Medical treatment has, however, been associated with frequent incidences of organ malperfusion, as a result of extension of the dissection, expansion of the aneurysm, and compression of the adjacent structures .Surgical intervention is indicated in most patients with ascending aorta (type A) dissections , as well as in some patients with descending aortic (type B) dissection who show rapid expansion of a dissecting aneurysm, blood leakage, impending rupture, persistent and uncontrollable pain despite medical therapy, recurrent and/or refractory pain, and/or impairment of blood flow to an organ or limb [8, 36, 39–41].Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression.Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics.These involve computed tomography (CT) (61% usage), transoesophageal echocardiography (TEE) (33% usage), aortography (4% usage), and magnetic resonance imaging (2% usage) [6, 10].CT and TEE are normally used at the initial investigation of suspected acute dissection [2, 4, 11, 12].
Special emphasis is placed on factors causing initiation and progression of aortic dissection and effectiveness of the different therapeutic approaches, particularly stent graft treatment.
Aortic dissection may lead to serious complications, including aortic rupture, myocardial ischemia, aortic regurgitation, cardiac tamponade, hypotension/shock, end organ ischemia, and death .
Hypotension or shock generally indicates a rupture or impending rupture of the aorta in type B aortic dissection, and this normally occurs in the elderly patients .
CT provides information about the extent of aortic involvement [2, 10, 11], while TEE has the advantages of defining the mechanism of aortic regurgitation, visualizing the coronary ostia, and ascertaining the function of the left and right heart.
Apart from the various imaging modalities, biomarkers such as elastin fragments , D-dimers [2, 13], and smooth muscle myosin heavy-chain protein have also started to attract wide interest.
This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment.