Aim: The goal is to simulate different stages of the endovascular procedure in the preoperative phase. Methods: We have developed a numerical model of the endovascular treatment of abdominal aortic aneurysms (AAA) using finite element analysis (FEA), we took into account the geometry of the biological region reconstructed from scans, a local characterization of the guidewire/catheter mechanical properties, a mapping of material properties depending on the degree of calcification, a real behavior of the vascular walls, and a projection of the aorta environment. Results: Our results present the endovascular system navigation from the femoral artery to the neck of the aneurysm, predict the deformation of femoral, iliac and aortic arteries while driving flexible and stiff endovascular devices, and detect stress concentration due to tortuous and calcified artery zones. A given group of patients with very angulated and calcified arteries were validated, based on a tuning between clinical data and our endovascular simulation. Conclusion: Our model allows controlling with accuracy the delivery system rise during surgery, predicting the feasibility of the surgery with reliability as well as choose the best guide for each patient, taking into account the risk of rupture of calcified areas in the case of high angulations, and using planning simulated images with deformation of artery walls to propose stent sizing.

The endovascular treatment of abdominal aortic aneurism (EVAR-EndoVascular Aneurism Repair) has become an alternative therapy to conventional open surgery. The objective of ANGIOVISION project was to contribute to the improvement of EVAR procedures in terms of accuracy and customization of the interventional strategy. Our approach was mainly based on the use of patient specific data, computer aided endovascular navigation and numerical simulation. We proposed a new FEM based patient specific simulation solution to estimate the deformations caused by the introduction of stiff endovascular devices. We developed and implemented an original endovascular navigation system to augment the intra-operative fluoroscopy with the visualization of deformed pre-operative aorto-iliac structure, and related information concerning vessel wall (calcifications), as well as stentgraft virtual deployment. The proposed solution, that requires only lightweight computer equipment, can be used in a standard operating room in order to optimize device placement (from a single angle of incidence). Evaluation is currently under way. Résumé Le traitement endovasculaire de l'anévrisme de l'aorte abdominale (EVAR-EndoVascular Aneurism Repair) constitue une alternative à la chirurgie ouverte. Le projet ANGIOVISION avait pour objectif de contribuer à l'amélioration des procédures EVAR en termes de précision et de personnalisation de la stratégie opératoire. Notre approche était principalement fondée sur le recours aux données spécifiques au patient, à la navigation endovasculaire assistée par ordinateur, et à la simulation numérique. Nous avons proposé une nouvelle solution de simulation par éléments finis, spécifique patient, afin d'estimer les déformations engendrées par les outils endovasculaires. Nous avons développé et mis en oeuvre un système de navigation endovasculaire permettant d'augmenter l'imagerie fluoroscopique per-opératoire avec la représentation de la structure aorto-iliaque préopératoire déformée, incluant les informations relatives à la qualité pariétale, ainsi que le pré-déploiement virtuel de l'endoprothèse. La solution proposée, qui n'implique que des moyens matériels (informatiques) légers, peut être utilisée dans un bloc opératoire standard afin d'optimiser le placement des dispositifs endovasculaires (à partir d'une seule incidence d'acquisition). L'évaluation du système est actuellement en cours.