Prediction of femoro-distal arterial reconstruction based on the simulation of biomechanic parametes in patients with peripheral arterial occlusive disease

[Dragan B. Sekulić]

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Uvod. Periferna arterijska okluzivna bolest (PAOB), zahteva hirurško lečenje u vidu „by-pass“ hirurgije. Analizom konačnih elemenata (AKE) na osnovu „Ankle- brachial indeksa“, multislajsne kompjuterizovane angiografije (MSKA) moguće je simulirati protok kroz arterije i izračunati vrednosti pritiska. Cilj studije. Pokazati da metodom AKE možemo konstruisati virtuelni femorodistalni „by-pass“ na osnovu kog bi sa velikom verovatnoćom mogli izračunati postoperativne ABI i čije vrednosti ne zavise od faktora rizika, vazoprotektivne i antiagregacione terapije i mesta okluzije. Metod. Istraživanje je sprovedeno kao opservaciona studija sa matematičkim modeliranjem na osnovu podataka dobijenih merenjima na 60 pacijenata sa PAOB kod kojih je indikovana femoro-distalna arterijska rekonstrukcija. Preoperativno i postoperativno je učinjena MSKA KSDE i AKE modeli, ABI su mereni svim pacijentima preoperativno i postoperativno. Na osnovu preoperativnog MSKA nalaza napravljen je po jedan postoperativni model na kome su takođe računati ABI. Statistički su poređene vradnosti ABI izmerene na modelima sa vrednostima izmerenim na pacijentima preoperativno i postoperativno. Vrednosti ABI su poređene u odnosu na faktore rizika, mesto PAOB i dužinu korišćenja vazoprotektivne terapije. Rezultati. Poređenjem vrednosti ABI preoperativno i postoperativno na pacijentima i modelima i u odnosu na faktore rizika, mesto okluzije i terapiju nisu uočene statistički značajne razlike. Zaključak. Na osnovu preoperativnog MSKA nalaza metodom AKE može se napraviti postoperativni angiografski model na kome se mogu izračunati arterijski pritisci i očekivani postoperativni ABI

Introduction. Peripheral arterial occlusive disease (PAOD) requires surgical treatment in the form of "by-pass" surgery. Using Finite Element Analysis (FEA), based on Anlke– brachial indexes (ABI) multidetector computerised angiography (MDCA) it is possible to simulate the flow through the arteries. Aim of the study. Show that with the AKE method we can construct a virtual femorodistal "by-pass" on the basis of which the postoperative ABI could be calculated with high probability and whose values do not depend on risk factors, vasoprotective and antipleteled therapy and occlusion site. Method. The research was conducted as an observational study with mathematical modeling based on data obtained by measurements on 60 patients with PAOD who were indicated for femoro-distal arterial reconstruction. MSCA BVLE was performed preoperatively and postoperatively and FEA models were made. ABI was measured preoperatively and postoperatively for all patients. Based on the preoperative MSCA findings one postoperative model was made which will also be used to calculate the ABI. ABI values measured on models were statistically compared with values measured on patients preoperatively and postoperatively. ABI values were compared in relation to risk factors, site of PAOD and length of use of vasoprotective therapy. Results. By comparing ABI values preoperatively and postoperatively on patients and models and in relation to risk factors therapy and the site of occlusion no statistically significant differences were observed. Conclusion. On the preoperative MSKA findings using the FEA method a postoperative angiographic model can be created on which arterial pressures and expected postoperative ABI can be calculated.

Periferna arterijska okluzivna bolest, femoro-distalni „bypass“, „ankle-brachial indeks“, analiza konačnih elemenata

Peripheral arterial occlusive disease, femoro-distal "by-pass", "ankle-brachial index", finite element analysis

616-089(043.3)

Hirurgija

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