REMODELADO AÓRTICO TRAS TEVAR: DETERMINANTES BIOMECÁNICOS DEL ESTRÉS PARIETAL Y LA DISCREPANCIA DE DISTENSIBILIDAD
Aortic Remodeling After TEVAR: Biomechanical Determinants of Wall Stress and Compliance Mismatch
DOI:
https://doi.org/10.47187/cssn.Vol17.Iss1.511Palabras clave:
Aorta, Endoprótesis, Procedimientos endovasculares, HemodinámicaResumen
Introducción: El Thoracic Endovascular Aortic Repair (TEVAR) representa una alternativa mínimamente invasiva a la cirugía convencional, se realiza mediante implante de un endoinjerto vía femoral, permitiendo excluir el flujo sanguíneo sin la necesidad de bypass. Objetivo: Analizar los determinantes biomecánicos del estrés parietal y la discrepancia de distensibilidad asociados al remodelado aórtico tras TEVAR. Metodología: Se realizó una revisión narrativa enfocada en enfermedad aórtica, utilizando bases de datos como PubMed, Scielo, Scopus y Google Académico como buscador complementario. Se identificaron 95 artículos, 75 en inglés y 20 en español de los cuales se incluyeron 41 posterior al cribado y evaluación de elegibilidad. Resultados: La discrepancia de distensibilidad entre el endoinjerto y la aorta nativa, con reducciones de hasta 50% en el segmento cubierto constituyó el principal determinante biomecánico identificado, asociado a alteración del efecto Windkessel, aumento de la velocidad de onda de pulso y sobrecarga ventricular izquierda. Factores geométricos (curvatura del arco, diámetro aórtico) y protésicos (fuerza radial, oversizing, material del dispositivo) determinaron la dimensión de esta discrepancia y el riesgo de remodelado negativo. Discusión: Estos hallazgos sugieren que la alteración del efecto Windkessel constituye un eje fisiopatológico común que integra manifestaciones clínicas previamente descritas de forma independiente, aunque la evidencia disponible proviene mayoritariamente de estudios experimentales y computacionales, limitando la extrapolación clínica directa. Conclusión: La intensidad del estrés parietal y la discrepancia de distensibilidad inducidos por la endoprótesis se asocian a remodelado aórtico negativo, lo que respalda la utilidad de un seguimiento funcional sistemático en pacientes sometidos a TEVAR.
Abstract
Introduction: Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive alternative to conventional open surgery. The procedure involves femoral delivery of an endovascular stent graft to exclude the diseased aortic segment from blood flow without the need for cardiopulmonary bypass. Objective: To analyze the biomechanical determinants of wall stress and compliance mismatch associated with aortic remodeling after TEVAR. Methods: A narrative review of the literature on aortic disease was conducted using PubMed, SciELO, Scopus, and Google Scholar as a supplementary search tool. A total of 95 articles were identified (75 in English and 20 in Spanish), of which 41 met the eligibility criteria and were included in the review. Results: Compliance mismatch between the stent graft and the native aorta, with reductions in vascular compliance of up to 50% in the treated segment, was the main biomechanical determinant identified. This mismatch was associated with impairment of the Windkessel effect, increased pulse wave velocity, and increased left ventricular afterload. Geometric factors (aortic arch curvature and aortic diameter) and device-related factors (radial force, graft oversizing, and stent graft material) influenced the magnitude of compliance mismatch and the risk of adverse aortic remodeling. Discussion: The findings suggest that impairment of the Windkessel effect represents a common pathophysiological mechanism underlying clinical manifestations previously described separately. However, the available evidence is derived mainly from experimental and computational studies, limiting its direct clinical applicability. Conclusion: The degree of wall stress and compliance mismatch induced by the stent graft is associated with adverse aortic remodeling, supporting the need for systematic functional follow-up in patients undergoing TEVAR.
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