Computational tools for clinical support: a multi-scale compliant model for haemodynamic simulations in an aortic dissection based on multi-modal imaging data

TLDR

Aortic dissection is a vascular disease with high morbidity and mortality, and while computational fluid dynamics can illuminate its progression, oversimplified models and high computational cost limit its clinical utility. The study aims to overcome these limitations by developing a patient‑specific CFD multi‑scale model that couples Windkessel boundary conditions with wall compliance to investigate aortic dissection. This model incorporates a moving‑boundary algorithm to capture wall displacement, is calibrated and validated against a rich in‑vivo clinical dataset, and uses patient‑specific geometry and boundary conditions. Comparisons with in‑vivo data show the model accurately reproduces flow and pressure waves, predicts false‑lumen pressure, identifies low and oscillatory wall shear stress and elevated diastolic pressures that may signal expansion risk, and demonstrates a simple, computationally efficient CFD approach that advances clinical support for aortic dissection.

Abstract

Aortic dissection (AD) is a vascular condition with high morbidity and mortality rates. Computational fluid dynamics (CFD) can provide insight into the progression of AD and aid clinical decisions; however, oversimplified modelling assumptions and high computational cost compromise the accuracy of the information and impede clinical translation. To overcome these limitations, a patient-specific CFD multi-scale approach coupled to Windkessel boundary conditions and accounting for wall compliance was developed and used to study a patient with AD. A new moving boundary algorithm was implemented to capture wall displacement and a rich in vivo clinical dataset was used to tune model parameters and for validation. Comparisons between in silico and in vivo data showed that this approach successfully captures flow and pressure waves for the patient-specific AD and is able to predict the pressure in the false lumen (FL), a critical variable for the clinical management of the condition. Results showed regions of low and oscillatory wall shear stress which, together with higher diastolic pressures predicted in the FL, may indicate risk of expansion. This study, at the interface of engineering and medicine, demonstrates a relatively simple and computationally efficient approach to account for arterial deformation and wave propagation phenomena in a three-dimensional model of AD, representing a step forward in the use of CFD as a potential tool for AD management and clinical support.