A 3D-simulation hemodynamic study of the correlation between aortic arch morphology and aortic dissection

Abstract

Abstract Background Reverse tearing and the correlation between aortic arch morphology and aortic dissection were studied with a 3D simulation hemodynamic technique. Methods From 2018 to 2023, 140 patients with aortic dissection admitted to Suzhou Hospital affiliated with Nanjing Medical University and Guangyuan First People's Hospital (age 56.5 ± 12.0 years; 52 female) and 143 healthy controls (age 53.1 ± 11.8 years; 50 female) underwent CTA examination of the whole thoracic and abdominal aorta; the diameter of the three branches of the aortic arch, the angle of the branches, the distance of the branches and the type of the aortic arch were recorded and analyzed. By adjusting the parameter values of risk factors, the morphology of the aortic arch and its branches was simulated, and the regional differences in blood flow velocity and shear force in the 3D simulation experiment were used to evaluate the hemodynamics of the aortic arch. Results Compared with healthy controls, patients with aortic dissection had an angle of the left subclavian artery (OR = 0.841, 95% CI = 0.752–0.942, P = 0.003). The length of the ascending aorta (OR = 0.935, 95% CI = 0.885–0.998, P = 0.017). The bifurcation of the LSA in patients with aortic dissection is the position where WSS in the aortic arch is the highest (compared with other parts of the aortic arch). Compared with patients with nonaortic dissection, the left subclavian artery angle WSS significantly differed. The location of the damaged dissection was categorized as type 1 (Z3) and type 2 (Z2 + Z3). The comparative analysis of the data on the arch in the two groups indicated that the left subclavian angle (P < 0.05) was an independent risk factor. The maximum shear force of the aortic arch was at the LSA bifurcation, and the WSS mean of type 1 and type 2 (10.48 ± 3.09 vs. 21.57 ± 7.31 Pa, p = 0.0001). The LPD of type 1 and type 2 (2.53 ± 2.14 vs. 13.83 ± 8.87 Pa, p = 0.0001). Conclusion The angle of the left subclavian artery and the length of the ascending aorta are independent risk factors for the formation of aortic dissection. Aortic dissection patients receive the greatest shear pressure at the bifurcation of the left subclavian artery and aorta, which is the common location of dissection. The small angle of the left subclavian artery is an independent risk factor for dissection avulsion.