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Donik Ž, Li W, Nnate B, Pugar JA, Nguyen N, Milner R, Cerda E, Pocivavsek L, Kramberger J. A computational study of artery curvature and endograft oversize influence on seal zone behavior in endovascular aortic repair. Comput Biol Med 2024; 178:108745. [PMID: 38901185 PMCID: PMC11317088 DOI: 10.1016/j.compbiomed.2024.108745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/18/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
Thoracic endovascular aortic repair (TEVAR) is a minimally invasive procedure involving the placement of an endograft inside the dissection or an aneurysm to direct blood flow and prevent rupture. A significant challenge in endovascular surgery is the geometrical mismatch between the endograft and the artery, which can lead to endoleak formation, a condition where blood leaks between the endograft and the vessel wall. This study uses computational modeling to investigate the effects of artery curvature and endograft oversizing, the selection of an endograft with a larger diameter than the artery, on endoleak creation. Finite element analysis is employed to simulate the deployment of endografts in arteries with varying curvature and diameter. Numerical simulations are conducted to assess the seal zone and to quantify the potential endoleak volume as a function of curvature and oversizing. A theoretical framework is developed to explain the mechanisms of endoleak formation along with proof-of-concept experiments. Two main mechanisms of endoleak creation are identified: local buckling due to diameter mismatch and global buckling due to centerline curvature mismatch. Local buckling, characterized by excess graft material buckling and wrinkle formation, increases with higher levels of oversizing, leading to a larger potential endoleak volume. Global buckling, where the endograft bends or deforms to conform to the centerline curvature of the artery, is observed to require a certain degree of oversizing to bridge the curvature mismatch. This study highlights the importance of considering both curvature and diameter mismatch in the design and clinical use of endografts. Understanding the mechanisms of endoleak formation can provide valuable insights for optimizing endograft design and surgical planning, leading to improved clinical outcomes in endovascular aortic procedures.
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Affiliation(s)
- Žiga Donik
- Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, 2000 Maribor, Slovenia.
| | - Willa Li
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC 5028, Chicago, IL 60637, USA
| | - Blessing Nnate
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC 5028, Chicago, IL 60637, USA
| | - Joseph A Pugar
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC 5028, Chicago, IL 60637, USA
| | - Nhung Nguyen
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC 5028, Chicago, IL 60637, USA
| | - Ross Milner
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC 5028, Chicago, IL 60637, USA
| | - Enrique Cerda
- Departamento de Física, Facultad de Ciencia, Universidad de Santiago de Chile (USACH), Santiago Chile
| | - Luka Pocivavsek
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, The University of Chicago, 5841 S Maryland Ave, MC 5028, Chicago, IL 60637, USA.
| | - Janez Kramberger
- Faculty of Mechanical Engineering, University of Maribor, Smetanova ulica 17, 2000 Maribor, Slovenia
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Derycke L, Avril S, Vermunt J, Perrin D, El Batti S, Alsac JM, Albertini JN, Millon A. Computational prediction of proximal sealing in endovascular abdominal aortic aneurysm repair with unfavorable necks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107993. [PMID: 38142515 DOI: 10.1016/j.cmpb.2023.107993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Endovascular aortic aneurysm repair (EVAR) has become the standard treatment for abdominal aortic aneurysms in most centers. However, proximal sealing complications leading to endoleaks and migrations sometimes occur, particularly in unfavorable aortic anatomies and are strongly dependent on biomechanical interactions between the aortic wall and the endograft. The objective of the present work is to develop and validate a computational patient-specific model that can accurately predict these complications. METHODS Based on pre-operative CT-scans, we developed finite element models of the aorta of 10 patients who underwent endovascular aortic aneurysm repair, 7 with standard morphologies and 3 with unfavorable anatomies. We simulated the deployment of stent grafts in each aorta by solving mechanical equilibrium with a virtual shell method. Eventually we compared the actual stent ring positions from post-operative computed-tomography-scans with the predicted simulated positions. RESULTS A successful deployment simulation could be performed for each patient. Relative radial, transverse and longitudinal deviations were 6.3 ± 4.4%, 2.5 ± 0.9 mm and 1.4 ± 1.1 mm, respectively. CONCLUSIONS The numerical model predicted accurately stent-graft positions in the aortic neck of 10 patients, even in complex anatomies. This shows the potential of computer simulation to anticipate possible proximal endoleak complications before EVAR interventions.
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Affiliation(s)
- L Derycke
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, SAINBIOSE U1059, F-42023 Saint-Etienne, France; Department of Vascular Surgery, Hôpital Paris Saint-Joseph, F-75014 Paris, France
| | - S Avril
- Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, SAINBIOSE U1059, F-42023 Saint-Etienne, France.
| | | | | | - S El Batti
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - J-M Alsac
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | | | - A Millon
- Department of Vascular and Endovascular Surgery, Hospices Civils de Lyon, Louis Pradel University, Hospital, F-69500 Bron, France
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Chinsakchai K, Sirivech T, Moll FL, Tongsai S, Hongku K. The Correlation of Aortic Neck Angle and Length in Abdominal Aortic Aneurysm with Severe Neck Angulation for Prediction of Intraoperative Neck Complications and Postoperative Outcomes after Endovascular Aneurysm Repair. J Clin Med 2023; 12:5797. [PMID: 37762737 PMCID: PMC10531816 DOI: 10.3390/jcm12185797] [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: 07/31/2023] [Revised: 09/02/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES Endovascular aneurysm repair (EVAR) in a hostile neck has been associated with adverse outcomes. We aimed to determine the association of infrarenal aortic neck angle and length and establish an optimal cutoff value to predict intraoperative neck complications and postoperative outcomes. METHODS This was a retrospective review of patients with an intact infrarenal abdominal aortic aneurysm (AAA) with severe neck angulation (>60 degrees) who underwent EVAR from October 2010 to October 2018. Demographic data, aneurysm morphology, and operative details were collected. The ratio of neck angle and length was calculated as the optimal cutoff value of the aortic neck angle-length index. The patients were categorized into two distinct groups using latent profile analysis, a statistical technique employed to identify concealed subgroups within a larger population by examining a predetermined set of variables. Intraoperative neck complications, adjunct neck procedures, and early and late outcomes were compared. RESULTS 115 patients were included. Group 1 (G1) had 95 patients with an aortic neck angle-length index ≤ 4.8, and Group 2 (G2) had 20 patients with an aortic neck angle-length index > 4.8. Demographic data and aneurysm morphology were not significantly different between groups except for neck length (p < 0.001). G2 had more intraoperative neck complications than G1 (21.1% vs. 55%, p = 0.005). Adjunctive neck procedures were more common in G2 (18.9% vs. 60%, p < 0.001). The thirty-day mortality rate was not statistically different. G1 patients had a 5-year proximal neck re-intervention-free rate comparable to G2 patients (93.7% G1 vs. 87.5% G2, p = 0.785). The 5-year overall survival rate was not statistically different (59.9% G1 vs. 69.2% G2, p = 0.891). CONCLUSIONS Patients with an aortic neck angle-length index > 4.8 are at greater risk of intraoperative neck complications and adjunctive neck procedures than patients with an aortic neck angle-length index ≤ 4.8. The 5-year proximal neck re-intervention-free rate and the 5-year survival rate were not statistically different. Based on our findings, this study suggests that the aortic neck angle-length index is a reliable predictor of intraoperative neck complications during EVAR in AAA with severe neck angulation.
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Affiliation(s)
- Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (T.S.); (K.H.)
| | - Thana Sirivech
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (T.S.); (K.H.)
| | - Frans L. Moll
- Vascular Surgery Department, University Medical Center Utrecht, 3584 Utrecht, The Netherlands;
| | - Sasima Tongsai
- Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Kiattisak Hongku
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (T.S.); (K.H.)
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Brand M, Yoel B, Eichler E, Speter C, Halak M, Marom G. The effect of stent graft curvature on the hemodynamic displacement force after abdominal aortic aneurysm endovascular repair. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230563. [PMID: 37416831 PMCID: PMC10320339 DOI: 10.1098/rsos.230563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Endovascular aortic aneurysm repair is a minimally invasive procedure with low mortality and morbidity. Clinical studies have revealed that a displacement force (DF) can cause stent graft (SG) migration in some circumstances requiring repeated intervention. This study aims to determine the relationship between the SG curvature and the calculated DF from four patient-specific computational fluid dynamics models. The SG's curvature was defined according to the centrelines of the implanted SG's branches. The centrelines were defined as either intersecting or separated lines. The centreline curvature (CLC) metrics were calculated based on the local curvature radii and the distances from the centrelines of idealized straight branches. The average CLC value and average variation were calculated to represent the entire graft's curvature. These CLC calculations were compared, and the method that gave the best correlation to the calculated DF was found. The optimal correlation is obtained from calculating the CLC average variation using separated centrelines and distance from straight lines, with an R2 = 0.89. Understanding the relationship between vascular morphology and DF can help identify at-risk patients before the procedure. In these cases, we can provide appropriate treatment and follow up with the patient to prevent future failure.
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Affiliation(s)
| | | | | | - Chen Speter
- Department of Vascular Surgery, The Chaim Sheba Medical Centre, Tel Hashomer, Israel
| | - Moshe Halak
- Department of Vascular Surgery, The Chaim Sheba Medical Centre, Tel Hashomer, Israel
| | - Gil Marom
- Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Derycke L, Avril S, Millon A. Patient-Specific Numerical Simulations of Endovascular Procedures in Complex Aortic Pathologies: Review and Clinical Perspectives. J Clin Med 2023; 12:jcm12030766. [PMID: 36769418 PMCID: PMC9917982 DOI: 10.3390/jcm12030766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
The endovascular technique is used in the first line treatment in many complex aortic pathologies. Its clinical outcome is mostly determined by the appropriate selection of a stent-graft for a specific patient and the operator's experience. New tools are still needed to assist practitioners with decision making before and during procedures. For this purpose, numerical simulation enables the digital reproduction of an endovascular intervention with various degrees of accuracy. In this review, we introduce the basic principles and discuss the current literature regarding the use of numerical simulation for endovascular management of complex aortic diseases. Further, we give the future direction of everyday clinical applications, showing that numerical simulation is about to revolutionize how we plan and carry out endovascular interventions.
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Affiliation(s)
- Lucie Derycke
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, F-75015 Paris, France
- Centre CIS, Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, SAINBIOSE U1059, F-42023 Saint-Etienne, France
| | - Stephane Avril
- Centre CIS, Mines Saint-Etienne, Université Jean Monnet Saint-Etienne, INSERM, SAINBIOSE U1059, F-42023 Saint-Etienne, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Hospices Civils de Lyon, Louis Pradel University Hospital, F-69500 Bron, France
- Correspondence:
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Georgakarakos E, Karaolanis GI, Argyriou C, Papatheodorou N, Karangelis D, Georgiadis GS. Update on the TREO endograft device: overview of its safety and efficacy. Expert Rev Med Devices 2022; 19:31-35. [PMID: 34913785 DOI: 10.1080/17434440.2022.2020093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The TREO abdominal aortic stent graft system (Terumo Aortic, Sunrise, Fla) is a low-profile, trimodular endovascular endoprosthesis for the endovascular repair of abdominal aortic aneurysm (AAA). The objective of the present study was to collect and discuss all the available modern data of this device highlighting especially its mid-and long-term clinical results. AREAS COVERED This updated review article presents the most current results from great-scale clinical studies and the RATIONALE registry involving also angulated neck anatomies and challenging AAA geometries, reflecting the real-world experience. EXPERT OPINION The global, multicenter RATIONALE registry prospectively enrolled 202 patients (mean age 73.0 ± 7.8 years) who underwent EVAR. Technical success, primary clinical success and assisted primary patency rate was 96%, 92.2% and 97%, respectively. The clinical success at 1 year was 96%. Another multicenter, non-randomized, clinical trial confirmed also high technical and clinical success. Additionally, a comparative study comparing favorable and hostile necks in AAA, demonstrated a comparable technical success (95.2%), achieving proper sealing and technical success in the hostile neck group. TREO endograft seems to be safe and effective for EVAR, especially in hostile neck anatomies. Long-term outcomes from ongoing registries are awaited to complete these results.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios I Karaolanis
- Vascular Unit, Department of Surgery, University Hospital of Ioannina, School of Medicine, Ioannina, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papatheodorou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimos Karangelis
- Department of Cardiac Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Avril S, Gee MW, Hemmler A, Rugonyi S. Patient-specific computational modeling of endovascular aneurysm repair: State of the art and future directions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3529. [PMID: 34490740 DOI: 10.1002/cnm.3529] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Endovascular aortic repair (EVAR) has become the preferred intervention option for aortic aneurysms and dissections. This is because EVAR is much less invasive than the alternative open surgery repair. While in-hospital mortality rates are smaller for EVAR than open repair (1%-2% vs. 3%-5%), the early benefits of EVAR are lost after 3 years due to larger rates of complications in the EVAR group. Clinicians follow instructions for use (IFU) when possible, but are left with personal experience on how to best proceed and what choices to make with respect to stent-graft (SG) model choice, sizing, procedural options, and their implications on long-term outcomes. Computational modeling of SG deployment in EVAR and tissue remodeling after intervention offers an alternative way of testing SG designs in silico, in a personalized way before intervention, to ultimately select the strategies leading to better outcomes. Further, computational modeling can be used in the optimal design of SGs in cases of complex geometries. In this review, we address some of the difficulties and successes associated with computational modeling of EVAR procedures. There is still work to be done in all areas of EVAR in silico modeling, including model validation, before models can be applied in the clinic, but much progress has already been made. Critical to clinical implementation are current efforts focusing on developing fast algorithms that can achieve (near) real-time solutions, as well as ways of dealing with inherent uncertainties related to patient aortic wall degradation on an individualized basis. We are optimistic that EVAR modeling in the clinic will soon become a reality to help clinicians optimize EVAR interventions and ultimately reduce EVAR-associated complications.
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Affiliation(s)
- Stéphane Avril
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, Saint-Étienne, France
| | - Michael W Gee
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - André Hemmler
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Sandra Rugonyi
- Biomedical Engineering Department, Oregon Health & Science University, Portland, Oregon, USA
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Seike Y, Fukuda T, Yokawa K, Inoue Y, Shijo T, Uehara K, Sasaki H, Matsuda H. Preoperative Neck Angulation is Associated with Aneurysm Sac Growth Due to Persistent Type Ia Endoleak after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Dis 2020; 13:261-268. [PMID: 33384728 PMCID: PMC7751068 DOI: 10.3400/avd.oa.20-00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to determine how instructions for use affect the occurrence of aneurysm sac growth and endoleaks after an endovascular aneurysm repair (EVAR). Materials and Methods: We reviewed 302 patients who underwent EVAR for abdominal aortic aneurysm between 2007 and 2013, and we were able to enroll 159 patients (74% men, mean age 78±7 years) with adequate data (mean follow-up; 48±20 months). Results: The angle of the proximal landing zone (LZ) (hazard ratio: 1.02, 95% confidence interval: 1.00–1.03, p=0.01) was recognized as an independent risk factor of sac growth (≥5 mm). The receiver operating characteristics curve (area under the curve: 0.72) showed a cutoff value of 47° of the minimum angle of the proximal LZ to predict sac growth. Freedom rates for persistent type Ia endoleaks were also found to be lower in the angulated group than those in the other groups (p=0.0095, log-rank). Conclusion: The angle of the proximal LZ was identified as an independent risk factor for sac growth post-EVAR. The incidence of persistent type Ia endoleaks was significantly higher in the angulated group.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Takayuki Shijo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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Mathlouthi A, Locham S, Dakour-Aridi H, Black JH, Malas MB. Impact of suprarenal neck angulation on endovascular aneurysm repair outcomes. J Vasc Surg 2020; 71:1900-1906. [DOI: 10.1016/j.jvs.2019.08.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/03/2019] [Indexed: 11/30/2022]
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Chinsakchai K, Suksusilp P, Wongwanit C, Hongku K, Hahtapornsawan S, Puangpunngam N, Moll FL, Sermsathanasawadi N, Ruangsetakit C, Mutirangura P. Early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between severe and non-severe infrarenal neck angulation. Vascular 2020; 28:683-691. [DOI: 10.1177/1708538120924552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Abdominal aortic aneurysm with severe infrarenal neck angle (>60°) has long been thought to be an obstacle to endovascular aneurysm repair. However, some previous studies reported endovascular aneurysm repair to be safe and efficacious for treating abdominal aortic aneurysm in patients with severe neck angulation. The aim of this study was to investigate the early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between patients with severe and non-severe infrarenal neck angulation. Methods Fifty-four severe and 144 non-severe neck angulation patients who were treated at Siriraj Hospital (Bangkok, Thailand) during January 2010–October 2013 were recruited. The primary endpoints were intraoperative neck complications (e.g., type 1A endoleak or proximal graft migration) and immediate adjunct aortic neck procedures. The secondary endpoints included perioperative mortality, overall survival, and the proportion of patients that were reintervention-free at five years compared between the severe and non-severe groups. Results Severe angulation patients were significantly older than non-severe angulation patients (77 ± 6.3 vs. 74 ± 7.9 years; p = 0.021). The median proximal angle was significantly greater in the severe group (82° vs. 13.5°; p < 0.001). Intraoperative proximal neck complications developed in 29.6% of patients in the severe angulation group compared with 9.0% in the non-severe group ( p < 0.001). Significantly more patients in the severe group required intraoperative adjunct procedures (29.6% vs. 7.6%; p < 0.001). There was no significant difference in perioperative mortality between groups. At the five-year follow-up, there was no significant difference between groups for overall survival or the proportion of patients that remained reintervention-free. Conclusions Endovascular aneurysm repair to treat abdominal aortic aneurysm in patients with severe proximal neck angulation is technically feasible and safe Although the severe angulation group had a higher rate of intraoperative neck complications and immediate adjunct neck procedures than the non-severe group, there was no significant difference between groups for 30-day mortality, overall survival or the proportion of patients who remained reintervention-free at five years.
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Affiliation(s)
- Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichawat Suksusilp
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chumpol Wongwanit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kiattisak Hongku
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suteekhanit Hahtapornsawan
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattawut Puangpunngam
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanean Ruangsetakit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pramook Mutirangura
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Derycke L, Sénémaud J, Perrin D, Avril S, Desgranges P, Albertini JN, Cochennec F, Haulon S. Patient Specific Computer Modelling for Automated Sizing of Fenestrated Stent Grafts. Eur J Vasc Endovasc Surg 2019; 59:237-246. [PMID: 31865026 DOI: 10.1016/j.ejvs.2019.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 09/26/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim was to validate a computational patient specific model of Zenith® fenestrated device deployment in abdominal aortic aneurysms to predict fenestration positions. METHODS This was a retrospective analysis of the accuracy of numerical simulation for fenestrated stent graft sizing. Finite element computational simulation was performed in 51 consecutive patients that underwent successful endovascular repair with Zenith® fenestrated stent grafts in two vascular surgery units with a high volume of aortic procedures. Longitudinal and rotational clock positions of fenestrations were measured on the simulated models. These measurements were compared with those obtained by (i) an independent observer on the post-operative computed tomography (CT) scan and (ii) by the stent graft manufacturer planning team on the pre-operative CT scan. (iii) Pre- and post-operative positions were also compared. Longitudinal distance and clock face discrepancies >3 mm and 15°, respectively, were considered significant. Reproducibility was assessed using Bland-Altman and linear regression analysis. RESULTS A total of 195 target arteries were analysed. Both Bland-Altman and linear regression showed good reproducibility between the three measurement techniques performed. The median absolute difference between the simulation and post-operative CT scan was 1.0 ± 1.1 mm for longitudinal distance measurements and 6.9 ± 6.1° for clock positions. The median absolute difference between the planning centre and post-operative CT scan was 0.8 ± 0.8 mm for longitudinal distance measurements and 5.1 ± 5.0° for clock positions. Finally, the median absolute difference between the simulation and the planning centre was 0.96 ± 0.97 mm for longitudinal distance measurements and 4.8 ± 3.6° for clock positions. CONCLUSION The numerical model of deployed fenestrated stent grafts is accurate for planning position of fenestrations. It has been validated in 51 patients, for whom fenestration locations were similar to the sizing performed by physicians and the planning centre.
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Affiliation(s)
- Lucie Derycke
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023 Saint-Etienne, France; Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France.
| | - Jean Sénémaud
- Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France
| | | | - Stephane Avril
- Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023 Saint-Etienne, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France
| | - Jean-Noel Albertini
- Department of Cardio-Vascular Surgery, Centre Hospitalier Régional Universitaire de Saint-Etienne, Saint-Priez-en-Jarez, France
| | - Frederic Cochennec
- Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France
| | - Stephan Haulon
- Department of Aortic and Vascular Surgery, Marie Lannelongue Hospital, Le Plessis-Robinson, INSERM UMR_S 999, Université Paris Sud, France
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Hemmler A, Lutz B, Reeps C, Gee MW. In silico study of vessel and stent-graft parameters on the potential success of endovascular aneurysm repair. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3237. [PMID: 31315160 DOI: 10.1002/cnm.3237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/29/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
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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Affiliation(s)
- André Hemmler
- Mechanics & High Performance Computing Group, Technische Universität München, Parkring 35, Garching b. München, 85748, Germany
| | - Brigitta Lutz
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, Dresden, 01307, Germany
| | - Christian Reeps
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, Dresden, 01307, Germany
| | - Michael W Gee
- Mechanics & High Performance Computing Group, Technische Universität München, Parkring 35, Garching b. München, 85748, Germany
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Patient-specific in silico endovascular repair of abdominal aortic aneurysms: application and validation. Biomech Model Mechanobiol 2019; 18:983-1004. [PMID: 30834463 DOI: 10.1007/s10237-019-01125-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
Abstract
Non-negligible postinterventional complication rates after endovascular aneurysm repair (EVAR) leave room for further improvements. Since the potential success of EVAR depends on various patient-specific factors, such as the complexity of the vessel geometry and the physiological state of the vessel, in silico models can be a valuable tool in the preinterventional planning phase. A suitable in silico EVAR methodology applied to patient-specific cases can be used to predict stent-graft (SG)-related complications, such as SG migration, endoleaks or tissue remodeling-induced aortic neck dilatation and to improve the selection and sizing process of SGs. In this contribution, we apply an in silico EVAR methodology that predicts the final state of the deployed SG after intervention to three clinical cases. A novel qualitative and quantitative validation methodology, that is based on a comparison between in silico results and postinterventional CT data, is presented. The validation methodology compares average stent diameters pseudo-continuously along the total length of the deployed SG. The validation of the in silico results shows very good agreement proving the potential of using in silico approaches in the preinterventional planning of EVAR. We consider models of bifurcated, marketed SGs as well as sophisticated models of patient-specific vessels that include intraluminal thrombus, calcifications and an anisotropic model for the vessel wall. We exemplarily show the additional benefit and applicability of in silico EVAR approaches to clinical cases by evaluating mechanical quantities with the potential to assess the quality of SG fixation and sealing such as contact tractions between SG and vessel as well as SG-induced tissue overstresses.
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Rockley M, Hadziomerovic A, van Walraven C, Bose P, Scallan O, Jetty P. A new "angle" on aortic neck angulation measurement. J Vasc Surg 2019; 70:756-761.e1. [PMID: 30837183 DOI: 10.1016/j.jvs.2018.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 11/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Infrarenal aortic neck angulation is one of the most powerful predictors of endovascular aneurysm repair failure. Whereas the "gold standard" to measure this angle is three-dimensional (3D) reconstruction and centerline measurement, many surgeons rely on estimations of angulation based on two-dimensional (2D) views of computed tomography imaging. Unfortunately, these views do not accurately represent the true angle, particularly if aortic angulation is oblique to the standard views. In response to this issue, our group has developed a novel trigonometric formula that uses coronal and sagittal measured angles to calculate the true angle. The purpose of this study was to compare the paired angle formula with 3D centerline measurements for estimating true aortic neck angulation. METHODS Fifty randomly selected patients treated by endovascular aneurysm repair at The Ottawa Hospital between 2010 and 2015 were studied. The 3D centerline aortic neck angle measurements were made by a radiology staff physician. The paired angle formula was applied by a vascular surgeon, resident, and student using 2D coronal and sagittal angles from computed tomography imaging to estimate the true angle. RESULTS The average age was 78 years; 74% of patients were male, and average preoperative aneurysm diameter was 5.7 cm. The mean neck length was 1.9 cm (1.1-3.2 cm), and mean neck angulation calculated by the gold standard measurements was 39 degrees (2-84 degrees). Linear regression demonstrated strong association between 3D measurements and the paired angle formula, with correlations comparable to the intraobserver variability (intraclass correlation coefficient values range, 0.74-0.87). The average user estimates deviated minimally from the gold standard (absolute difference, 6 degrees; 95% confidence interval, 4-8 degrees) without systemic bias. The paired angle formula accurately ruled out severe angulation >60 degrees with an overall negative predictive value of >99%. Compared with isolated 2D measurements, application of the paired angle formula significantly decreased the false-negative rate of unappreciated severe angulation >60 degrees from 4.8% to 0.7% (P = .032). CONCLUSIONS The paired angle formula detects significantly more severe angles than isolated 2D measurements and can accurately rule out severe angulation >60 degrees compared with the 3D measurements. The implementation of this angle estimation method is a useful adjunct in the measurement of aortic neck angulation, especially if 3D reconstruction software is not readily available. Furthermore, the importance of accurate angle measurement is not limited to vascular surgery and has direct relevance to any procedural specialty that relies on preoperative angle measurements.
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Affiliation(s)
- Mark Rockley
- Division of Vascular Surgery, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Carl van Walraven
- Ottawa Hospital Research Institute, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Prosenjit Bose
- School of Computer Science, Carleton University, Ottawa, Ontario, Canada
| | - Oonagh Scallan
- Division of Vascular Surgery, University of Western Ontario, London, Ontario, Canada
| | - Prasad Jetty
- Division of Vascular Surgery, University of Ottawa, Ottawa, Ontario, Canada
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Predictive Numerical Simulations of Double Branch Stent-Graft Deployment in an Aortic Arch Aneurysm. Ann Biomed Eng 2019; 47:1051-1062. [PMID: 30706308 DOI: 10.1007/s10439-019-02215-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/18/2019] [Indexed: 01/04/2023]
Abstract
Total endovascular repair of the aortic arch represents a promising option for patients ineligible to open surgery. Custom-made design of stent-grafts (SG), such as the Terumo Aortic® RelayBranch device (DB), requires complex preoperative measures. Accurate SG deployment is required to avoid intraoperative or postoperative complications, which is extremely challenging in the aortic arch. In that context, our aim is to develop a computational tool able to predict SG deployment in such highly complex situations. A patient-specific case is performed with complete deployment of the DB and its bridging stents in an aneurysmal aortic arch. Deviations of our simulation predictions from actual stent positions are estimated based on post-operative scan and a sensitivity analysis is performed to assess the effects of material parameters. Results show a very good agreement between simulations and post-operative scan, with especially a torsion effect, which is successfully reproduced by our simulation. Relative diameter, transverse and longitudinal deviations are of 3.2 ± 4.0%, 2.6 ± 2.9 mm and 5.2 ± 3.5 mm respectively. Our numerical simulations show their ability to successfully predict the DB deployment in complex anatomy. The results emphasize the potential of computational simulations to assist practitioners in planning and performing complex and secure interventions.
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16
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Hemmler A, Lutz B, Reeps C, Kalender G, Gee MW. A methodology for in silico endovascular repair of abdominal aortic aneurysms. Biomech Model Mechanobiol 2018; 17:1139-1164. [PMID: 29752606 DOI: 10.1007/s10237-018-1020-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2018] [Indexed: 11/29/2022]
Abstract
Endovascular aneurysm repair (EVAR) can involve some unfavorable complications such as endoleaks or stent-graft (SG) migration. Such complications, resulting from the complex mechanical interaction of vascular tissue, SG and blood flow or incompatibility of SG design and vessel geometry, are difficult to predict. Computational vascular mechanics models can be a predictive tool for the selection, sizing and placement process of SGs depending on the patient-specific vessel geometry and hence reduce the risk of potential complications after EVAR. In this contribution, we present a new in silico EVAR methodology to predict the final state of the deployed SG after intervention and evaluate the mechanical state of vessel and SG, such as contact forces and wall stresses. A novel method to account for residual strains and stresses in SGs, resulting from the precompression of stents during the assembly process of SGs, is presented. We suggest a parameter continuation approach to model various different sizes of SGs within one in silico EVAR simulation which can be a valuable tool when investigating the issue of SG oversizing. The applicability and robustness of the proposed methods are demonstrated on the example of a synthetic abdominal aortic aneurysm geometry.
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Affiliation(s)
- André Hemmler
- Mechanics and High Performance Computing Group, Technische Universität München, Parkring 35, 85748, Garching b. München, Germany
| | - Brigitta Lutz
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Reeps
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Günay Kalender
- Klinik für vaskuläre und endovaskuläre Chirurgie, DRK Kliniken Berlin, Salvador-Allende-Straße 2-8, 12559, Berlin, Germany
| | - Michael W Gee
- Mechanics and High Performance Computing Group, Technische Universität München, Parkring 35, 85748, Garching b. München, Germany.
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17
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Aortic Anatomy and Complications of the Proximal Sealing Zone after Endovascular Treatment of the Thoracic Aorta. Ann Vasc Surg 2018; 48:141-150. [DOI: 10.1016/j.avsg.2017.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 07/25/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022]
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18
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Georgakarakos E, Kratimenos T, Koutsoumpelis A, Georgiadis GS. The Bolton Treo endograft for treatment of abdominal aortic aneurysms: just another trimodular platform? Expert Rev Med Devices 2017; 15:5-14. [DOI: 10.1080/17434440.2018.1419864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodoros Kratimenos
- Department of Interventional Radiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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19
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Georgakarakos E, Pitoulias G, Schoretsanitis N, Argyriou C, Mavros DM, Lazarides MK, Georgiadis GS. Early Results of the Bolton Treovance Endograft in the Treatment of Abdominal Aortic Aneurysms. J Endovasc Ther 2017; 24:559-565. [DOI: 10.1177/1526602817713736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - George Pitoulias
- Department of Surgery, Genimatas Hospital, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Dimitrios M. Mavros
- Department of Surgery, Genimatas Hospital, Aristotle University of Thessaloniki, Greece
| | - Miltos K. Lazarides
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Greece
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Perrin D, Badel P, Orgeas L, Geindreau C, du Roscoat SR, Albertini JN, Avril S. Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts. J Mech Behav Biomed Mater 2016; 63:86-99. [PMID: 27344232 DOI: 10.1016/j.jmbbm.2016.06.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/10/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022]
Abstract
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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Affiliation(s)
- David Perrin
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France
| | - Pierre Badel
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France
| | - Laurent Orgeas
- CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | - Christian Geindreau
- CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France
| | | | - Jean-Noël Albertini
- INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France; CHU Hôpital Nord Saint-Etienne, Department of CardioVascular Surgery, Saint-Etienne F-42055, France
| | - Stéphane Avril
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France.
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Norman E, Harling M, Skervin AL, Riga C, Khalifa M, Gibbs R, Hamady M. Modified use of thoracic and iliac branch endografts to treat an abdominal aortic aneurysm with an unusually narrow neck. BJR Case Rep 2016; 2:20150402. [PMID: 30363651 PMCID: PMC6180878 DOI: 10.1259/bjrcr.20150402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/29/2015] [Accepted: 01/08/2016] [Indexed: 11/16/2022] Open
Abstract
Abdominal aortic aneurysms with hostile anatomy are a recognized hindrance to the continuing application of endovascular aortic interventions. Narrowed aneurysm necks pose technical difficulties, particularly in the absence of customized endografts. There are multiple suggested approaches to overcome shortened and angulated necks endovascularly; however, none of these address narrowed necks. We present a case where an endograft was used outside of its “instruction for use” by combining the thoracic and iliac branch technologies to overcome this problem. Expanding the use of commercially available endografts for aortic aneurysms with hostile anatomy could have significant practical and financial benefits.
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Affiliation(s)
| | | | | | - Celia Riga
- Section of Vascular Surgery, Division of Surgery and Cancer, Imperial College London, London, UK
| | - Mohamed Khalifa
- Interventional Radiology, Imperial College London, London, UK
| | - Richard Gibbs
- Division of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Mohamad Hamady
- Department of Interventional Radiology, Imperial College London, London, UK
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22
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Georgakarakos E, Ioannou CV, Georgiadis GS, Storck M, Trellopoulos G, Koutsias S, Lazarides MK. The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2016; 13:253-62. [DOI: 10.1586/17434440.2016.1147949] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Georgakarakos E, Ioannou CV, Trellopoulos G, Kontopodis N, Papachristodoulou A, Torsello G, Bisdas T. Immediate Change in Suprarenal Neck Angulation After Endovascular Aneurysm Repair. J Endovasc Ther 2015; 22:613-9. [DOI: 10.1177/1526602815591562] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare the immediate suprarenal neck angulation change between the Ovation stent-graft, with its inflatable sealing rings, and a stent-graft with a conventional sealing mechanism. Methods: A case-control study was conducted in which 30 consecutive patients (mean age 67 years; all men) with abdominal aortic aneurysm (AAA) treated with the Ovation stent-graft (group O) were retrospectively compared with 24 patients (mean age 77 years; all men) contemporaneously treated with the Endurant stent-graft (group E) at 3 high-volume tertiary vascular centers. The variables recorded were the aortic neck length, preoperative and postoperative angulation, minimum and maximum diameters of the infrarenal neck, as well as the maximum AAA diameter. All patients had undergone preoperative and postoperative (within 30 days) computed tomographic angiography. Multiple regression analysis compared the relative contribution to neck angulation change of each geometric parameter and the type of endograft. Data are presented as the mean ± standard deviation. Results: The mean preoperative suprarenal neck angulation in group O was 23.2°±18.0° compared with 23.8°±22.9° in group E ( t test, p=0.91). The neck lengths were 29.2±14.6 and 23.2±11.0 mm in groups O and E, respectively (p=0.1). Similarly, the minimum and maximum neck diameters were 22.4±2.6 and 25±3.5 mm, respectively, in group O vs 23.3±3.6 mm and 27.0±5.7 mm, respectively, in group E (p=0.3 and 0.12, respectively). The maximum transverse diameters of the AAA in the 2 groups were comparable, that is, 57.0±9.0 mm in group O vs 53.2±11.1 mm in group E (p=0.17). The Ovation stent-graft caused greater decrease in the aortic neck angulation postoperatively compared with the Endurant device (13.2°±16.1° vs 6.1°±5.9°, p=0.04). Multiple regression analysis revealed that preoperative neck angulation (β coefficient 0.37, p<0.001) and the type of endograft (β coefficient −7.91, p=0.01) had significant influence on the postoperative neck angulation change. The intraclass correlation coefficient ranged from 0.951 to 0.990 for the preoperative measurements and from 0.911 to 0.999 for the postoperative measurements for each examiner or the total of estimates at the measurement time points. Conclusion: The Ovation stent-graft induces greater postoperative reduction in the AAA neck angulation compared to an endograft with stent-supported graft seal. Expanded research to infrarenal angle as well to greater angles and correlation to clinical events is justified.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Christos V. Ioannou
- Department of Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - George Trellopoulos
- First Surgical Clinic, General Hospital “G. Papanikolaou” Exohi, Thessaloniki, Greece
| | - Nikolaos Kontopodis
- Department of Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | | | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, and University Clinic of Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital, and University Clinic of Münster, Germany
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24
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Thakor AS, Tanner J, Ong SJ, Hughes-Roberts Y, Ilyas S, Cousins C, See TC, Klass D, Winterbottom AP. Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair. Can Assoc Radiol J 2015; 66:277-90. [PMID: 25978867 DOI: 10.1016/j.carj.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 02/07/2023] Open
Abstract
Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.
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Affiliation(s)
- Avnesh S Thakor
- Department of Interventional Radiology, Stanford University, Stanford University Medical Center, Palo Alto, California, USA
| | - James Tanner
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shao J Ong
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ynyr Hughes-Roberts
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shahzad Ilyas
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Claire Cousins
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Teik C See
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Darren Klass
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew P Winterbottom
- Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
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