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Background <p>Acute type A aortic dissection (ATAAD) treated with total arch replacement (TAR) plus frozen elephant trunk (FET) can achieve favorable early remodeling; however, late enlargement of the distal descending aorta still occurs in some patients.</p> Methods <p>Study 1 included ATAAD patients who underwent TAR with FET between January 2015 and December 2023 and achieved complete false-lumen obliteration at the distal FET level. We identified cases with more than 5&#xa0;mm enlargement at the distal FET level during follow-up and performed statistical analyses. Among these, patients with contrast-enhanced CT were analyzed using CFD. Study 2 used idealized aorta–stent graft models with different aorto-stent graft angles (AS angle) to isolate the hemodynamic effect of angulation.</p> Results <p>In Study 1, larger AS angle was associated with subsequent aortic enlargement, and a cutoff around 38.3° suggested higher risk. CFD tended to show disturbed/recirculating flow along the lesser curvature in high-angle cases, with lower WSS and higher OSI at the distal FET level. In Study 2, increasing AS angle accentuated lesser-curvature flow disturbance and increased greater-curvature WSS; Pearson correlations suggested a positive association between AS angle and greater-curvature WSS/TAWSS.</p> Conclusions <p>A larger AS angle may be associated with enlargement of the distal aorta after FET. Larger and more precise studies are warranted to validate these findings.</p>

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Computational fluid dynamics analysis for enlargement of the descending aorta after frozen elephant trunk implantation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月18日

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  • Hiroki Nakabori,
  • Kenji Iino,
  • Ai Sakai,
  • Masaki Kitazawa,
  • Hideyasu Ueda,
  • Yoshitaka Yamamoto,
  • Yukiko Yamada,
  • Akira Murata,
  • Hirofumi Takemura,
  • Takahiro Kiwata

摘要

Background

Acute type A aortic dissection (ATAAD) treated with total arch replacement (TAR) plus frozen elephant trunk (FET) can achieve favorable early remodeling; however, late enlargement of the distal descending aorta still occurs in some patients.

Methods

Study 1 included ATAAD patients who underwent TAR with FET between January 2015 and December 2023 and achieved complete false-lumen obliteration at the distal FET level. We identified cases with more than 5 mm enlargement at the distal FET level during follow-up and performed statistical analyses. Among these, patients with contrast-enhanced CT were analyzed using CFD. Study 2 used idealized aorta–stent graft models with different aorto-stent graft angles (AS angle) to isolate the hemodynamic effect of angulation.

Results

In Study 1, larger AS angle was associated with subsequent aortic enlargement, and a cutoff around 38.3° suggested higher risk. CFD tended to show disturbed/recirculating flow along the lesser curvature in high-angle cases, with lower WSS and higher OSI at the distal FET level. In Study 2, increasing AS angle accentuated lesser-curvature flow disturbance and increased greater-curvature WSS; Pearson correlations suggested a positive association between AS angle and greater-curvature WSS/TAWSS.

Conclusions

A larger AS angle may be associated with enlargement of the distal aorta after FET. Larger and more precise studies are warranted to validate these findings.