Impact of stent graft geometry on hemodynamics in superior mesenteric artery reconstruction after fenestrated/branched endovascular aneurysm repair.

Authors

ShuTing Gao, TianMing Huang, MengQiang Hu, BingJing Chen, XiaoYu Qi, YuanMing Luo, YiQing Li, Chao Yang

Published in

Frontiers in bioengineering and biotechnology. Volume 14. Pages 1901373. Epub Sep 15, 2026.

Abstract

During visceral artery reconstruction in fenestrated/branched endovascular aneurysm repair (F/B-EVAR), the superior mesenteric artery (SMA) plays a critical role in intestinal perfusion and often exhibits complex postoperative geometry. In this study, we employed computational fluid dynamics (CFD) with virtual modeling to simulate various SMA reconstruction strategies and systematically evaluate the impact of postoperative geometric configurations on SMA hemodynamics.
Virtual parametric models representing 12 postoperative geometric configurations were artificially reconstructed from CTA images. Proximal parameters of the superior mesenteric artery stent, including the stent graft inflow angle (θ) and intraluminal length-to-aortic diameter ratio (L/D), as well as the distal parameter, the outlet angle (α), were defined to differentiate these 12 configurations. Hemodynamic parameters Pressure ratio (the SMA outlet pressure/descending aortic inlet pressure), flow fraction (branch flow/total aortic inflow), and hemodynamic indices, including time-averaged wall shear stress and oscillatory shear index were defined to evaluate hemodynamic differences across the configurations.
PR decreased up to 5.2% for maximum as θ increased. Retrograde configurations (θ > 90°) generated inlet vortices during deceleration, most pronounced at θ = 180°. Variation in L/D did not produce a meaningful change in PR, whereas increasing L/D was associated with a more pronounced local flow disturbance beneath the protruding segment. Vortical structures formed beneath stent segments protruding into the aorta during systole, with vortex size positively correlated with L/D and more pronounced during systolic deceleration. PR values were similar among models with different α configurations. But hemodynamic indices indicated that a larger outlet angle α conferred greater benefits to the endothelial environment. The patient-specific illustrations showed consistency with these findings.
This study elucidates the hemodynamic consequences of varying SMA stent graft configurations during F/B-EVAR and provides biomechanical insights to aid optimal clinical decision-making for SMA stent graft positioning.

PMID:
42812263
Bibliographic data and abstract were imported from PubMed on 30 Sep 2026.

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