Experimental Analysis of Endovascular Treatment of AAA and Predictors of Long Term Outcomes

Corbett, Timothy J.; Molony, David; Kavanagh, Eamon G.; Grace, Pierce A.; Walsh, Michael T.; McGloughlin, Tim

doi:10.1007/8415_2011_74

Cited by 2 publications

(4 citation statements)

References 59 publications

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“…For instance, in a conical vessel there is always the trade-off between SG undersizing, that is, too little SG oversizing, at the wide end of the vessel and excessive SG oversizing at the narrow end of the vessel. This means there is always a trade-off between complications associated with SG undersizing, 7,50 such as SG migration and endoleaks, and complications related to excessive SG oversizing, 27,51 such as postinterventional aortic neck dilatation. It was shown that by using second level customized SGs this inconsistency in choosing the degree of SG oversizing is obsolete.…”

Section: Discussionmentioning

confidence: 99%

“…Further, smaller degree of SG oversizing could be used for customized SGs to obtain the same passive fixation forces between SG and vessel and hence reduce potential negative effects of large SG oversizing. 7,27,51 The smallest impact of SG customization was identified for straight and elliptical vessels. It is explained by the relatively small lateral stiffness of a cylindrical SG.…”

Section: Discussionmentioning

confidence: 99%

“…Even if the likelihood of SG migration is reduced by introduction of barbs in latest generation SG devices, 54 customization might further contribute positively to long‐term fixation of the SG without migration. Further, smaller degree of SG oversizing could be used for customized SGs to obtain the same passive fixation forces between SG and vessel and hence reduce potential negative effects of large SG oversizing 7,27,51 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Customized stent‐grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept

Hemmler

Lin

Thierfelder

et al. 2020

Numer Methods Biomed Eng

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Endovascular aortic repair (EVAR) is a challenging intervention whose longterm success strongly depends on the appropriate stent-graft (SG) selection and sizing. Most off-the-shelf SGs are straight and cylindrical. Especially in challenging vessel morphologies, the morphology of off-the-shelf SGs is not able to meet the patient-specific demands. Advanced manufacturing technologies facilitate the development of highly customized SGs. Customized SGs that have the same morphology as the luminal vessel surface could considerably improve the quality of the EVAR outcome with reduced likelihoods of EVAR related complications such as endoleaks type I and SG migration. In this contribution, we use an in silico EVAR methodology that approximates the deployed state of the elastically deformable SG in a hyperelastic, anisotropic vessel. The in silico EVAR results of off-the-shelf SGs and customized SGs are compared qualitatively and quantitatively in terms of mechanical and geometrical parameters such as stent stresses, contact tractions, SG fixation forces and the SG-vessel attachment. In a numerical proof of concept, eight different vessel morphologies, such as a conical vessel, a barrel shaped vessel and a curved vessel, are used to demonstrate the added value of customized SGs compared to off-the-shelf SGs. The numerical investigation has shown large benefits of the highly customized SGs compared to off-the-shelf SGs with respect to a better SG-vessel attachment and a considerable increase in SG fixation forces of up to 50% which indicate decreased likelihoods of EVAR related complications. Hence, this numerical proof of concept motivates further research and development of highly customized SGs for the use in challenging vessel morphologies. K E Y W O R D Sabdominal aortic aneurysm, customized stent-graft, endovascular repair, personalized medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Customized stent‐grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept

Hemmler

Lin

Thierfelder

et al. 2020

Numer Methods Biomed Eng

View full text Add to dashboard Cite

show abstract

“…In contrast, EVAR is considered to be successful if the aneurysm stays excluded and has no expansion for several years after the intervention. Reasons for immediate or long-term failure of EVAR are difficult to identify, but both wrong SG sizing [1][2][3][4] and inappropriate vessel morphologies [5][6][7] are frequent explanations in literature. Device manufacturers formulate the limits of applicability of EVAR in their instructions for use (IFU), 5,8 which state, for instance, that the aortic neck should not exceed a certain angle and that the neck requires a certain minimum length.…”

Section: Introductionmentioning

confidence: 99%

In silico study of vessel and stent‐graft parameters on the potential success of endovascular aneurysm repair

Hemmler

Lutz

Reeps

et al. 2019

Numer Methods Biomed Eng

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The variety of stent‐graft (SG) design variables (eg, SG type and degree of SG oversizing) and the complexity of decision making whether a patient is suitable for endovascular aneurysm repair (EVAR) raise the need for the development of predictive tools to assist clinicians in the preinterventional planning phase. Recently, some in silico EVAR methods have been developed to predict the deployed SG configuration. However, only few studies investigated how to assess the in silico EVAR outcome with respect to EVAR complication likelihoods (eg, endoleaks and SG migration). Based on a large literature study, in this contribution, 20 mechanical and geometrical parameters (eg, SG drag force and SG fixation force) are defined to evaluate the quality of the in silico EVAR outcome. For a cohort of n = 146 realizations of parameterized vessel and SG geometries, the in silico EVAR results are studied with respect to these mechanical and geometrical parameters. All degrees of SG oversizing in the range between 5% and 40% are investigated continuously by a computationally efficient parameter continuation approach. The in silico investigations have shown that the mechanical and geometrical parameters are able to indicate candidates at high risk of postinterventional complications. Hence, this study provides the basis for the development of a simulation‐based metric to assess the potential success of EVAR based on engineering parameters.

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Experimental Analysis of Endovascular Treatment of AAA and Predictors of Long Term Outcomes

Cited by 2 publications

References 59 publications

Customized stent‐grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept

Customized stent‐grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept

In silico study of vessel and stent‐graft parameters on the potential success of endovascular aneurysm repair

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