Phase changes of the flow rate in the vertebral artery caused by debranching thoracic endovascular aortic repair: Effects of flow path and local vessel stiffness on vertebral arterial pulsation

Despite numerous studies on cerebral arterial blood flow, there has not yet been a comprehensive description of hemodynamics in patients undergoing debranching thoracic endovascular aortic repair (dTEVAR), a promising surgical option for aortic arch aneurysms. A phase delay of the flow rate in the left vertebral artery (LVA) in patients after dTEVAR compared to those before was experimentally observed, while the phase in the right vertebral artery (RVA) remained almost the same before and after surgery. Since this surgical intervention included stent graft implantation and extra-anatomical bypass, it was expected that the intracranial hemodynamic changes due to dTEVAR were coupled with fluid flow and pulse waves in cerebral arteries. To clarify this issue, a one-dimensional model (1D) was used to numerically investigate the relative contribution (i.e., local vessel stiffness and flow path changes) of the VA flow rate to the phase difference. The numerical results demonstrated a phase delay of flow rate in the LVA but not the RVA in postoperative patients undergoing dTEVAR relative to preoperative patients. The results further showed that the primary factor affecting the phase delay of the flow rate in the LVA after surgery compared to that before was the bypass, i.e., alteration of flow path, rather than stent grafting, i.e., the change in local vessel stiffness. The numerical results provide insights into hemodynamics in postoperative patients undergoing dTEVAR, as well as knowledge about therapeutic decisions.