Joav Birjiniuk
PhD Thesis Proposal
Friday, May 8
11:00 AM
Emory, SOM A153

Advisors: David Ku, MD, PhD and John Oshinski, PhD

Committee: J. Brandon Dixon, PhD, Wei Sun, PhD, W. Robert Taylor, MD, PhD, Lucas Timmins, PhD, Ravi Veeraswamy, MD

Title: Investigation of fluid dynamic effects of endovascular intervention in Type B descending aortic dissection

Abstract:

Though endovascular stent-grafting of the thoracic aorta has become a standard treatment for patients with dissection of the descending aorta (Stanford Type B), little is known about its effects on aortic hemodynamics. Additionally, only a single randomized controlled trial exists studying the effectiveness of this treatment modality in the absence of acute hemodynamic complications. As such, its role in the treatment of patients with uncomplicated Type B dissection remains unclear.

This work aims to determine the extent to which aortic stent-grafting improves hemodynamics in selected patients. The goal of this is twofold: a) to develop risk stratification criteria for patients based on dissection geometry, ultimately improving patient selection and b) to determine the optimal methods of graft employment, in order to improve treatment methods. As the fluid dynamics of the aorta are governed by the boundary conditions of the vessel, dissection geometry is hypothesized to play a critical role in determining the severity of the patient’s hemodynamic status. In particular, geometries aligning with the natural skewness of aortic velocity profiles are expected to have the greatest relative false lumen flow. Thus, large entry tear dissections located on the greater curvature of the aorta are expected to have highest false lumen flow and shear rates, requiring stent-grafting.