Effects of preoperative aortic tortuosity and postoperative hypertension on patient-specific hemodynamics of abdominal aortic aneurysm

Abstract

Abdominal aortic aneurysm (AAA) is a serious dilated vascular disease. The risk factors of aneurysm rupture and postoperative blood pressure are the major clinical concerns. The purpose of this work is to analyze the hemodynamic difference between preoperative and postoperative AAA using patient-specific boundary conditions and explore the rupture risk of AAA with different torsion and to simulate the blood flow of different degrees of hypertension. A three-element Windkessel model is utilized as the outlet boundary condition. 20-sim software and self-developed user-defined functions are used to calibrate the parameters. To analyze the influence of aortic tortuosity on hemodynamics, five AAA geometries with different torsion degrees are modified and obtained. We also grade the hypertension and explore the effect of hypertension after operation. The analysis results are consistent with the patient-specific situation. The results show that stent implantation for aneurysms reduces the pressure at the lesion site and increase the speed and wall shear stress. Vessels with high torsion have lower time-averaged wall shear stress (TAWSS), higher oscillatory shear stress index (OSI) and relative retention time, and more disordered blood flow. After stent implantation, with the increase in blood pressure, TAWSS and OSI continue to increase, and the blood flow speed is also faster. AAA with high torsion is more likely to rupture. In clinical practice, attention should be paid to the degree of torsion of the lesion site. Furthermore, blood pressure should be monitored and controlled in time to prevent postoperative complications.