How Does the Multilayer Flow Modulator Work? The Science behind the Technical Innovation

• Published in: Journal of endovascular therapy 2014-12, Vol.21 (6), p.814-821
• Main Authors: Sultan, Sherif, Hynes, Niamh, Kavanagh, Edel P., Diethrich, Edward B.
• Format: Article
• Language: English
• Subjects: Abdomen; Aneurysms; Aorta, Abdominal - physiopathology; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - diagnosis; Aortic Rupture - physiopathology; Aortic Rupture - surgery; Biomechanical Phenomena; Biomechanics; Blood clots; Blood Flow Velocity; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation - instrumentation; Computer-Aided Design; Diffusion of Innovation; Einstein, Albert (1879-1955); Endothelium; Geometry; Humans; Models, Cardiovascular; Prosthesis Design; Regional Blood Flow; Shear stress; Smooth muscle; Stress, Mechanical; Treatment Outcome; Vortices
• ISSN: 1526-6028; 1545-1550
• DOI: 10.1583/14-4858.1

[...]aneurysms with diameters more than double the cutoff value remain intact prior to elective repair, while on the other hand, up to 23% of aortic aneurysms have been reported to rupture at diameters below 5 cm.1-6 These inconsistencies lead one to believe that a 2-dimensional (2D) marker such as diameter may be too basic a measure and really only of historic relevance. [...]the rupture potential is highest where the ratio of peak wall stress to peak wall strength is higher. [...]the maximum diameter criterion to predict rupture risk ignores the important roles of vessel wall topography, geometry, wall stiffness, intraluminal thrombus thickness, calcification, iliac bifurcation angle, rate of aneurysm growth, and peak wall WHY ANEURYSMS EXPAND AND RUPTURE The pathophysiology of aneurysmal disease is characterized by thinning of the aortic media resulting from proteolytic injury to the extracellular matrix and to smooth muscle cell senescence and apoptosis, allowing further proteolytic injury leading to dilation and rupture.27-33 Aneurysms of the aortic root and ascending aorta are most commonly related to cystic medial degeneration.