A method of planning surgical intervention for aortic residual dissection

Abstract

The application discloses a kind of methods for planning aortic residual dissection surgical intervention, comprising the following steps: step 1: according to clinical image, three-dimensional modeling is carried out to aortic dissection;Step 2: determine the position and morphological characteristics of the aortic residual dissection;Step 3: the residual dissection area in step 2 is intervened digitally;Step 4: on the basis of step 3, obtain a new three-dimensional model;Step 5: on the basis of the new three-dimensional model, carry out the blood flow dynamics analysis based on computational fluid dynamics (CFD), and obtain the local blood flow dynamics parameter distribution result, on the basis of step 5 result, assess the influence of various intervention schemes on the blood flow dynamics of residual dissection area, provide reference for planning surgical re-intervention.

Description

Technical Field

[0001] This invention belongs to the field of surgical intervention, specifically relating to a method for planning surgical intervention for residual aortic dissection. Background Technology

[0002] Aortic dissection (AD) is a serious cardiovascular emergency caused by blood entering the aortic wall through a proximal tear in the aortic intima, resulting in separation of the aortic wall and the formation of a true and false lumen, as well as secondary distal intimal tears. It has a high mortality rate. Currently, endovascular aortic repair (TEVAR) has become the preferred treatment for Stanford type A and B aortic dissections due to its lower complication and mortality rates compared to conservative treatment. However, residual dissection is commonly observed after aortic dissection surgery, which negatively impacts long-term mortality.

[0003] On the other hand, residual dissection is commonly observed after aortic dissection surgery, and it has long-term adverse effects on patients. Clinically, different interventional approaches are often used to treat residual dissection based on the physician's clinical experience, and some patients even require a combination of various procedures. The formulation of various re-intervention plans is mainly based on the physician's clinical judgment. There are currently no suitable methods for preoperative assessment of the impact on hemodynamics at the site of residual dissection and the potential for further thrombosis of the false lumen. This makes it difficult for physicians to conduct efficient surgical planning for these patients, and the basis for selecting clinical intervention methods is also insufficient. Summary of the Invention

[0004] To overcome the shortcomings of existing technologies, this invention provides a method for planning surgical intervention for residual aortic dissection. It studies the relevant hemodynamic characteristics of the distal residual dissection in patients after surgery, simulates preoperative re-intervention using digitized three-dimensional patient models, and uses CFD-based hemodynamic analysis to evaluate the impact of different intervention methods on the hemodynamic changes of the residual dissection segment. This allows for the prediction and evaluation of the postoperative effects of various intervention methods and their impact on further thrombosis of the false lumen before actual clinical intervention, enabling the planning of more effective surgical intervention methods to eliminate the distal dissection and providing a reference for clinicians.

[0005] A method for planning surgical intervention for residual aortic dissection includes the following steps:

[0006] Step 1: Create a 3D model of aortic dissection based on clinical images;

[0007] Step 2: Determine the location and morphological characteristics of the tear in the residual aortic dissection based on 3D modeling;

[0008] Step 3: Perform digital intervention on the residual interlayer region from Step 2;

[0009] Step 4: Based on Step 3, obtain a new 3D model;

[0010] Step 5: Based on the new 3D model, perform hemodynamic analysis based on computational fluid dynamics (CFD) to obtain the distribution results of local hemodynamic parameters;

[0011] Step 6: Based on the results of Step 5, evaluate the impact of various intervention programs on the hemodynamics of the residual dissection area to provide a reference for planning surgical re-intervention.

[0012] Furthermore, based on the patient's clinical medical images, such as CTA and MRI images, a precise three-dimensional model reconstruction of the aortic dissection area is performed, such as... Figure 1 As shown, we present the results of a five-year follow-up of a patient who underwent TEVAR surgery for aortic dissection. A residual false lumen was observed in the abdominal aortic segment of this patient post-surgery, and the CT angiography (CTA) from the most recent follow-up examination (5 years post-surgery) was acquired by us.

[0013] Furthermore, the residual dissection region includes morphological features such as ruptures at different locations, true and false lumens of the dissection segment, and branch arteries originating from the false lumen of the dissection.

[0014] While ensuring that the patient's accurate 3D model morphological information is not lost, we determine the detailed situation of the patient's residual dissection area. As can be seen, three tears (DT1, DT2, DT3) are visible in the distal residual dissection area of ​​the example patient after surgery. The left renal artery and the accessory renal artery both originate from the false lumen of the dissection. The local lesion is complex, and the impact of implementing various types of clinical interventions on the local lesion is difficult to predict.

[0015] Furthermore, in step 4, the intervention methods for the rupture include: stent implantation, rupture closure, angioplasty, and interventional embolization. Clinically, different intervention methods are often adopted for different patients based on the doctor's clinical experience, and some patients even involve a combination of various procedures. The formulation of various re-intervention plans is mainly based on the doctor's clinical judgment. There is currently no suitable means to preoperatively assess the impact of different intervention methods on the hemodynamics of the residual dissection and the further thrombosis of the false lumen of the dissection. By using digital three-dimensional patient model information for preoperative re-intervention simulation, and using CFD-based hemodynamic analysis to evaluate the impact of different intervention methods on the hemodynamic changes of the residual dissection segment, this study aims to predict and evaluate the postoperative effects of various intervention plans and their impact on the further thrombosis of the false lumen of the dissection before actual clinical intervention, and to plan more effective surgical intervention methods to eliminate distal dissection, providing a reference for doctors in clinical practice.

[0016] Furthermore, in step 5, the slower the local blood flow velocity within the blood vessel and the lower the wall shear stress, the higher the likelihood of intravascular thrombosis. Based on the three-dimensional models generated by different intervention schemes, hemodynamic analysis based on computational fluid dynamics (CFD) is performed to obtain the distribution results of local hemodynamic parameters at the residual dissection. The results are compared with the analysis results of the original three-dimensional model to obtain the changes in parameters such as blood flow velocity and wall shear stress within the false lumen of the residual dissection.

[0017] Furthermore, in step 6, if the decrease in blood flow velocity and wall shear stress within the false lumen is more significant based on the analysis results of a certain scheme, it indicates a greater likelihood of further thrombosis of the false lumen and a more effective elimination of residual dissection. If the decrease in blood flow velocity and wall shear stress within the false lumen is not significant based on the analysis results of a certain scheme, or if the local blood flow velocity and wall shear stress increase, it indicates a lower likelihood of further thrombosis of the false lumen and a less significant effect of the surgical intervention scheme.

[0018] The beneficial effects of this invention are as follows: Firstly, the surgical planning and analysis method for residual aortic dissection after surgery, as demonstrated in this application, has not been mentioned in previous research. It is used to evaluate the effects of various clinical interventions before actual surgery. Secondly, the surgical planning method shown can be entirely based on medical imaging information, mainly involving the reprocessing of clinically acquired images, without significantly increasing the burden on patients. Furthermore, these digital interventions are non-invasive and will not cause any harm to the patient's body. The CFD-based surgical planning method shown pays more attention to the hemodynamic changes in the dissected lesion segment to assess the impact of various interventions on the distribution of local hemodynamic parameters, explore more effective surgical plans, and provide valuable reference for clinicians. Attached Figure Description

[0019] Figure 1 This is a three-dimensional model of the aorta in this invention.

[0020] Figure 2 The results are hemodynamic analyses following different intervention protocols.

[0021] Figure 3 A two-dimensional planar schematic diagram of the residual interstitial area in the patient. Detailed Implementation

[0022] The present invention will be further described below with reference to the accompanying drawings and reference numerals.

[0023] To better understand the above-mentioned objectives, features, and advantages of the present invention, the present invention will be described in detail below with reference to the accompanying drawings and specific embodiments. It should be noted that, unless otherwise specified, the embodiments and features described in these embodiments can be combined with each other.

[0024] The terms “first,” “second,” “third,” etc., are used only to distinguish descriptions and should not be interpreted as indicating or implying relative importance.

[0025] In the description of this invention, it should also be noted that, unless otherwise explicitly specified and limited, the terms "set," "install," "connect," and "link" should be interpreted broadly. For example, they can refer to a fixed connection, a detachable connection, or an integral connection; they can refer to a mechanical connection or an electrical connection; they can refer to a direct connection or an indirect connection through an intermediate medium; and they can refer to the internal connection of two components. Those skilled in the art can understand the specific meaning of the above terms in this invention based on the specific circumstances.

[0026] The specific embodiments of the present invention will be described in detail below with reference to the accompanying drawings. It should be understood that the specific embodiments described herein are for illustration and explanation only and are not intended to limit the present invention.

[0027] Example 1:

[0028] like Figure 1 As shown, a method for planning surgical intervention for residual aortic dissection includes the following steps:

[0029] Step 1: Create a 3D model of aortic dissection based on clinical images;

[0030] Step 2: Determine the location and morphological characteristics of the tear in the residual aortic dissection based on 3D modeling;

[0031] Step 3: Perform digital intervention on the residual interlayer region from Step 2;

[0032] Step 4: Based on Step 3, obtain a new 3D model;

[0033] Step 5: Based on the new 3D model, perform hemodynamic analysis based on computational fluid dynamics (CFD) to obtain the distribution results of local hemodynamic parameters;

[0034] Step 6: Based on the results of Step 5, evaluate the impact of various intervention programs on the hemodynamics of the residual dissection area to provide a reference for planning surgical re-intervention.

[0035] Example 2:

[0036] Based on Example 1, a precise three-dimensional model reconstruction of the aortic dissection region is performed using patient clinical medical images, such as CTA and MRI images, or directly obtained from clinical medical images. Figure 1 As shown, we use the five-year follow-up results of a patient who underwent surgery for aortic dissection as an example. A residual false lumen was observed in the abdominal aortic segment of this patient post-surgery, and the CT angiography (CTA) from the most recent follow-up examination (5 years post-surgery) was acquired by us.

[0037] Figure 1 (a) A three-dimensional model reconstruction of the distal residual dissection area after aortic dissection in the patient. (b) A simplified diagram of the lesion location in the patient, where TL (True Lumen) and FL (False Lumen) represent the true lumen and false lumen, respectively, DT (Distal Tear) represents the distal tear, and SMA, RRA, LRA, and ARA represent the superior mesenteric artery, right renal artery, left renal artery, and accessory renal artery, respectively.

[0038] Example 3:

[0039] Based on Example 2, the morphological characteristics of the residual dissection region include ruptures at different locations, true and false lumens in the dissection segment, and branch arteries originating from the false lumen of the dissection. Specifically, the residual dissection region includes ruptures DT1, DT2, and DT3, the left renal artery, and the accessory renal artery, all originating from the false lumen of the dissection.

[0040] While ensuring that the patient's accurate three-dimensional model or clinical imaging morphological information is not lost, we can determine the detailed situation of the patient's postoperative residual dissection. As can be seen, in the example patient, three tears (DT1, DT2, DT3) are visible in the distal residual dissection area after surgery. The left renal artery and the accessory renal artery both originate from the false lumen of the dissection. The local lesion is complex, and the impact of implementing various types of clinical interventions on the local lesion is difficult to predict.

[0041] To address this issue, we digitally conduct various types of interventions based on this precise 3D model or clinical image, and adjust the digital 3D model of the patient's lesion area based on various intervention protocols.

[0042] Example 4:

[0043] Based on Example 3, step 4 includes:

[0044] Option 1: Seal the breach DT1;

[0045] Option 2: Place a renal artery stent at the DT3 site of the rupture;

[0046] Option 3: In addition to placing a renal artery stent at the DT3 rupture site, the DT2 rupture site was simultaneously sealed, and the accessory renal artery was embolized.

[0047] Table 1: Three-dimensional model reconstruction of the residual aortic region after surgery in patients using different clinical intervention protocols.

[0048]

[0049] Note: N represents No, Y represents Yes, and green represents a 6mm×6mm×50mm renal artery stent.

[0050] Plan 1 sealed the rupture DT1. Plan 2 deployed a renal artery stent at the rupture DT3. Plan 3, in addition to deploying a stent at DT3, simultaneously sealed the rupture DT2 and embolized the accessory renal artery.

[0051] Example 5:

[0052] Based on Example 4, hemodynamic analysis based on computational fluid dynamics (CFD) is performed on the acquired three-dimensional model or clinical images to obtain the distribution results of local hemodynamic parameters:

[0053] Based on 3D models or clinical images generated from different intervention protocols, hemodynamic analysis based on computational fluid dynamics (CFD) was performed to obtain the distribution of local hemodynamic parameters at the residual dissection. This was compared with the results of the original 3D model or clinical image analysis to obtain changes in parameters such as blood flow velocity and wall shear stress within the false lumen of the residual dissection. Figure 2 As shown.

[0054] In this patient, due to the presence of three ruptures and the fact that the left renal artery and accessory renal artery originate from the false lumen, blood flow from the true lumen through the three ruptures and then supplies the LRA and ARA. Blood flow can be seen inside the false lumen, which locally undertakes a certain blood supply function.

[0055] After we sealed the proximal rupture (Plan 1), there was no significant blood flow through the proximal segment of the false cavity, and the blood supply mainly came through the two ruptures in the distal segment.

[0056] Similarly, different interventions, including Plan 2 and Plan 3, altered the hemodynamics of the dissection area. In particular, Plan 3 completely eliminated the blood supply function of the false lumen, which may facilitate further thrombosis of the false lumen and completely eradicate the presence of residual dissection in the abdominal aortic segment.

[0057] Example 6:

[0058] Based on Example 5, such as Figure 2 As shown, step 5: Obtain the distribution results of local hemodynamic parameters;

[0059] Figure 2 In the figure, (a), (b), and (c) represent the overall flow velocity distribution, the flow velocity distribution in the local interlayer region, and the wall shear stress (WSS) distribution, respectively. 1, 2, 3, and 4 represent the analysis results of the patient's actual condition (origin), Plan 1, Plan 2, and Plan 3, respectively.

[0060] Table 2: Blood flow velocity distribution at different cross sections under various clinical interventions (unit: cm / s).

[0061]

[0062] Combination Figure 2 It can be seen that various clinical intervention protocols affected local hemodynamics at different cross-sections.

[0063] Example 7:

[0064] Based on Example 6, such as Figure 2 As shown, in step 6, when the analysis results based on a certain scheme show a more significant decrease in blood flow velocity and wall shear stress within the false lumen, it indicates a greater likelihood of further thrombosis of the false lumen and a more effective elimination of residual dissection. Conversely, when the analysis results based on a certain scheme show a less significant decrease in blood flow velocity and wall shear stress within the false lumen, or an increase in local blood flow velocity and wall shear stress, it indicates a lower likelihood of further thrombosis of the false lumen and a less significant effect of the surgical intervention.

[0065] For Plan 1 and Plan 3, the blood flow velocity in most areas of the false lumen is close to zero, which may help to further thrombosis at the dissection site. Surgeons can also judge the impact of various clinical interventions on the residual dissection area and the possible expected consequences based on the changes in these hemodynamic parameters, providing a reference for the doctor's surgical plan and further clinical intervention.

[0066] This invention is not limited to the above-described optional embodiments. Anyone can derive other various forms of products under the guidance of this invention. However, regardless of any changes made in their shape or structure, any technical solution that falls within the scope of the claims of this invention shall be protected by this invention.

Claims

1. A method for planning surgical intervention for residual aortic dissection, characterized in that: Includes the following steps: Step 1: Create a 3D model of aortic dissection based on clinical images; Step 2: Determine the location and morphological characteristics of the tear in the residual aortic dissection based on 3D modeling; Step 3: Perform digital intervention on the residual interlayer region from Step 2; Step 4: Based on Step 3, obtain a new 3D model; Step 5: Based on the new 3D model, perform hemodynamic analysis based on computational fluid dynamics (CFD) to obtain the distribution results of local hemodynamic parameters; Step 6: Based on the results of Step 5, evaluate the impact of various intervention programs on the hemodynamics of the residual dissection area to provide a reference for planning surgical re-intervention.

2. The method for planning surgical intervention for residual aortic dissection according to claim 1, characterized in that: The morphological features of the residual dissection region include ruptures at different locations, true and false lumens in the dissection segment, and branch arteries originating from the false lumen of the dissection.

3. The method for planning surgical intervention for residual aortic dissection according to claim 2, characterized in that: In step 4, the re-intervention methods for the residual dissection include: stent implantation, rupture closure, angioplasty, and interventional embolization.

4. The method for planning surgical intervention for residual aortic dissection according to claim 2, characterized in that: In step 5, the slower the local blood flow velocity within the blood vessel and the smaller the wall shear stress, the higher the likelihood of thrombosis formation within the blood vessel.

5. The method for planning surgical intervention for residual aortic dissection according to claim 4, characterized in that: In step 6, if the decrease in blood flow velocity and wall shear stress within the false lumen is more significant based on the analysis results of a certain scheme, it indicates a greater possibility of further thrombosis of the false lumen and a more effective elimination of residual dissection. If the decrease in blood flow velocity and wall shear stress within the false lumen is less significant based on the analysis results of a certain scheme, or if the local blood flow velocity and wall shear stress increase, it indicates a lower possibility of further thrombosis of the false lumen and a less significant effect of the surgical intervention scheme.

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