Virtual evaluation of stent graft deployment: A validated modeling and simulation study

Bock, Sander De; Iannaccone, Francesco; Santis, Gianluca De; Beule, Matthieu De; Loo, Denis Van; Devos, Daniël; Vermassen, Frank; Segers, Patrick; Verhegghe, Benedict

doi:10.1016/j.jmbbm.2012.04.021

Cited by 78 publications

(61 citation statements)

References 40 publications

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“…At the moment, simulation results could be post-processed to estimate luminal areas along the vessel centreline (De Bock et al, 2012;Demanget et al, 2013) and stents apposition defects (De Bock et al, 2014;Perrin et al, 2015b). These estimates could point out possible SG kink, gap between SG and arterial wall or collateral artery coverage, and thus potential risk of thrombosis, endoleak or artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

“…Afterwards, these models were used to feed FE simulations of SG deployment. About SG deployment, we can cite limb deployment in idealised vessels (Perrin et al, 2015b), simulation of in vitro SG main body deployment (De Bock et al, 2012) and patientspecific aortic endografting (Auricchio et al, 2013). Our group also recently managed to simulate the deployment of aorto-bi-iliac SGs in patient-specific AAAs (Perrin et al, 2015a).…”

Section: Introductionmentioning

confidence: 99%

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Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Perrin

Badel

Orgéas

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to help practitioners plan their intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Perrin

Badel

Orgéas

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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“…In the past few years, more realistic multimaterial stent-graft models have been proposed, [21][22][23][24] but to date, very few studies have used this approach. Kleinstreuer et al 21 were the first to formulate such numerical models.…”

mentioning

confidence: 99%

“…In 2012, deployment of a bifurcated Talent stent-graft within an aneurysm was simulated. 24 Geometric numerical results were validated by means of X-ray microtomography of the stent-graft deployed within a silicone aneurysm phantom. However, in that study, numerical results were exploited geometrically but not from the mechanical point of view.…”

mentioning

confidence: 99%

Finite Element Analysis of the Mechanical Performances of 8 Marketed Aortic Stent-Grafts

Demanget

Duprey

Badel

et al. 2013

Journal of Endovascular Therapy

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“…Thrombosis is a hazard that cannot be ignored [85,86,87,88,89,90,91]. New twisting resistant devices are now commercially available, such as Endurant and Cook LP.…”

Section: Discussionmentioning

confidence: 99%

An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

Jing

Guidoin

et al. 2016

Materials

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Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.

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Virtual evaluation of stent graft deployment: A validated modeling and simulation study

Cited by 78 publications

References 40 publications

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Finite Element Analysis of the Mechanical Performances of 8 Marketed Aortic Stent-Grafts

An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

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