{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:09:15Z","timestamp":1784113755211,"version":"3.55.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Fenestrated and branched endovascular aneurysm repair can be complicated by branch vessel occlusion in the absence of structural stenosis. We hypothesized that computational flow simulation could identify adverse hemodynamic features associated with postfenestrated and branched endovascular aneurysm repair branch occlusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Patients undergoing 4\u2010vessel fenestrated and branched endovascular aneurysm repair for Extent II to IV thoracoabdominal aortic aneurysms were retrospectively reviewed. Branches that occluded without identifiable kinking or stenosis on computed tomography were included, along with an equal cohort of anatomy\u2010matched patent controls. Patient\u2010specific pulsatile rigid\u2010wall simulations were performed using SimVascular with individualized geometries and boundary conditions. Abnormal time\u2010averaged wall shear stress (TAWSS) was defined as &lt;10 or &gt;70 dynes\/cm\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Nine patients (36 target vessels) experienced 10 branch occlusions. Postoperative pressure and flow did not differ significantly between occluded and patent renal or mesenteric branches. However, occluded renal and mesenteric branches demonstrated significantly larger postoperative areas of abnormal TAWSS compared with controls (renal: 14.5% versus 5.9%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.003; mesenteric: 17.7% versus 9.9%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.035). Logistic generalized estimating equation modeling showed abnormal TAWSS to be a significant predictor of renal branch occlusion (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.0085). Model estimates suggested occlusion probabilities of 1.1%, 31%, and 94% at 0%, 10%, and 20% abnormal TAWSS surface area, respectively. A cluster\u2010bootstrapped receiver operating characteristic curve (area under the curve, 0.876) identified a &gt;10.2% threshold that correctly classified 92% of renal occlusions. Abnormal TAWSS frequently localized to distal stent\u2013artery interfaces.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Elevated abnormal TAWSS within stented renal branches is associated with subsequent branch occlusion after fenestrated and branched endovascular aneurysm repair. Computational flow simulation\u2010derived TAWSS thresholds may help identify high\u2010risk branches before failure, warranting prospective validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044790","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T10:15:15Z","timestamp":1769768115000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Patient\u2010Specific Computational Flow Simulation Reveals Adverse Hemodynamic Factors Associated With Occlusion of Directional Branches After Fenestrated\u2010Branched Endovascular Aneurysm Repair"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5121-1735","authenticated-orcid":false,"given":"Kenneth","family":"Tran","sequence":"first","affiliation":[{"name":"Stanford University","place":["Stanford, USA"]},{"name":"Stanford University","place":["Stanford, USA"]},{"name":"Stanford University","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4755-2596","authenticated-orcid":false,"given":"Jesse","family":"Chait","sequence":"additional","affiliation":[{"name":"Mayo Clinic","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9128-6256","authenticated-orcid":false,"given":"Emmanuel","family":"Tenorio","sequence":"additional","affiliation":[{"name":"UT Health Sciences at Houston","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiguang","family":"Yang","sequence":"additional","affiliation":[{"name":"University of Texas Rio Grande Valley","place":["Edinburg, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-171X","authenticated-orcid":false,"given":"Alison","family":"Marsden","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Stanford, USA"]},{"name":"Stanford University","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernardo","family":"Mendes","sequence":"additional","affiliation":[{"name":"University of California Los Angeles","place":["Los Angeles, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason T.","family":"Lee","sequence":"additional","affiliation":[{"name":"Stanford University","place":["Stanford, USA"]},{"name":"Stanford University","place":["Stanford, USA"]},{"name":"Stanford University","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-7514","authenticated-orcid":false,"given":"Gustavo S.","family":"Oderich","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine","place":["Houston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.09.046"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2015.12.014"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.068234"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2012.09.071"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.12.036"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.bioeng.10.061807.160521"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000000499"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-018-00393-z"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ppedcard.2010.09.002"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.04.421"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1526602815587261"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/1526602816651425"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2023.07.050"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvssci.2023.100183"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2015.01.040"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/1526602817731096"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2018.04.074"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000612"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-010-0004-8"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2020.04.317"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-008-0359-2"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1088\/0143-0815\/10\/3\/001"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1114\/1.1511239"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.21.2035"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.654412"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.044790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T10:54:37Z","timestamp":1784112877000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.044790"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,2,3]]}},"alternative-id":["10.1161\/JAHA.125.044790"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.044790","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]},"assertion":[{"value":"2025-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e044790"}}