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He Z, Mongrain R, Lessard S, Chayer B, Cloutier G, Soulez G. Anthropomorphic and biomechanical mockup for abdominal aortic aneurysm. Med Eng Phys 2020; 77:60-68. [PMID: 31954613 DOI: 10.1016/j.medengphy.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/08/2019] [Accepted: 12/15/2019] [Indexed: 11/16/2022]
Abstract
Abdominal aortic aneurysm (AAA) is an asymptomatic condition due to the dilation of abdominal aorta along with progressive wall degeneration, where rupture of AAA is life-threatening. Failures of AAA endovascular repair (EVAR) reflect our inadequate knowledge about the complex interaction between the aortic wall and medical devices. In this regard, we are presenting a hydrogel-based anthropomorphic mockup (AMM) to better understand the biomechanical constraints during EVAR. By adjusting the cryogenic treatments, we tailored the hydrogel to mimic the mechanical behavior of human AAA wall, thrombus and abdominal fat. A specific molding sequence and a pressurizing system were designed to reproduce the geometrical and diseased characteristics of AAA. A mechanically, anatomically and pathologically realistic AMM for AAA was developed for the first time, EVAR experiments were then performed with and without the surrounding fat. Substantial displacements of the aortic centerlines and vessel expansion were observed in the case without surrounding fat, revealing an essential framework created by the surrounding fat to account for the interactions with medical devices. In conclusion, the importance to consider surrounding tissue for the global deformation of AAA during EVAR was highlighted. Furthermore, potential use of this AMM for medical training was also suggested.
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Affiliation(s)
- Zinan He
- McGill University, 845 Sherbrooke Street West, Montréal, Québec H3A 0G4, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada
| | - Rosaire Mongrain
- McGill University, 845 Sherbrooke Street West, Montréal, Québec H3A 0G4, Canada
| | - Simon Lessard
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada
| | - Boris Chayer
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada
| | - Guy Cloutier
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada; Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Gilles Soulez
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 900 Rue Saint-Denis, Montréal, Québec H2X 0A9, Canada; Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada.
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Perry A, Graffeo CS, Carlstrom LP, Anding WJ, Link MJ, Rangel-Castilla L. Novel rodent model for simulation of sylvian fissure dissection and cerebrovascular bypass under subarachnoid hemorrhage conditions: technical note and timing study. Neurosurg Focus 2019; 46:E17. [DOI: 10.3171/2018.11.focus18533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESylvian fissure dissection following subarachnoid hemorrhage (SAH) is a challenging but fundamental skill in microneurosurgery, and one that has become increasingly difficult to develop during residency, given the overarching management trends. The authors describe a novel rodent model for simulation of sylvian fissure dissection and cerebrovascular bypass under SAH conditions.METHODSA standardized microvascular anastomosis model comprising rat femoral arteries and veins was used for the experimental framework. In the experimental protocol, following exposure and skeletonization of the vessels, extensive, superficial (1- to 2-mm) soft-tissue debridement was conducted and followed by wound closure and delayed reexploration at intervals of 7, 14, and 28 days. Two residents dissected 1 rat each per time point (n = 6 rats), completing vessel skeletonization followed by end-to-end artery/vein anastomoses. Videos were reviewed postprocedure to assess scar score and relative difficulty of dissection by blinded raters using 4-point Likert scales.RESULTSAt all time points, vessels were markedly invested in friable scar, and exposure was subjectively assessed as a reasonable surrogate for sylvian fissure dissection under SAH conditions. Scar score and relative difficulty of dissection both indicated 14 days as the most challenging time point.CONCLUSIONSThe authors’ experimental model of femoral vessel skeletonization, circumferential superficial soft-tissue injury, and delayed reexploration provides a novel approximation of sylvian fissure dissection and cerebrovascular bypass under SAH conditions. The optimal reexploration interval appears to be 7–14 days. To the authors’ knowledge, this is the first model of SAH simulation for microsurgical training, particularly in a live animal system.
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Affiliation(s)
| | | | | | | | - Michael J. Link
- Departments of 1Neurologic Surgery,
- 3Otolaryngology–Head and Neck Surgery, and
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