Title:
Investigation of fluid dynamic effects of endovascular intervention in a model of descending aortic dissection

dc.contributor.advisor Ku, David N.
dc.contributor.advisor Oshinski, John N.
dc.contributor.author Birjiniuk, Joav
dc.contributor.committeeMember Veeraswamy, Ravi K
dc.contributor.committeeMember Taylor, W. Robert
dc.contributor.committeeMember Sun, Wei
dc.contributor.committeeMember Dixon, J. B
dc.contributor.department Biomedical Engineering (Joint GT/Emory Department)
dc.date.accessioned 2017-08-17T18:59:55Z
dc.date.available 2017-08-17T18:59:55Z
dc.date.created 2017-08
dc.date.issued 2017-07-24
dc.date.submitted August 2017
dc.date.updated 2017-08-17T18:59:55Z
dc.description.abstract With advances in endovascular technology and technique, Thoracic EndoVascular Aortic Repair (TEVAR) has emerged as an integral component of the management of Stanford Type B dissection of the descending aorta. Whereas this modality is considered vital in the treatment of patients experiencing severe complications as a result of dissection, it has not been shown to be demonstratively superior to treatment with medical therapy alone in the absence of malperfusion, rupture, or aneurysmal degeneration. However, results from various clinical studies on the relative benefits of these therapies may be confounded by the vast heterogeneity in dissection anatomy and hemodynamics. Therefore, little is known regarding which patients should undergo TEVAR, as well as the effect of stent-graft deployment on the functional status of the aorta. In order to address this knowledge gap, compliant models of the aorta possessing a mobile intimal flap mimicking dissection were fabricated and imaged via four-dimensional phase contrast magnetic resonance (4D PCMR) imaging sensitive to fluid flow. We aimed to understand how the fluid flow varies with changes to the dissection anatomy as well as the effect of varying anatomies on the fluid shear rate, which has been related to the thrombotic potential of blood-contacting surfaces. Furthermore, we aimed to study the effects of graft deployment on these hemodynamic effects. Dissection induced flow reversal in the aorta, with concomitant low and oscillatory shear zones, which were reduced in dissections with multiple tears. Device deployment was found to restore normal hemodynamics locally, while preserving distal hemodynamic alterations. These findings suggest a potential for risk-stratification based on anatomical and functional imaging as well as more aggressive intervention to rectify aberrant fluid mechanics of the dissected aorta.
dc.description.degree Ph.D.
dc.format.mimetype application/pdf
dc.identifier.uri http://hdl.handle.net/1853/58687
dc.language.iso en_US
dc.publisher Georgia Institute of Technology
dc.subject aortic dissection, fluid mechanics, hemodynamics, experimental model
dc.title Investigation of fluid dynamic effects of endovascular intervention in a model of descending aortic dissection
dc.type Text
dc.type.genre Dissertation
dspace.entity.type Publication
local.contributor.advisor Oshinski, John N.
local.contributor.advisor Ku, David N.
local.contributor.corporatename Wallace H. Coulter Department of Biomedical Engineering
local.contributor.corporatename College of Engineering
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relation.isOrgUnitOfPublication da59be3c-3d0a-41da-91b9-ebe2ecc83b66
relation.isOrgUnitOfPublication 7c022d60-21d5-497c-b552-95e489a06569
thesis.degree.level Doctoral
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