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True-Lumen Collapse in Aortic Dissection ¹

Part I. Evaluation of Causative Factors in Phantoms with Pulsatile Flow

¹ From the Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, Stanford Vascular Center, H-3647, 300 Pasteur Dr, Stanford, CA 94304-5105. Received November 30, 1998; revision requested January 21, 1999; revision received March 19; accepted May 6. Address reprint requests to M.D.D. (e-mail: mddake@leland.stanford.edu).

PURPOSE: To investigate the causative factors in true-lumen collapse in a model of aortic dissection.

MATERIALS AND METHODS: Phantoms with an aortic arch, true and false lumina with abdominal branch vessels, and a distal bifurcation were used to model a Stanford type B aortic dissection. The effects of anatomic factors (entry-tear size, branch-vessel flow distribution, fenestrations, distal reentry communication) and physiologic factors (peripheral resistance in the branch vessels, pump output and rate, vascular compliance) on true-lumen collapse were investigated. The morphology of the true lumen was observed. Branch pressures and flow rates were measured.

RESULTS: True-lumen collapse was induced and was exacerbated by an increase in the size of the entry tear, a decrease in the false-lumen outflow caused by occluding the false-lumen branch vessels, and an increase in the true-lumen outflow caused by lowering the peripheral resistance in true-lumen branch vessels. Two kinds of true-lumen collapse depended on pump output. With low pump output and low outflow resistance from the true lumen, the true lumen collapsed. With high pump output and low inflow resistance in the false lumen, the true lumen was compressed. Distal reentry communication between the true and false limbs was more effective than aortic fenestrations in preventing true-lumen collapse.

CONCLUSION: True-lumen collapse in this dissection model strongly depends on the difference in the ratios of inflow capacity to outflow capacity in the true and false lumina. Both anatomic and physiologic factors can affect true-lumen collapse.

Index terms: Aorta, dissection, 942.4124, 943.743, 981.743 • Aorta, flow dynamics • Aorta, stenosis or obstruction, 943.743, 981.743 • Aorta, US, 943.1298 • Phantoms, 942.412, 943.743, 981.743

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True-Lumen Collapse in Aortic Dissection ¹: Part II. Evaluation of Treatment Methods in Phantoms with Pulsatile Flow

Jin Wook Chung, Christopher Elkins, Toyohiko Sakai, Noriyuki Kato, Thomas Vestring, Charles P. Semba, Suzanne M. Slonim, and Michael D. Dake
Radiology 2000 214: 99-106. [Abstract] [Full Text] [PDF]

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