Determinants of Hemodynamic Risk in Type II Endoleak: A CFD Study on Inferior Mesenteric and Lumbar Arteries

Determinants of Hemodynamic Risk in Type II Endoleak: A CFD Study on Inferior Mesenteric and Lumbar Arteries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Hemodynamic Risk in Type II Endoleak: A CFD Study on Inferior Mesenteric and Lumbar Arteries Xiao Mo, Yanxia Wang, Kaixiong Qing, Feng Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7446843/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Mar, 2026 Read the published version in Biomechanics and Modeling in Mechanobiology → Version 1 posted 11 You are reading this latest preprint version Abstract Background Type II endoleak (T2EL), the most common complication after endovascular aortic aneurysm repair (EVAR), remains a leading cause of reintervention due to persistent retrograde flow from patent inferior mesenteric artery (IMA) and lumbar arteries (LAs). The influence of specific anatomical features of these vessels on the hemodynamic environment remains poorly understood. Methods This study evaluated two key anatomical characteristics: branch vessel count and luminal diameter. Thirteen patient-specific post-EVAR models were constructed. Computational fluid dynamics (CFD) simulations were performed to quantify key hemodynamic parameters, including flow velocity, pressure, wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT). Results A patent IMA has the greatest impact on intrasac pressure. Increased LA numbers predominantly alter flow field patterns and shear stress distribution, while larger vessel diameters significantly affect flow rate, WSS directionality, and intra-sac blood residence time. Enlarged IMA diameter combined with multiple patent LAs expanded retrograde flow regions and created high-shear-stress environments that inhibited thrombus formation, promoting T2EL persistence and sac expansion. A risk-stratified embolization strategy was proposed: high-risk patients (IMA ≥ 2.5 mm with ≥ 2 patent LAs) should undergo embolization of IMA and LAs ≥ 2 mm; intermediate-risk (IMA 2.0–2.5 mm or ≤ 1 LA) receive IMA embolization; low-risk patients (IMA < 2.0 mm with ≤ 1 LA) require regular follow-up. Conclusion This study provides the first quantitative analysis of the hemodynamic effects of IMA/LA patency, vessel number, and diameter, establishing a biomechanical framework for individualized T2EL risk stratification and management. EVAR Type II endoleak Hemodynamics Computational fluid dynamics Inferior mesenteric artery Lumbar arteries Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Mar, 2026 Read the published version in Biomechanics and Modeling in Mechanobiology → Version 1 posted Editorial decision: Revision requested 11 Nov, 2025 Reviews received at journal 08 Nov, 2025 Reviews received at journal 06 Nov, 2025 Reviews received at journal 05 Nov, 2025 Reviewers agreed at journal 16 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviewers invited by journal 14 Oct, 2025 Editor assigned by journal 31 Aug, 2025 Submission checks completed at journal 30 Aug, 2025 First submitted to journal 24 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7446843","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":534485800,"identity":"9eb8b80a-3de7-4051-886c-702f531074e7","order_by":0,"name":"Xiao Mo","email":"","orcid":"","institution":"Kunming University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Mo","suffix":""},{"id":534485801,"identity":"693bc76e-5432-4432-81bc-00a2701c2232","order_by":1,"name":"Yanxia Wang","email":"","orcid":"","institution":"Kunming University of Science and 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Arteries","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"biomechanics-and-modeling-in-mechanobiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmmb","sideBox":"Learn more about [Biomechanics and Modeling in Mechanobiology](http://link.springer.com/journal/10237)","snPcode":"10237","submissionUrl":"https://submission.nature.com/new-submission/10237/3","title":"Biomechanics and Modeling in Mechanobiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"EVAR, Type II endoleak, Hemodynamics, Computational fluid dynamics, Inferior mesenteric artery, Lumbar arteries","lastPublishedDoi":"10.21203/rs.3.rs-7446843/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7446843/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eType II endoleak (T2EL), the most common complication after endovascular aortic aneurysm repair (EVAR), remains a leading cause of reintervention due to persistent retrograde flow from patent inferior mesenteric artery (IMA) and lumbar arteries (LAs). The influence of specific anatomical features of these vessels on the hemodynamic environment remains poorly understood.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study evaluated two key anatomical characteristics: branch vessel count and luminal diameter. Thirteen patient-specific post-EVAR models were constructed. Computational fluid dynamics (CFD) simulations were performed to quantify key hemodynamic parameters, including flow velocity, pressure, wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA patent IMA has the greatest impact on intrasac pressure. Increased LA numbers predominantly alter flow field patterns and shear stress distribution, while larger vessel diameters significantly affect flow rate, WSS directionality, and intra-sac blood residence time. Enlarged IMA diameter combined with multiple patent LAs expanded retrograde flow regions and created high-shear-stress environments that inhibited thrombus formation, promoting T2EL persistence and sac expansion. A risk-stratified embolization strategy was proposed: high-risk patients (IMA\u0026thinsp;\u0026ge;\u0026thinsp;2.5 mm with \u0026ge;\u0026thinsp;2 patent LAs) should undergo embolization of IMA and LAs\u0026thinsp;\u0026ge;\u0026thinsp;2 mm; intermediate-risk (IMA 2.0\u0026ndash;2.5 mm or \u0026le;\u0026thinsp;1 LA) receive IMA embolization; low-risk patients (IMA\u0026thinsp;\u0026lt;\u0026thinsp;2.0 mm with \u0026le;\u0026thinsp;1 LA) require regular follow-up.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study provides the first quantitative analysis of the hemodynamic effects of IMA/LA patency, vessel number, and diameter, establishing a biomechanical framework for individualized T2EL risk stratification and management.\u003c/p\u003e","manuscriptTitle":"Determinants of Hemodynamic Risk in Type II Endoleak: A CFD Study on Inferior Mesenteric and Lumbar Arteries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-28 15:10:11","doi":"10.21203/rs.3.rs-7446843/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-11T19:37:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-08T09:52:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T16:50:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-05T23:20:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315979880546827294703936505234056020955","date":"2025-10-16T09:24:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250644160841293220010381074583627430113","date":"2025-10-15T11:21:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"172634699537626841606662948801979543320","date":"2025-10-14T12:07:03+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-14T11:57:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-31T04:03:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-30T09:31:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Biomechanics and Modeling in Mechanobiology","date":"2025-08-24T14:31:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"biomechanics-and-modeling-in-mechanobiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmmb","sideBox":"Learn more about [Biomechanics and Modeling in Mechanobiology](http://link.springer.com/journal/10237)","snPcode":"10237","submissionUrl":"https://submission.nature.com/new-submission/10237/3","title":"Biomechanics and Modeling in Mechanobiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a6e14629-c3ce-4ea1-8613-aea2b4d2ef2c","owner":[],"postedDate":"October 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:06:38+00:00","versionOfRecord":{"articleIdentity":"rs-7446843","link":"https://doi.org/10.1007/s10237-026-02043-z","journal":{"identity":"biomechanics-and-modeling-in-mechanobiology","isVorOnly":false,"title":"Biomechanics and Modeling in Mechanobiology"},"publishedOn":"2026-03-05 15:58:09","publishedOnDateReadable":"March 5th, 2026"},"versionCreatedAt":"2025-10-28 15:10:11","video":"","vorDoi":"10.1007/s10237-026-02043-z","vorDoiUrl":"https://doi.org/10.1007/s10237-026-02043-z","workflowStages":[]},"version":"v1","identity":"rs-7446843","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7446843","identity":"rs-7446843","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}