{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:57:20Z","timestamp":1792807040265,"version":"4.5.0"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: The aberrant subclavian artery (ASA) represents the most common congenital anomaly of the aortic arch, and is frequently associated with a Kommerell diverticulum, an aneurysmal dilation at the anomalous vessel origin. This condition carries a significant risk of rupture and dissection, and growing evidence indicates that local hemodynamic alterations may contribute to its development and progression. Computational Fluid Dynamics (CFD) provides a valuable non-invasive modality to assess biomechanical stresses and elucidate the pathophysiological mechanisms underlying these vascular abnormalities. Methods: In this study, twelve thoracic CT angiography scans were analyzed: six from patients with ASA and six from individuals with normal aortic anatomy. CFD simulations were performed using OpenFOAM, with standardized boundary conditions applied across all cases to isolate the influence of anatomical differences in flow behavior. Four key hemodynamic metrics were evaluated\u2014Wall Shear Stress (WSS), Oscillatory Shear Index (OSI), Drag Forces (DF), and Turbulent Viscosity Ratio (TVR). The aortic arch was subdivided into Ishimaru zones 0\u20133, with an adapted definition accounting for ASA anatomy. For each region, time- and space-averaged quantities were computed to characterize mean values and oscillatory behavior. Conclusions: The findings demonstrate that patients with ASA exhibit markedly altered hemodynamics in zones 1\u20133 compared to controls, with consistently elevated WSS, OSI, DF, and TVR. The most pronounced abnormalities occurred in zones 2\u20133 near the origin of the aberrant vessel, where disturbed flow patterns and off-axis mechanical forces were observed. These features may promote chronic wall stress, endothelial dysfunction, and localized aneurysmal degeneration. Notably, two patients (M1 and M6) displayed particularly elevated drag forces and TVR in the distal arch, correlating with the presence of a distal aneurysm and right-sided arch configuration, respectively. Overall, this work supports the hypothesis that aberrant hemodynamics contribute to Kommerell diverticulum formation and progression, and highlights the CFD\u2019s feasibility for clarifying disease mechanisms, characterizing flow patterns, and informing endovascular planning by identifying hemodynamically favorable landing zones.<\/jats:p>","DOI":"10.3390\/jpm15120603","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T16:37:02Z","timestamp":1764952622000},"page":"603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hemodynamic Impact of the Aberrant Subclavian Artery: A CFD Investigation"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1054-7718","authenticated-orcid":false,"given":"Edoardo","family":"Ugolini","sequence":"first","affiliation":[{"name":"Industrial Engineering Department, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0586-3791","authenticated-orcid":false,"given":"Giorgio","family":"La Civita","sequence":"additional","affiliation":[{"name":"Independent Researcher, 40127 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2994-449X","authenticated-orcid":false,"given":"Marco","family":"Ferraresi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Alessandro Manzoni Hospital, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2327-8383","authenticated-orcid":false,"given":"Moad","family":"Alaidroos","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Alessandro Manzoni Hospital, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro Carlo Luigi","family":"Molinari","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Alessandro Manzoni Hospital, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Katsarou","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Alessandro Manzoni Hospital, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8991-6805","authenticated-orcid":false,"given":"Giovanni","family":"Rossi","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Alessandro Manzoni Hospital, 23900 Lecco, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3805-8761","authenticated-orcid":false,"given":"Emanuele","family":"Ghedini","sequence":"additional","affiliation":[{"name":"Industrial Engineering Department, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1111\/j.1572-0241.2000.02071.x","article-title":"Dysphagia lusoria: Clinical aspects, manometric findings, diagnosis, and therapy","volume":"95","author":"Janssen","year":"2000","journal-title":"Am. J. Gastroenterol."},{"key":"ref_2","first-page":"312","article-title":"The aberrant left subclavian artery with right-sided aortic arch","volume":"115","author":"Shuford","year":"1972","journal-title":"Am. J. Roentgenol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.avsg.2011.02.012","article-title":"Contemporary management of aberrant right subclavian arteries","volume":"25","author":"Stone","year":"2011","journal-title":"Ann. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/S0003-4975(01)02806-5","article-title":"Vascular anomalies and tracheoesophageal compression: A single institution\u2019s 25-year experience","volume":"72","author":"Woods","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.jtcvs.2013.02.063","article-title":"Hybrid repair of Kommerell diverticulum","volume":"147","author":"Idrees","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.athoracsur.2014.05.045","article-title":"Macgillivray, Contemporary surgical approaches and outcomes in adults with kommerell diverticulum","volume":"98","author":"Kim","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"E442","DOI":"10.1016\/S0735-1097(13)60442-8","article-title":"Kommerell diverticulum should be removed when operating symptomatic children with aberrant right subclavian artery (VAS-CULAR RING)","volume":"61","author":"Fraisse","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"ytaf054","DOI":"10.1093\/ehjcr\/ytaf054","article-title":"Endovascular management of a giant aortic arch aneurysm diverticulum: A case report","volume":"9","author":"Sultan","year":"2025","journal-title":"Eur. Heart. J. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1016\/j.jacc.2018.02.073","article-title":"Local Low Shear Stress and Endothelial Dysfunction in Patients with Nonobstructive Coronary Atherosclerosis","volume":"71","author":"Siasos","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"448","DOI":"10.36660\/abc.20200926","article-title":"Computational Fluid Dynamics to Assess the Future Risk of Ascending Aortic Aneurysms","volume":"118","author":"Almeida","year":"2022","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhou, M., Yu, Y., Chen, R., Liu, X., Hu, Y., Ma, Z., Gao, L., Jian, W., and Wang, L. (2023). Wall shear stress and its role in atherosclerosis. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1083547"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"355","DOI":"10.31083\/j.rcm2412355","article-title":"Systematic Review of the Application of Computational Fluid Dynamics for Adult Aortic Diseases","volume":"24","author":"Song","year":"2023","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.avsg.2021.02.042","article-title":"Drag Forces after Thoracic Endovascular Aortic Repair. General Review of the Literature","volume":"75","author":"Domanin","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/j.neuroimage.2006.01.015","article-title":"User-guided 3D active contour segmentation of anatomical structures: Significantly improved efficiency and reliability","volume":"31","author":"Yushkevich","year":"2006","journal-title":"NeuroImage"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.jvs.2019.11.052","article-title":"Long-term results of hybrid repair techniques for Kommerell\u2019s diverticulum","volume":"72","author":"Tinelli","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Menter, F.R. (1993, January 6\u20139). Zonal two equation \u03ba-\u03c9 turbulence models for aerodynamic flows. Proceedings of the AIAA 23rd Fluid Dynamics, Plasmadynamics, and Lasers Conference, Orlando, FL, USA.","DOI":"10.2514\/6.1993-2906"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"H663","DOI":"10.1152\/ajpheart.00175.2015","article-title":"A database of virtual healthy subjects to assess the accuracy of foot-to-foot pulse wave velocities for estimation of aortic stiffness","volume":"309","author":"Willemet","year":"2015","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Ene-Iordache, B. (2025). Descriptors of Flow in Computational Hemodynamics. Fluids, 10.","DOI":"10.3390\/fluids10080191"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cheng, H., Zhong, W., Wang, L., Zhang, Q., Ma, X., Wang, Y., Wang, S., He, C., Wei, Q., and Fu, C. (2023). Effects of shear stress on vascular endothelial functions in atherosclerosis and potential therapeutic approaches. Biomed. Pharmacother., 158.","DOI":"10.1016\/j.biopha.2022.114198"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1038\/s41569-023-00883-1","article-title":"Flow-induced reprogramming of endothelial cells in atherosclerosis","volume":"20","author":"Tamargo","year":"2023","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.compfluid.2016.04.025","article-title":"A patient-specific follow up study of the impact of thoracic endovascular repair (TEVAR) on aortic anatomy and on post-operative hemodynamics","volume":"141","author":"Gallo","year":"2016","journal-title":"Comput. Fluids"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/ehjci\/jead283","article-title":"Oscillatory shear stress is elevated in patients with bicuspid aortic valve and aortic regurgitation: A 4D flow cardiovascular magnetic resonance cross-sectional study","volume":"25","author":"Trenti","year":"2024","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"235","DOI":"10.2463\/mrms.mp.2019-0188","article-title":"Abnormal Flow Dynamics Result in Low Wall Shear Stress and High Oscillatory Shear Index in Abdominal Aortic Dilatation: Initial in vivo Assessment with 4D-flow MRI","volume":"19","author":"Takehara","year":"2020","journal-title":"Magn. Reson. Med. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Moerman, A.M., Korteland, S., Dilba, K., van Gaalen, K., Poot, D.H.J., van Der Lugt, A., Verhagen, H.J.M., Wentzel, J.J., van Der Steen, A.F.W., and Gijsen, F.J.H. (2022). The Correlation Between Wall Shear Stress and Plaque Composition in Advanced Human Carotid Atherosclerosis. Front. Bioeng. Biotechnol., 9.","DOI":"10.3389\/fbioe.2021.828577"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.jcp.2015.11.022","article-title":"Computational modeling of cardiac hemodynamics: Current status and future outlook","volume":"305","author":"Mittal","year":"2016","journal-title":"J. Comput. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez, A., Hoeijmakers, M., Geronzi, L., Morgenthaler, V., Tomasi, J., Rochette, M., and Biancolini, M.E. (2023). Effect of turbulence and viscosity models on wall shear stress derived biomarkers for aorta simulations. Comput. Biol. Med., 167.","DOI":"10.1016\/j.compbiomed.2023.107603"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hu, M., Chen, B., and Luo, Y. (2025). Computational fluid dynamics modelling of hemodynamics in aortic aneurysm and dissection: A review. Front. Bioeng. Biotechnol., 13.","DOI":"10.3389\/fbioe.2025.1556091"},{"key":"ref_28","unstructured":"Wilcox, D.C. (2006). Turbulence Modeling for CFD, DCW Industries. [3rd ed.]."},{"key":"ref_29","first-page":"527","article-title":"Hybrid Treatment of Aortic Arch Disease","volume":"29","author":"Metzger","year":"2014","journal-title":"Rev. Bras. Cir. Cardiovasc."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ahrens, J., Geveci, B., and Law, C. (2005). ParaView: An End-User Tool for Large Data Visualization. Visualization Handbook, Elsevier.","DOI":"10.1016\/B978-012387582-2\/50038-1"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s10237-010-0238-2","article-title":"Mechanistic insight into the physiological relevance of helical blood flow in the human aorta: An in vivo study","volume":"10","author":"Morbiducci","year":"2010","journal-title":"Biomech. Model. Mechanobiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1152\/physrev.00047.2009","article-title":"Effects of disturbed flow on vascular endothelium: Pathophysiological basis and clinical perspectives","volume":"91","author":"Chiu","year":"2011","journal-title":"Physiol. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/ncpcardio1397","article-title":"Hemodynamic shear stress and the endothelium in cardiovascular pathophysiology","volume":"6","author":"Davies","year":"2009","journal-title":"Nat. Clin. Pract. Cardiovasc. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1148\/radiol.09091437","article-title":"Higgins, Bicuspid aortic valve: Four-dimensional MR evaluation of ascending aortic systolic flow patterns","volume":"255","author":"Hope","year":"2010","journal-title":"Radiology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"14787","DOI":"10.1007\/s13369-024-08810-3","article-title":"Investigation of Rupture Risk of Thoracic Aortic Aneurysms via Fluid\u2013Structure Inter-action and Artificial Intelligence Method","volume":"49","author":"Koru","year":"2024","journal-title":"Arab. J. Sci. Eng."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Duronio, F., and Di Mascio, A. (2023). Blood Flow Simulation of Aneurysmatic and Normal Thoracic Aorta Using OpenFOAM CFD Software. Fluids, 8.","DOI":"10.3390\/fluids8100272"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Ugolini, E., La Civita, G., Al Aidroos, M., Salti, S., Lisanti, G., Ghedini, E., Faggioli, G., Gargiulo, M., and Rossi, G. (2025). Validation of Replicable Pipeline 3D Surface Reconstruction for Patient-Specific Abdominal Aortic Lumen Diagnostics. BioMed, 5.","DOI":"10.3390\/biomed5020009"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/12\/603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T16:56:13Z","timestamp":1764953773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/12\/603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":37,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jpm15120603"],"URL":"https:\/\/doi.org\/10.3390\/jpm15120603","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}