{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:04:48Z","timestamp":1777633488298,"version":"3.51.4"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      This exploratory study aimed to utilize patient-specific computational fluid dynamics (CFD) simulations to evaluate and compare the hemodynamic effects of different fenestration stent configurations following\n                      <jats:italic>in situ<\/jats:italic>\n                      fenestration thoracic endovascular aortic repair (ISF-TEVAR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six patient-specific aortic models (pre- and postoperative) were reconstructed from CTA images of three ISF-TEVAR patients with distinct fenestration stent configurations. The hemodynamic parameters of the aortic arch and its main branches (including pressure, flow velocity, flow volume, and vascular wall shear stress (WSS)) were systematically analyzed to evaluate the effects of the stent configuration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Marked increases in pressure drop and WSS were observed in the left subclavian artery (LSA) in cases with higher stent compression. Compared to forward-leaning stent orientation, a near-perpendicular insertion was associated with more pronounced complex and disordered flow patterns around the fenestration site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this small case series, different fenestration stent configurations significantly influenced local hemodynamics, particularly in the LSA. Minimizing stent compression and, where anatomically feasible, adopting a forward-leaning orientation may help reduce adverse hemodynamic effects. These preliminary findings highlight the potential utility of patient-specific CFD simulation in preoperative planning for ISF-TEVAR, though further studies with larger cohorts are needed to validate these observations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1824395","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:38:44Z","timestamp":1777437524000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamic consequences of TEVAR with different configurations of in-situ fenestration stents: a patient-specific CFD analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Yunpeng","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Ningbo No.2 Hospital, Wenzhou Medical University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Songjie","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ningbo No.2 Hospital, Wenzhou Medical University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Di","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ningbo No.2 Hospital, Wenzhou Medical University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dehai","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ningbo No.2 Hospital, Wenzhou Medical University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiequan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Ningbo No.2 Hospital, Wenzhou Medical University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunbo","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Ningbo No.2 Hospital, Wenzhou Medical University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1136\/heartjnl-2014-306690","article-title":"Aortic disease: thoracic endovascular aortic repair","volume":"101","author":"Bicknell","year":"2015","journal-title":"Heart"},{"key":"B2","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1177\/152660280701400420","article-title":"Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR)","volume":"14","author":"Feezor","year":"2007","journal-title":"J Endovasc Ther"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1016\/j.jvs.2016.10.111","article-title":"Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases","volume":"65","author":"Bradshaw","year":"2017","journal-title":"J Vasc Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"55s","DOI":"10.1016\/j.jvs.2020.05.076","article-title":"Society for vascular surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms","volume":"73","author":"Upchurch","year":"2021","journal-title":"J Vasc Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/j.jtcvs.2021.11.091","article-title":"The society of thoracic surgeons\/American association for thoracic surgery clinical practice guidelines on the management of type B aortic dissection","volume":"163","author":"MacGillivray","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.ejvs.2015.11.014","article-title":"Laser Generated in situ fenestrations in dacron stent grafts","volume":"51","author":"Sonesson","year":"2016","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.athoracsur.2015.07.032","article-title":"Endovascular total arch repair Using in situ fenestration for arch aneurysm and chronic type A dissection","volume":"101","author":"Katada","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.ejvs.2018.09.016","article-title":"Editor\u2019s choice - current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European association for cardio-thoracic surgery (EACTS) & the European society for vascular surgery (ESVS)","volume":"57","author":"Czerny","year":"2019","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e004542","DOI":"10.1161\/jaha.116.004542","article-title":"In situ Laser fenestration is a feasible method for revascularization of aortic arch during thoracic endovascular aortic repair","volume":"6","author":"Qin","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.ejvs.2015.12.002","article-title":"Editor\u2019s choice - subsequent results for arch aneurysm repair with inner branched endografts","volume":"51","author":"Spear","year":"2016","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1016\/j.jvs.2022.02.031","article-title":"A systematic review and meta-analysis of stroke rates in patients undergoing thoracic endovascular aortic repair for descending thoracic aortic aneurysm and type B dissection","volume":"76","author":"Karaolanis","year":"2022","journal-title":"J Vasc Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1093\/ejcts\/ezy068","article-title":"A computational analysis of different endograft designs for zone 0 aortic arch repair","volume":"54","author":"van Bakel","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ijcard.2016.02.099","article-title":"A systematic review of computational fluid dynamics in type B aortic dissection","volume":"210","author":"Sun","year":"2016","journal-title":"Int J Cardiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.3390\/app8081309","article-title":"Computational fluid dynamic accuracy in mimicking changes in blood hemodynamics in patients with acute type IIIb aortic dissection treated with TEVAR","volume":"8","author":"Polanczyk","year":"2018","journal-title":"Appl Sci"},{"key":"B15","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1016\/j.compfluid.2018.06.002","article-title":"A novel computational framework to predict patient-specific hemodynamics after TEVAR: integration of structural and fluid-dynamics analysis by image elaboration","volume":"179","author":"Romarowski","year":"2019","journal-title":"Comput Fluids"},{"key":"B16","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1177\/1526602815587261","article-title":"Comparison of blood flow in branched and fenestrated stent-grafts for endovascular repair of abdominal aortic aneurysms","volume":"22","author":"Kandail","year":"2015","journal-title":"J Endovasc Ther"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2153","DOI":"10.1007\/s10439-009-9760-8","article-title":"On coupling a lumped parameter heart model and a three-dimensional finite element aorta model","volume":"37","author":"Kim","year":"2009","journal-title":"Ann Biomed Eng"},{"key":"B18","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/j.jbiomech.2003.09.016","article-title":"Non-Newtonian blood flow in human right coronary arteries: steady state simulations","volume":"37","author":"Johnston","year":"2004","journal-title":"J Biomech"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1016\/j.medengphy.2011.12.001","article-title":"Bone remodelling analysis of the humerus after a shoulder arthroplasty","volume":"34","author":"Quental","year":"2012","journal-title":"Med Eng Phys"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1016\/j.jbiomech.2011.01.016","article-title":"Design and validation of surface-marker clusters for the quantification of joint rotations in general movements in early infancy","volume":"44","author":"Berthouze","year":"2011","journal-title":"J Biomech"},{"key":"B21","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/0021-9290(69)90024-4","article-title":"Analog studies of the human systemic arterial tree","volume":"2","author":"Westerhof","year":"1969","journal-title":"J Biomech"},{"key":"B22","doi-asserted-by":"publisher","first-page":"20160073","DOI":"10.1098\/rsif.2016.0073","article-title":"On the impact of modelling assumptions in multi-scale, subject-specific models of aortic haemodynamics","volume":"13","author":"Alastruey","year":"2016","journal-title":"J R Soc Interface"},{"key":"B23","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.jmbbm.2012.04.021","article-title":"Virtual evaluation of stent graft deployment: a validated modeling and simulation study","volume":"13","author":"De Bock","year":"2012","journal-title":"J Mech Behav Biomed Mater"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1016\/j.athoracsur.2015.10.112","article-title":"European Multicenter registry for the performance of the chimney\/snorkel technique in the treatment of aortic arch pathologic conditions","volume":"101","author":"Bosiers","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"17085381231192376","DOI":"10.1177\/17085381231192376","article-title":"Early and midterm outcomes of in situ fenestration via adjustable puncture needle for ankura aortic stent graft: a single-center experience","volume":"32","author":"Yu","year":"2023","journal-title":"Vascular"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1903","DOI":"10.1182\/blood-2006-04-011551","article-title":"Activation-independent platelet adhesion and aggregation under elevated shear stress","volume":"108","author":"Ruggeri","year":"2006","journal-title":"Blood"},{"key":"B27","doi-asserted-by":"publisher","first-page":"3537","DOI":"10.1182\/blood-2005-02-0618","article-title":"Mechanism of platelet adhesion to von willebrand factor and microparticle formation under high shear stress","volume":"107","author":"Reininger","year":"2006","journal-title":"Blood"},{"key":"B28","doi-asserted-by":"publisher","first-page":"11460","DOI":"10.1038\/s41598-024-62165-1","article-title":"Material strengths of shear-induced platelet aggregation clots and coagulation clots","volume":"14","author":"Kim","year":"2024","journal-title":"Sci Rep"},{"key":"B29","doi-asserted-by":"publisher","first-page":"4800","DOI":"10.3390\/ijms25094800","article-title":"Platelet biorheology and mechanobiology in thrombosis and hemostasis: perspectives from multiscale computation","volume":"25","author":"Tuna","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B30","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1161\/01.res.35.4.608","article-title":"Measured turbulence and its effect on thrombus formation","volume":"35","author":"Stein","year":"1974","journal-title":"Circ Res"},{"key":"B31","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s00109-006-0101-1","article-title":"The impact of blood rheology on the molecular and cellular events underlying arterial thrombosis","volume":"84","author":"Nesbitt","year":"2006","journal-title":"J Mol Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1067\/mva.1988.avs0070261","article-title":"Turbulence occurring after carotid bifurcation endarterectomy: a harbinger of residual and recurrent carotid stenosis","volume":"7","author":"Bandyk","year":"1988","journal-title":"J Vasc Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1824395\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:38:56Z","timestamp":1777437536000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1824395\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":32,"alternative-id":["10.3389\/fcvm.2026.1824395"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1824395","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"article-number":"1824395"}}