Fenestrated endovascular aneurysm repair (FEVAR) is a minimally invasive method of abdominal aortic aneurysm (AAA) repair utilized in patients with complex vessel anatomies. Stent grafts (SG) used in this process contain fenestrations within the device that need to be aligned with the visceral arteries upon successful SG deployment. Proper alignment is crucial to maintain blood flow to these arteries and avoid surgical complications. During fenestrated SG deployment, rotation of the SG can occur during the unsheathing process. This leads to misalignment of the vessels, and the fenestrations and is associated with poor clinical outcomes. The aim of this study was to develop a computational model of the FEVAR process to predict SG rotation. Six patient-specific cases are presented and compared with surgical case data. Realistic material properties, frictional effects, deployment methods, and boundary conditions are included in the model. A mean simulation error of 2 deg (range 1–4 deg) was observed. This model was then used to conduct a parameter study of frictional properties to see if rotation could be minimized. This study showed that increasing or decreasing the coefficients of friction (COF) between the sheath and the vessel walls would decrease the amount of rotation observed. Our model accurately predicts the amount of SG rotation observed during FEVAR and can be used as a preoperative planning tool within the surgical workflow.
Issue Section:
Research Papers
References
1.
Nordon
, I. M.
, Hinchcliffe
, R. J.
, Loftus
, I. M.
, and Thompson
, M. M.
, 2011
, “Pathophysiology and Epidemiology of Abdominal Aortic Aneurysms
,” Nat. Rev. Cardiol.
, 8
(2
), pp. 92
–102
.2.
Kuivanieme
, H.
, Platsoucas
, C. D.
, and Tilson
, M. D.
, 2008
, “Aortic Aneurysms: An Immune Disease With a Strong Genetic Component
,” Circulation
, 117
(2
), pp. 242
–252
.3.
Crawford
, S. A.
, Sanford
, R. M.
, Doyle
, M. G.
, Amon
, C. H.
, and Forbes
, T. L.
, 2016
, “Understanding and Predicting Endovascular Device Rotation
,” J. Vasc. Surg.
, 64
(5
), p. 1547
.4.
Crawford
, S. A.
, Sanford
, R. M.
, Doyle
, M. G.
, Wheatcroft
, M.
, Amon
, C. H.
, and Forbes
, T. L.
, 2018
, “Prediction of Advanced Endovascular Stent Graft Rotation and Its Associated Morbidity and Mortality
,” J. Vasc. Surg.
, in press.5.
Doyle
, M. G.
, Crawford
, S. A.
, Osman
, E.
, Eisenberg
, N.
, Tse
, L. W.
, Amon
, C. H.
, and Forbes
, T. L.
, 2018
, “Analysis of Iliac Artery Geometric Properties in Fenestrated Aortic Stent Graft Rotation
,” Vasc. Endovasc. Surg.
, 52
(3
), pp. 188
–194
.6.
Zhao
, S.
, Gu
, L.
, and Froemming
, S. R.
, 2012
, “Performance of Self-Expanding Nitinol Stent in a Curved Artery: Impact of Stent Length and Deployment Orientation
,” ASME J. Biomech. Eng.
, 134
(7
), p. 071007
.7.
Shek
, T. L.
, Tse
, L. W.
, Nobovati
, A.
, and Amon
, C. H.
, 2012
, “Computational Fluid Dynamics Evaluation of the Cross-Limbed Stent Graft Configuration for Endovascular Aneurysm Repair
,” ASME J. Biomech. Eng.
, 134
(12
), p. 121002
.8.
Li
, Z.
, and Kleinstreuer
, C.
, 2005
, “Fluid-Structure Interaction Effects on Sac-Blood Pressure and Wall Stress in a Stented Aneurysm
,” ASME J. Biomech. Eng.
, 127
(4
), pp. 662
–671
.9.
Xiang
, J.
, Damiano
, R. J.
, Lin
, N.
, Snyder
, K. V.
, Siddiqui
, A. H.
, Levy
, E. I.
, and Meng
, H.
, 2015
, “High-Fidelity Virtual Stenting: Modeling of Flow Diverter Deployment for Hemodynamic Characterization of Complex Intracranial Aneurysms
,” J. Neurosurg.
, 123
(4
), pp. 832
–840
.10.
Babiker
, M. H.
, Chong
, B.
, Gonzalez
, L. F.
, Cheema
, S.
, and Frakes
, D. H.
, 2013
, “Finite Element Modeling of Embolic Coil Deployment: Multifactor Characterization of Treatment Effects on Cerebral Aneurysm Hemodynamics
,” J. Biomech.
, 46
(16
), pp. 2809
–2816
.11.
Roszelle
, B. N.
, Gonzalez
, L. F.
, Babiker
, M. H.
, Ryan
, J.
, Albuquerque
, F. C.
, and Frakes
, D. H.
, 2013
, “Flow Diverter Effect on Cerebral Aneurysm Hemodynamics: An In Vitro Comparison of Telescoping Stents and the Pipeline
,” Neuroradiology
, 55
(6
), pp. 751
–758
.12.
De Bock
, S.
, Iannaccone
, F.
, De Beule
, M.
, Van Loo
, D.
, Devos
, D.
, Vermassen
, F.
, Segers
, P.
, and Verhegghe
, B.
, 2012
, “Virtual Evaluation of Stent Graft Deployment: A Validated Modeling and Simulation Study
,” J. Mech. Behav. Biomed. Mater.
, 13
, pp. 129
–139
.13.
Demanget
, N.
, Duprey
, A.
, Badel
, P.
, Orgeas
, L.
, Avril
, S.
, Geindreau
, C.
, Albertini
, J.-N.
, and Favre
, J. P.
, 2013
, “Finite Element Analysis of the Mechanical Performances of 8 Marketed Aortic Stent-Grafts
,” J. Endovasc. Ther.
, 20
(4
), pp. 523
–535
.14.
Perrin
, D.
, Badel
, P.
, Orgeas
, L.
, Geindreau
, C.
, rolland du Roscoat
, S.
, Albertini
, J.-N.
, and Avril
, S.
, 2016
, “Patient-Specific Simulation of Endovascular Repair Surgery With Tortuous Aneurysms Requiring Flexible Stent-Grafts
,” J. Mech. Behav. Biomed. Mater.
, 63
, pp. 86
–99
.15.
Desender
, L. M.
, Van Herzeele
, I.
, Lachat
, M. L.
, Rancic
, Z.
, Duchateau
, J.
, Rudarakanchana
, N.
, Bicknell
, C. D.
, Heyligers
, J. M. M.
, Teijink
, J. A. W.
, and Vermassen
, F. E.
, 2016
, “Patient Specific Rehearsal before EVAR: Influence on Technical and Nontechnical Operative Performance. A Randomized Controlled Trial
,” Ann. Surg.
, 264
(5
), pp. 703
–709
.16.
Perrin
, D.
, Badel
, P.
, Orgeas
, L.
, Geindreau
, C.
, Dumenil
, A.
, Albertini
, J.-N.
, and Avril
, S.
, 2015
, “Patient Specific Numerical Simulation of Stent-Graft Deployment: Validation on Three Clinical Cases
,” J. Biomech.
, 48
(10
), pp. 1868
–1875
.17.
Roy
, D.
, Holzapfel
, G.
, Kauffman
, C.
, and Soulez
, G.
, 2014
, “Finite Element Analysis of Abdominal Aortic Aneurysms: Geometrical and Structural Reconstruction With Application of an Anisotropic Material Model
,” IMA J. Appl. Math.
, 79
(5
), pp. 1011
–1026
.18.
LSTC
, 2015
, “LS-DYNA Keyword User's Manual
,” Livermore Software Technology Corporation
, Livermore, CA
.19.
Orobix
, 2018, “What is VMTK
,” Orobix, Bergamo, Italy, accessed Mar. 17, 2017 http://www.vmtk.org/what-is-vmtk.html20.
Schulze-Bauer
, C. A.
, Morth
, C.
, and Holzapfel
, G. A.
, 2003
, “Passive Biaxial Mechanical Response of Aged Human Iliac Arteries
,” ASME J. Biomech. Eng.
, 125
(3
), pp. 395
–406
.21.
Sanford
, R. M.
, 2017
, “Computational Simulations of Fenestrated Endovascular Aneurysm Repair
,” M.Sc. thesis
, University of Toronto, Toronto, ON, Canada.https://tspace.library.utoronto.ca/handle/1807/7928922.
Cook Medical
, 2012, “Lunderquist; Extra-Stiff Wire Guide
,” Cook Medical, Bloomington, IN, accessed Apr. 13, 2017, https://www.cookmedical.com/data/resources/AI-BM-LUNDS-EN-201202WEB.pdf23.
Cook Medical
, 2016
, “Zenith Fenestrated Endovascular Graft; Annual Clinical Update
,” Cook Medical
, Bloomington, IN
.24.
Roy
, D.
, Lerouge
, S.
, Inaekyan
, K.
, Kauffman
, C.
, Mongrain
, R.
, and Soulez
, G.
, 2016
, “Experimental Validation of More Realistic Computer Models for Stent-Graft Repair of Abdominal Aortic Aneurysms, Including Pre-Load Assessment
,” Int. J. Numer. Method. Biomed. Eng.
, 32
(12
), p. e02769
.25.
Kamenskiy
, A. V.
, Dzenis
, Y. A.
, Jaffar Kazmi
, S. A.
, Pemberton
, M. A.
, Pipinos
, I. I.
, Phillips
, N. Y.
, Herber
, K.
, Woodford
, T.
, Bowen
, R. E.
, Lomneth
, C. S.
, and MacTaggart
, J. N.
, 2014
, “Biaxial Mechanical Properties of the Human Thoracic and Abdominal Aorta, Common Carotid, Subclavian, Renal, and Common Iliac Arteries
,” Biomech. Model. Mechanobiol.
, 13
(6
), pp. 1341
–1359
.26.
Roy
, D.
, Lerouge
, S.
, Kauffmann
, C.
, Mongrain
, R.
, and Soulez
, G.
, 2014
, “Simulation of a Complete Stent-Graft Deployment in a Patient-Specific Abdominal Aortic Aneurysm
,” Seventh World Congress of Biomechanics
, Boston, MA, July 6–11, p. 376.https://www.researchgate.net/profile/David_Roy11/publication/264167552_Simulation_of_a_complete_stent-graft_deployment_in_a_patient-specific_abdominal_aortic_aneurysm/links/53d0fd010cf2fd75bc5d5897/Simulation-of-a-complete-stent-graft-deployment-in-a-patient-specific-abdominal-aortic-aneurysm.pdf27.
Cook Medical
, 2016
, “Physicians Pocket Reference Guide
,” Cook Medical
, Bloomington, IN
.28.
Doyle
, M. G.
, Lancaster
, M.
, Tse
, L. W.
, Forbes
, T. L.
, and Amon
, C. H.
, 2016
, “Measurement of Aortic Stent Graft Coefficients of Friction
,” Summer Biomechanics, Bioengineering and Biotransport Conference
, National Harbor, MD, June 29–July 2.29.
Vad
, S.
, Eskinazi
, A.
, Corbett
, T.
, McLoughlin
, T.
, and Vande Geest
, J. P.
, 2010
, “Determination of Coefficient of Friction for Self-Expanding Stent-Grafts
,” ASME J. Biomech. Eng.
, 132
(12
), p. 121007
.30.
Sturla
, F.
, Ronzoni
, M.
, Vitali
, M.
, Dimasi
, A.
, Vismara
, R.
, Preston Maher
, G.
, Burriesci
, G.
, Votta
, E.
, and Redaelli
, A.
, 2016
, “Impact of Different Aortic Valve Calcification Patterns on the Outcome of Transcatheter Aortic Valve Implantation: A Finite Element Study
,” J. Biomech.
, 49
(12
), pp. 2520
–2530
.31.
Crawford
, S. A.
, Doyle
, M. G.
, Tse
, L. W.
, and Roche-Nagle
, G.
, 2016
, “In-Stock' Fenestrated Stent Graft for the Urgent Repair of an Abdominal Aortic Aneurysm
,” BMJ Case Rep
.32.
Cronenwett
, J.
, Murphy
, T.
, Zelenock
, G.
, Whitehouse
, W. J.
, Lindenauer
, S.
, Graham
, L.
, Quint
, L.
, Silver
, T.
, and Stanley
, J.
, 1985
, “Actuarial Analysis of Variables Associated With Rupture of Small Abdominal Aortic Aneurysms
,” Surgery
, 98
(3), pp. 472
–483
.http://europepmc.org/abstract/med/389845333.
Holzapfel
, G. A.
, Gasser
, T. C.
, and Ogden
, R. W.
, 2000
, “A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models
,” J. Elast.
, 61
(1–3), pp. 1
–48
.34.
Vande Geest
, J. P.
, Sacks
, M. S.
, and Vorp
, D. A.
, 2006
, “The Effects of Aneurysm on the Biaxial Mechanical Behaviour of Human Abdominal Aorta
,” J. Biomech.
, 39
(7
), pp. 1324
–1334
.35.
Speelman
, L.
, Bohra
, A.
, Bosboom
, E. M. H.
, Schurink
, G. W. H.
, van de Vosse
, F. N.
, Makaroun
, M. S.
, and Vorp
, D. A.
, 2007
, “Effects of Wall Calcifications in Patient-Specific Wall Stress Analyses of Abdominal Aortic Aneurysms
,” ASME J. Biomech. Eng.
, 129
(1
), pp. 105
–109
.36.
Maier
, A.
, Gee
, M.
, Reeps
, C.
, Eckstein
, H.-H.
, and Wall
, W.
, 2010
, “Impact of Calcifications on Patient-Specific Wall Stress Analysis of Abdominal Aortic Aneurysms
,” Biomech. Model. Mechanobiol.
, 9
(5
), pp. 511
–521
.37.
Vande Geest
, J. P.
, Sacks
, M. S.
, and Vorp
, D. A.
, 2006
, “A Planar Biaxial Constitutive Relation for the Luminal Layer of Intra-Luminal Thrombus in Abdominal Aortic Aneurysm
,” J. Biomech.
, 39
(13
), pp. 2347
–2354
.38.
Wang
, D. H.
, Makaroun
, M.
, Webster
, M. W.
, and Vorp
, D. A.
, 2001
, “Mechanical Properties and Microstructure of Intraluminal Thrombus From Abdominal Aortic Aneurysm
,” ASME J. Biomech. Eng.
, 123
(6
), pp. 536
–539
.Copyright © 2018 by ASME
You do not currently have access to this content.
