the 0% PA in contrast to the 30% and 50% PA oversizing and TAB interventions, in which these flow disturbances remained. Conclusions:Both TAB and PA dramatically improved renal artery flow and pressure waveforms, although disturbed renal waveforms remained in many of the surgical scenarios. Importantly, only the 0% PA oversizing scenario eliminated all high-frequency disturbances, resulting in nearly normal aortorenal blood flow. The study also establishes the relevance of patient-specific computational modeling in planning interventions for the midaortic syndrome. Clinical Relevance:We performed computational fluid dynamics modeling to assess aortorenal blood flow in a child with a suprarenal abdominal aortic coarctation and to test the performance of different surgical interventions. We discovered high-frequency disturbances in the renal arteries that could potentially trigger excessive renin release. Thoracoabdominal bypass and patch aortoplasty with oversizing did not remove these disturbances completely. This could explain why the hypertension cure rates of surgical repair of suprarenal abdominal aortic coarctation are suboptimal. In addition, this study establishes the relevance of computational fluid dynamics modeling as a valuable tool to analyze complex hemodynamics and to test the performance of different surgical interventions.",

keywords = "CFD, High-frequency disturbances, Optimal surgical repair, Patient-specific modeling",

author = "Christopher Tossas-Betancourt and {van Bakel}, {Theodorus M.J.} and Arthurs, {Christopher J.} and Coleman, {Dawn M.} and Eliason, {Jonathan L.} and Figueroa, {C. Alberto} and Stanley, {James C.}",

year = "2020",

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doi = "10.1016/j.jvs.2019.02.063",

language = "English",

volume = "71",

pages = "505--516.e4",

journal = "Journal of Vascular Surgery",

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Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation. / Tossas-Betancourt, Christopher; van Bakel, Theodorus M.J.; Arthurs, Christopher J. et al.
In: Journal of Vascular Surgery, Vol. 71, No. 2, 01.02.2020, p. 505-516.e4.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation

AU - Tossas-Betancourt, Christopher

AU - van Bakel, Theodorus M.J.

AU - Arthurs, Christopher J.

AU - Coleman, Dawn M.

AU - Eliason, Jonathan L.

AU - Figueroa, C. Alberto

AU - Stanley, James C.

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Objective:Suprarenal abdominal aortic coarctation (SAAC) alters flow and pressure patterns to the kidneys and is often associated with severe angiotensin-mediated hypertension refractory to drug therapy. SAAC is most often treated by a thoracoabdominal bypass (TAB) or patch aortoplasty (PA). It is currently unclear what effect these interventions have on renal flow and pressure waveforms. This study, using retrospective data from a patient with SAAC subjected to a TAB, undertook computational modeling to analyze aortorenal blood flow preoperatively as well as postoperatively after a variety of TAB and PA interventions. Methods:Patient-specific anatomic models were constructed from preoperative computed tomography angiograms of a 9-year-old child with an isolated SAAC. Fluid-structure interaction (FSI) simulations of hemodynamics were performed to analyze preoperative renal flow and pressure waveforms. A parametric study was then performed to examine the hemodynamic impact of different bypass diameters and patch oversizing. Results:Preoperative FSI results documented diastole-dominated renal perfusion with considerable high-frequency disturbances in blood flow and pressure. The postoperative TAB right and left kidney volumes increased by 58% and 79%, respectively, reflecting the increased renal artery blood flows calculated by the FSI analysis. Postoperative increases in systolic flow accompanied decreases in high-frequency disturbances, aortic pressure, and collateral flow after all surgical interventions. In general, lesser degrees of high-frequency disturbances followed PA interventions. High-frequency disturbances were eliminated with the 0% PA in contrast to the 30% and 50% PA oversizing and TAB interventions, in which these flow disturbances remained. Conclusions:Both TAB and PA dramatically improved renal artery flow and pressure waveforms, although disturbed renal waveforms remained in many of the surgical scenarios. Importantly, only the 0% PA oversizing scenario eliminated all high-frequency disturbances, resulting in nearly normal aortorenal blood flow. The study also establishes the relevance of patient-specific computational modeling in planning interventions for the midaortic syndrome. Clinical Relevance:We performed computational fluid dynamics modeling to assess aortorenal blood flow in a child with a suprarenal abdominal aortic coarctation and to test the performance of different surgical interventions. We discovered high-frequency disturbances in the renal arteries that could potentially trigger excessive renin release. Thoracoabdominal bypass and patch aortoplasty with oversizing did not remove these disturbances completely. This could explain why the hypertension cure rates of surgical repair of suprarenal abdominal aortic coarctation are suboptimal. In addition, this study establishes the relevance of computational fluid dynamics modeling as a valuable tool to analyze complex hemodynamics and to test the performance of different surgical interventions.

AB - Objective:Suprarenal abdominal aortic coarctation (SAAC) alters flow and pressure patterns to the kidneys and is often associated with severe angiotensin-mediated hypertension refractory to drug therapy. SAAC is most often treated by a thoracoabdominal bypass (TAB) or patch aortoplasty (PA). It is currently unclear what effect these interventions have on renal flow and pressure waveforms. This study, using retrospective data from a patient with SAAC subjected to a TAB, undertook computational modeling to analyze aortorenal blood flow preoperatively as well as postoperatively after a variety of TAB and PA interventions. Methods:Patient-specific anatomic models were constructed from preoperative computed tomography angiograms of a 9-year-old child with an isolated SAAC. Fluid-structure interaction (FSI) simulations of hemodynamics were performed to analyze preoperative renal flow and pressure waveforms. A parametric study was then performed to examine the hemodynamic impact of different bypass diameters and patch oversizing. Results:Preoperative FSI results documented diastole-dominated renal perfusion with considerable high-frequency disturbances in blood flow and pressure. The postoperative TAB right and left kidney volumes increased by 58% and 79%, respectively, reflecting the increased renal artery blood flows calculated by the FSI analysis. Postoperative increases in systolic flow accompanied decreases in high-frequency disturbances, aortic pressure, and collateral flow after all surgical interventions. In general, lesser degrees of high-frequency disturbances followed PA interventions. High-frequency disturbances were eliminated with the 0% PA in contrast to the 30% and 50% PA oversizing and TAB interventions, in which these flow disturbances remained. Conclusions:Both TAB and PA dramatically improved renal artery flow and pressure waveforms, although disturbed renal waveforms remained in many of the surgical scenarios. Importantly, only the 0% PA oversizing scenario eliminated all high-frequency disturbances, resulting in nearly normal aortorenal blood flow. The study also establishes the relevance of patient-specific computational modeling in planning interventions for the midaortic syndrome. Clinical Relevance:We performed computational fluid dynamics modeling to assess aortorenal blood flow in a child with a suprarenal abdominal aortic coarctation and to test the performance of different surgical interventions. We discovered high-frequency disturbances in the renal arteries that could potentially trigger excessive renin release. Thoracoabdominal bypass and patch aortoplasty with oversizing did not remove these disturbances completely. This could explain why the hypertension cure rates of surgical repair of suprarenal abdominal aortic coarctation are suboptimal. In addition, this study establishes the relevance of computational fluid dynamics modeling as a valuable tool to analyze complex hemodynamics and to test the performance of different surgical interventions.

KW - CFD

KW - High-frequency disturbances

KW - Optimal surgical repair

KW - Patient-specific modeling

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DO - 10.1016/j.jvs.2019.02.063

M3 - Article

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SN - 0741-5214

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SP - 505-516.e4

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JF - Journal of Vascular Surgery

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ER -

Computational analysis of renal artery flow characteristics by modeling aortoplasty and aortic bypass interventions for abdominal aortic coarctation

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