Objective To explore the flow within the aortic arch and its supra-arch branches after fenestrated thoracic endovascular aortic repair (F-TEVAR) for the revascularization of the left subclavian artery by computational fluid dynamic.

Methods Totally, 10 patients at Zhongshan Hospital, Fudan University undergoing F-TEVAR for left subclavian artery revascularization between November 2016 and May 2019 were included. An individualized three-dimensional geometric model of the aorta was established based on the postoperative follow-up image data of patients undergoing thoracic aortic endovascular repair combined with fenestration technology. Numerical simulation was performed on the three-dimensional model of the aorta using computational software to evaluate the effects of fenestration on the hemodynamics of the aortic arch and supra-arch branches.

Results Primary procedural success was obtained in 9/10 patients. There were no serious complications and no surgery-related deaths. There was no target vessel loss or death during the follow-up. High-speed blood flow was observed in the fenestrated stents during systole and diastole. The velocity distribution in the aortic arches around the intragraft portions of the fenestrated stents was less uniform. Flow acceleration was observed between the fenestrated stents and the aortic stent-grafts, and the oscillatory shear index increased in this region. The blood flow of the supra-aortic branches was redistributed after F-TEVAR, with a significantly higher flow distribution rate for the right brachiocephalic artery than the left.

Conclusions Fenestration can effectively reconstruct the left subclavian artery in endovascular repair of the aorta, but it also affects blood flow in the aortic arch and supra-arch branches. Results of the current study may aid future modifications of operative methods and stent design.