Evaluation of aortic arch aneurysms treated with the streamliner multilayer flow modulator

BACKGROUND: The aim of this study was to experimentally assess the preoperative and postoperative hemodynamic flow patterns in six complex aortic arch aneurysm cases treated with the streamliner multilayer flow modulator (SMFM) device and examine what effect the SMFM has on aortic branch patency. METHODS: Six arch aneurysm were included. Six patient specific flexible models were produced to assess hemodynamic flow patterns pre and post-SMFM within a custom-built flow simulator. The following experimental assessments were conducted 1) comparison of pre and postoperative analysis in cases (cases F1, F3 and S1) treated with one SMFM; 2) comparison of preoperative and postoperative analysis in cases (cases F2, S2 and S3) treated with two SMFM; and 3) examine the effect of SMFM on pressure and blood flow rate through the supra-aortic vessels. RESULTS: Improved blood flow was observed in cases F1 and S1 with one SMFM and in case S3 treated with 2 SMFMs. Cases F2 and S2 treated with 2 SMFMs showed increased recirculation with disorganized blood flow at the wall of the aneurysm sac pre and postoperative. Type IIIb endoleak was observed in case F2 treated with 2 SMFMs and disorganized mosaic flow pattern in the aneurysm sac. Treatment with 1 and 2 SMFMs improved blood flow rate through the branching vessels and preserved systolic pressure within normal physiological conditions within the supra-aortic vessels in all six cases. CONCLUSIONS: Treatment of aortic arch aneurysms incorporating major branching vessels using the SMFM device has the potential of altering the sac hemodynamic without compromising branching vessels.