Computational Fluid Dynamics Modeling of Redundant Stent-Graft Configurations in Endovascular Aneurysm Repair

Abstract

During endovascular aneurysm repair (EVAR), if the stent-graft device is too long for a given patient the redundant (extra) length adopts a convex configuration in the aneurysm.Based on clinical experience, we hypothesize that redundant stent-graft configurations increase the downward force acting on the device, thereby increasing the risk of device dislodgement and failure. This work numerically studies both steady-state and physiologic pulsatile blood flow in redundant stent-graft configurations. Computational fluid dynamics simulations predicted a peak downward displacement force for the zero-, moderate-and severe-redundancy configurations of 7.36, 7.44 and 7.81 N, respectively for steady-state flow; and 7.35, 7.41 and 7.85 N, respectively for physiologic pulsatile flow. These results suggest that redundant stent-graft configurations in EVAR do increase the downward force acting on the device, but the clinical consequence depends significantly on device-specific resistance to dislodgement.ii