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Simmering JA, Koenrades MA, Slump CH, Groot Jebbink E, Zeebregts CJ, Reijnen MMPJ, Geelkerken RH. Renal and Visceral Artery Configuration During the First Year of Follow-Up After Fenestrated Aortic Aneurysm Repair Using the Anaconda Stent-graft: A Prospective Longitudinal Multicenter Study With ECG-Gated CTA Scans. J Endovasc Ther 2023:15266028231209929. [PMID: 37933525 DOI: 10.1177/15266028231209929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE The performance of fenestrated endovascular aortic aneurysm repair (FEVAR) may be compromised by complications related to the dynamic vascular environment. The aim of this study was to analyze the behavior of FEVAR bridging stent configurations during the cardiac cycle and during follow-up to improve our understanding on treatment durability. DESIGN Twenty-one patients presenting with complex abdominal aortic aneurysms (AAAs; 9 juxtarenal/6 pararenal/3 paravisceral/1 thoracoabdominal aortic aneurysm type IV), treated with a fenestrated Anaconda (Terumo Aortic, Inchinnan, Scotland, UK) with Advanta V12 bridging stents (Getinge, Merrimack, NH, USA), were prospectively enrolled in a multicenter observational cohort study and underwent electrocardiogram (ECG)-gated computed tomographic angiography (CTA) preoperatively, at discharge, 7-week, and 12-month follow-ups. METHODS Fenestrated endovascular aortic aneurysm repair stability was assessed considering the following variables: branch angle as the angle between the aorta and the target artery, end-stent angle as the angle between the end of the bridging stent and the native artery downstream from it, curvature and tortuosity index (TI) to describe the bending of the target artery. Body-bridging stent stability was assessed considering bridging stent flare lengths, the distances between the proximal sealing stent-ring and fenestrations and the distance between the fenestration and first apposition in the target artery. RESULTS Renal branch angles significantly increased after FEVAR toward a perpendicular position (right renal artery from median 60.9°, inter quartile range [IQR]=44.2-84.9° preoperatively to 94.4°, IQR=72.6-99.8°, p=0.001 at 12-month follow-up; left renal artery [LRA], from 63.7°, IQR=55.0-73.0° to 94.3°, IQR=68.2-105.6°, p<0.001), while visceral branch angles did not. The mean dynamic curvature only decreased for the LRA from preoperative (3.0, IQR=2.2-3.8 m-1) to 12-month follow-up (1.9, IQR=1.4-2.6 m-1, p=0.027). The remaining investigated variables did not seem to show any changes over time in this cohort. CONCLUSIONS Fenestrated endovascular aortic aneurysm repair for complex AAAs using the Anaconda fenestrated stent-graft and balloon-expandable Advanta V12 bridging stents demonstrated stable configurations up to 12-month follow-up, except for increasing renal branch angles toward perpendicular orientation to the aorta, yet without apparent clinical consequences in this cohort. CLINICAL IMPACT This study provides detailed information on the cardiac-pulsatility-induced (dynamic) and longitudinal geometry deformations of the target arteries and bridging stents after fenestrated endovascular aortic aneurysm repair (FEVAR) up to 12-month follow-up. The configuration demonstrated limited dynamic and longitudinal deformations in terms of branch angle, end-stent angle, curvature, and tortuosity index (TI), except for the increasing renal branch angles that go toward a perpendicular orientation to the aorta. Overall, the results suggest that the investigated FEVAR configurations are stable and durable, though careful consideration of increasing renal branch angles and significant geometry alterations is advised.
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Affiliation(s)
- Jaimy A Simmering
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maaike A Koenrades
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Medical 3D Lab, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Erik Groot Jebbink
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michel M P J Reijnen
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Robert H Geelkerken
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Simmering JA, Zagers DA, Geelkerken RH, Kuipers H, te Riet o.g. Scholten GA, Reijnen MM, Slump CH. The influence of electrocardiogram-gated computed tomography reconstruction into 8 or 10 cardiac phases on cardiac-pulsatility-induced motion quantification of stent grafts in the aorta. JVS Vasc Sci 2023; 4:100131. [PMID: 38033397 PMCID: PMC10682660 DOI: 10.1016/j.jvssci.2023.100131] [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: 06/23/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objective The goal of this study was to determine to what extent aortic stent graft motion quantification is comparable between electrocardiogram (ECG)-gated computed tomography (CT) scans with reconstructions into 8 and 10 cardiac phases on CT scanners from two different vendors. Methods An experimental setup that induces motion of an aortic stent graft, according to a predefined aortic blood pressure wave, was placed in two CT scanners of different vendors. The stent graft motion was captured using an ECG-gated CT technique and quantified using dedicated analysis algorithms. The calculated motion amplitudes and total traveled path lengths of stent segmentations were compared between scans reconstructed into 8 and 10 phases and between the scanners, after validation with sensor measurements and repeated measurements. Results No difference in motion amplitudes in z-direction (craniocaudal direction) was observed between the reconstructions into 8 and 10 phases (0.02 mm; 95% confidence interval [CI], -0.01 to 0.05 mm; P = .358). The z-amplitudes differed by 0.04 mm (95% CI, 0.01-0.07 mm; P = .003) between the different CT scanners. Path lengths differed 0.07 mm (95% CI, 0.01-to 0.13 mm; P = .013) between the reconstructions into 8 and 10 phases and 0.13 mm (95% CI, 0.06-0.17 mm; P < .001) between the different scanners. Conclusions The motion amplitudes can accurately be compared between 8 and 10 phases and between the two scanners, without differences larger than the voxel size of 0.3 × 0.3 × 0.5 mm. Clinical motion analysis results of different ECG-gated CT scans and CT scanners can be compared up to the accuracy of the CT scan.
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Affiliation(s)
- Jaimy A. Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Deborah A. Zagers
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Robert H. Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Gerben A. te Riet o.g. Scholten
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Michel M.P.J. Reijnen
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Cornelis H. Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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van Helvert M, Simmering JA, Koenrades MA, Slump CH, Heyligers JM, Geelkerken RH, Reijnen MM. Evaluation of electrocardiogram-gated computed tomography angiography to quantify changes in geometry and dynamic behavior of the iliac artery after placement of the Gore Excluder Iliac Branch Endoprosthesis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:454-463. [PMID: 35005875 DOI: 10.23736/s0021-9509.22.11980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE) is designed to treat iliac aneurysms with preservation of blood flow through the internal iliac artery (IIA). Little is known about the influence of IBE placement on the IIA geometry. This study aimed to provide detailed insights in the dynamic behavior and geometry of the common iliac artery (CIA) and IIA trajectory and how these are influenced after treatment with an IBE. METHODS Pre- and postoperative electrocardiogram-gated computed tomography angiography (ECG-gated CTA) scans were acquired in a prospective study design and analyzed with in-house written algorithms designed for aorto-iliac and endoprosthesis deformation evaluation. Cardiac pulsatility-induced motion patterns and pathlengths were computed by tracking predefined locations on the aorto-iliac tract. Centerlines through the CIA-IIA trajectory were used to investigate the static and dynamic geometry, including curvature, torsion, length and Tortuosity Index (TI). RESULTS Fourteen CIA-IIA trajectories were analyzed before and after IBE placement. Cardiac pulsatility-induced motion and pathlengths increased after IBE placement, especially at mid IIA and the first IIA bifurcation (P≤0.04). After IBE placement, static and dynamic curvature, length and TI decreased significantly (P<0.05). Furthermore, the average dynamic torsion increased significantly (P=0.030). The remaining geometrical outcomes were not statistically significant. CONCLUSIONS The placement of an IBE device stiffens and straightens the CIA-IIA trajectory. Its relation with clinical outcome is yet to be investigated, which can be done thoroughly with the ECG-gated CTA algorithms used in this study.
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Affiliation(s)
- Majorie van Helvert
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jaimy A Simmering
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands -
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Maaike A Koenrades
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Medical Technology, Medical 3D lab, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Jan M Heyligers
- Department of Vascular Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Robert H Geelkerken
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Michel M Reijnen
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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Yoon WJ, Rodriguez VM, Lee CJ. Insights on Bridging Stent Grafts in Fenestrated and Branched Aortic Endografting. Vasc Specialist Int 2021; 37:14. [PMID: 34135130 PMCID: PMC8209487 DOI: 10.5758/vsi.210025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/20/2022] Open
Abstract
Major branches of the aortic arch and visceral aorta pose a particular challenge for endovascular repair of aneurysms involving these regions. To preserve perfusion through these essential branches, fenestrated and branched endografts have been used. Current fenestrated and branched aortic endografts have evolved into modular devices in which the aortic main body provides appropriate access to the target branch vessel either through reinforced fenestrations or directional cuffs as the hinge point for bridging stent grafts (BSGs). BSGs are used to connect the aortic main body and target branch vessel, and must provide both unhindered flow and a seal. Appropriate selection of BSG for target vessels in branched and fenestrated endovascular aortic repair is critical for technical success and durability. At present, there are no dedicated devices for use as BSGs, and a variety of stent grafts are currently used off-label. In this report, we review the available published series on the performance of presently available BSGs in relation to their design and selection.
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Affiliation(s)
- William J Yoon
- Division of Vascular Surgery, Department of Surgery, University of California-Davis, Sacramento, CA, USA.,Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Victor M Rodriguez
- Division of Vascular Surgery, Department of Surgery, University of California-Davis, Sacramento, CA, USA.,Division of Cardiothoracic Surgery, Department of Surgery, University of California-Davis, Sacramento, CA, USA
| | - Cheong Jun Lee
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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Overeem S, Schuurmann R, Schumacher M, Jolink F, Ketel M, Nijendijk B, Slump K, Versluis M, de Vries JP. Validation of a Novel Methodology to Evaluate Changes in the Flare Geometry of Renovisceral Bridging Stent-Grafts After Fenestrated Endovascular Aneurysm Repair. J Endovasc Ther 2020; 27:436-444. [DOI: 10.1177/1526602820915932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To validate a novel method to evaluate changes in the geometry of renovisceral bridging stent-grafts (BSGs) in patients undergoing fenestrated endovascular aneurysm repair (fEVAR). Materials and Methods: Retrospective analysis was conducted of serial computed tomography angiograms (CTAs) of 10 fEVAR patients (31 BSGs) with at least 2 years of CTA follow-up. Centerline reconstructions were made through the fenestrated stent-graft (FSG) and each BSG. Flare geometry was reconstructed based on marker coordinates and a mesh of the aortic lumen. The shortest distance was calculated from the top of the flare circumference to the FSG fabric. The amount of flaring was assessed with the flare to fenestration diameter ratio and BSG compression to diameter ratio (D-ratio). All measurements were performed by 2 observers. Interobserver variability was assessed; results are presented as the intraclass correlation coefficient (ICC) and repeatability coefficient (RC). Results: Excellent interobserver agreement was achieved for BSG diameter and flare to fenestration distance calculations (ICC 0.865 and 0.944; RC 2.2% and 4.5%, respectively). Six patients had BSG-related complications during follow-up: 2 type IIIc endoleaks and 4 BSG occlusions. Five of the 6 BSGs with complications showed a considerable change in the D-ratio compared with the first postoperative CTA. Conclusion: Precise assessment of the geometry of visceral BSGs in fEVAR is feasible with the presented method. Geometrical changes that may precede later complications can be detected, which could aid in localization of the origin, but a larger series of patients is necessary to define its true clinical merit.
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Affiliation(s)
- Simon Overeem
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Richte Schuurmann
- Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, the Netherlands
| | - Michiel Schumacher
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Floortje Jolink
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mirte Ketel
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Bob Nijendijk
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Kees Slump
- Robotics and Mechatronics, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Jean-Paul de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, the Netherlands
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Electrocardiography-gated computed tomography angiography analysis of cardiac pulsatility-induced motion and deformation after endovascular aneurysm sealing with chimney grafts. J Vasc Surg 2020; 72:1743-1752.e5. [PMID: 32249042 DOI: 10.1016/j.jvs.2020.01.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the proximal stability of the chimney endovascular aneurysm sealing configuration (chEVAS) during the cardiac cycle by investigating the cardiac pulsatility-induced movement and deformation. METHODS We retrospectively analyzed postoperative electrocardiogram-gated computed tomography angiography scans of 11 chEVAS cases (9 primary chEVAS plus 2 chEVAS-in-chEVAS). ChEVAS procedures were conducted between September 2013 and June 2016. Motion and deformation of the EVAS stents, the chimney grafts, and the stented branch vessels were evaluated during the cardiac cycle using an established combination of image registration and segmentation techniques. RESULTS Electrocardiogram-gated computed tomography angiography scans of 11 chEVAS configurations including 22 EVAS stents and 20 chimney grafts were analyzed. The three-dimensional displacement was at most 1.7 mm for both the EVAS stents and the chimney grafts. The maximum change in distance between components was no more than 0.4 mm and did not differ between EVAS-to-EVAS stent and EVAS stent-to-chimney stent (0.2 ± 0.1 mm vs 0.2 ± 0.1 mm; P = .823). The mean change in chimney deflection angle was 1.2 ± 0.7°; the maximum change was greatest for the superior mesenteric artery (SMA) (2.6°). The EVAS stent-to-chimney angles for the left renal artery, right renal artery, and SMA varied on average by 0.7 ± 0.3° (range, 0.4°-1.3°), 1.0 ± 0.3° (range, 0.5°-1.7°), and 0.8 ± 0.4° (range, 0.3°-1.3°), respectively, during the cardiac cycle. The end-stent angles for the left renal artery, right renal artery, and SMA varied on average by 1.7 ± 0.9° (range, 0.5°-3.3°), 1.9 ± 0.8° (range, 0.7°-3.3°), and 1.3 ± 0.4° (range, 0.7°-1.6°), respectively, during the cardiac cycle. Overall, the end-stent angles varied on average by 1.7 ± 0.8° (range, 0.5°-3.3°). CONCLUSIONS The chEVAS configuration proved to be stable during the cardiac cycle, as demonstrated by minimal cyclical changes in distance between device components and angulation between the EVAS stents and the chimney grafts. The limited deflection angles of the chimney grafts decrease the risk of bending fatigue, but the more apparent change in end-stent angle distal to the chimney graft may raise concerns regarding late branch occlusion or stenosis.
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Khoury MK, Timaran DE, Knowles M, Timaran CH. Visceral stent patency after fenestrated endovascular aneurysm repair using bare-metal stent extensions versus covered stents only. J Vasc Surg 2020; 71:23-29. [DOI: 10.1016/j.jvs.2019.03.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/17/2019] [Indexed: 11/25/2022]
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Geometric Alteration of Renal Arteries After Fenestrated Grafting and the Impact on Renal Function. Ann Vasc Surg 2017; 41:89-95. [DOI: 10.1016/j.avsg.2016.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/16/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
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Iancu AC, Bălănescu Ș, Marc M, Homorodean C, Bindea D, Reimers B, Civilini E, Torsello G, Castriota F, Nerla R, Micari A, Cremonesi A. How should I treat renal artery in-stent restenosis and stent fracture after endovascular abdominal aortic aneurysm repair? EUROINTERVENTION 2016; 12:1312-1316. [PMID: 27866143 DOI: 10.4244/eijv12i10a216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mendes BC, Oderich GS, Reis de Souza L, Banga P, Macedo TA, DeMartino RR, Misra S, Gloviczki P. Implications of renal artery anatomy for endovascular repair using fenestrated, branched, or parallel stent graft techniques. J Vasc Surg 2016; 63:1163-1169.e1. [DOI: 10.1016/j.jvs.2015.11.047] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/12/2015] [Indexed: 10/22/2022]
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Mastracci T, Carrell T, Constantinou J, Dias N, Martin-Gonzalez T, Katsargyris A, Modarai B, Resch T, Verhoeven E, Burnell M, Haulon S. Editor's Choice – Effect of Branch Stent Choice on Branch-related Outcomes in Complex Aortic Repair. Eur J Vasc Endovasc Surg 2016; 51:536-42. [DOI: 10.1016/j.ejvs.2015.12.046] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
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Georgakarakos E, Xenakis A, Bisdas T, Georgiadis GS, Schoretsanitis N, Antoniou GA, Lazarides M. The shear stess profile of the pivotal fenestrated endograft at the level of the renal branches: A computational study for complex aortic aneurysms. Vascular 2015; 24:368-77. [PMID: 26232391 DOI: 10.1177/1708538115598726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE This study investigated the impact of the variant angulations on the values and distribution of wall shear stress on the renal branches and the mating vessels of a pivotal fenestrated design. METHODS An idealized endograft model of two renal branches was computationally reconstructed with variable angulations of the left renal branch. These ranged from the 1:30' to 3:30' o'clock position, corresponding from 45° to 105° with increments of 15°. A fluid-structure-interaction analysis was performed to estimate the wall shear stress. RESULTS The proximal part of the renal branch preserved quite constant wall shear stress. The transition zone between its distal end and the renal artery showed the highest values compared to the proximal and middle segments, ranging from 8.9 to 12.4 Pa. The lowest stress values presented at 90° whereas the highest at 45°. The post-mating arterial segment showed constantly low stress values regardless of the pivotal branch angle (6.3 to 6.6 Pa). The 45° configuration showed a distribution of the highest stress posteriorly whereas the 105°-angulation anteriorly. CONCLUSIONS The variant horizontal branch orientation influences the wall shear stress distribution across its length and affects its values only at its transition with the mating vessel. These findings and their potential association with adverse effects deserve further clinical validation.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - Antonios Xenakis
- Fluids Section, School of Mechanical Engineering, National Technical University of Athens, Athens, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Münster, Germany
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Miltos Lazarides
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
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Suess T, Anderson J, Danielson L, Pohlson K, Remund T, Blears E, Gent S, Kelly P. Examination of near-wall hemodynamic parameters in the renal bridging stent of various stent graft configurations for repairing visceral branched aortic aneurysms. J Vasc Surg 2015. [PMID: 26209577 DOI: 10.1016/j.jvs.2015.04.421] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study examined the flow behavior of four stent graft configurations for endovascular repair of complex aneurysms of the descending aorta. METHODS Computational fluid dynamics models with transient boundary conditions and rigid wall simplifying assumptions were developed and used with four distinct geometries to compare various near-wall hemodynamic parameters. RESULTS Graphic plots for time-averaged wall shear stress, oscillating shear index, and relative residence time were presented and compared among the four stent graft configurations of interest. CONCLUSIONS Abrupt 90° and 180° changes in stent geometry (particularly in the side branches) cause a high momentum change and thus increased flow separation and mixing, which has significant implications in blood flow characteristics near the wall. By comparison, longer bridging stents provide more gradual changes in momentum, thus allowing blood flow to develop before reaching the target vessel.
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Affiliation(s)
- Taylor Suess
- Department of Mechanical Engineering, South Dakota State University, Brookings, SDak
| | | | | | | | | | | | - Stephen Gent
- Department of Mechanical Engineering, South Dakota State University, Brookings, SDak
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Wang LC, Scott DJ, Clemens MS, Hislop SJ, Arthurs ZM. Mechanism of Stent Failure in a Patient with Fibromuscular Dysplasia following Renal Artery Stenting. Ann Vasc Surg 2015; 29:123.e19-21. [DOI: 10.1016/j.avsg.2014.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 07/03/2014] [Accepted: 08/29/2014] [Indexed: 11/30/2022]
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Georgakarakos E, Xenakis A, Georgiadis G, Argyriou C, Antoniou G, Schoretsanitis N, Lazarides M. The Hemodynamic Impact of Misalignment of Fenestrated Endografts: A Computational Study. Eur J Vasc Endovasc Surg 2014; 47:151-9. [DOI: 10.1016/j.ejvs.2013.09.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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Grimme FA, Zeebregts CJ, Verhoeven EL, Bekkema F, Reijnen MM, Tielliu IF. Visceral stent patency in fenestrated stent grafting for abdominal aortic aneurysm repair. J Vasc Surg 2014; 59:298-306. [DOI: 10.1016/j.jvs.2013.08.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 10/26/2022]
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Dynamics of the Aorta Before and After Endovascular Aneurysm Repair: A Systematic Review. Eur J Vasc Endovasc Surg 2009; 38:586-96. [DOI: 10.1016/j.ejvs.2009.06.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 06/26/2009] [Indexed: 11/20/2022]
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Abstract
The biomechanical nature of the arterial system and its major disease states provides a series of challenges to treatment strategies. Endovascular device design objectives have mostly centered on short-term challenges, such as deployability and immediate restoration of reliable flow channels. The resulting design features may be at odds with long-term clinical success. In-stent restenosis, endoleaks, and loss of device structural integrity (e.g., strut fractures) are all manifestations of a lack of compatibility between the host vessel biomechanical environment and the implant design. Initial attempts to adapt device designs for increased compatibility, including drug-eluting and bioabsorbable stents, barely begin to explore the ways in which implant design can be modulated in time to minimize risk of failure. Biomechanical modeling has the potential to provide a virtual vascular environment in which new designs can be tested for their implications on long-term tissue reaction. These models will be based on high quality, highly resolved imaging information, as well as mechanobiology experiments from the cellular to the whole tissue level. These models can then be extended to incorporate biodegradation mechanics, facilitating the next generations of devices whose designs (including drug delivery profiles) change with time to enhance healing. The possibility of initiating changes in device design or drug release according to information on vascular healing (through clinical intervention or automated methods) provides the opportunity for truly individualized dynamic device design optimization.
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Affiliation(s)
- James E Moore
- Biomedical Engineering Department, Texas A&M University, College Station, Texas 77843-3120, USA.
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Koning OHJ, Kaptein BL, van der Vijver R, Dias NV, Malina M, Schalij MJ, Valstar ER, van Bockel JH. Fluoroscopic Roentgen stereophotogrammetric analysis (FRSA) to study three-dimensional stent graft dynamics. J Vasc Surg 2009; 50:407-12. [PMID: 19631876 DOI: 10.1016/j.jvs.2009.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 03/02/2009] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
Abstract
We report the clinical feasibility of fluoroscopic Roentgen stereophotogrammetric analysis (FRSA), a validated method to quantify real time three-dimensional (3D) dynamic motion of stent grafts and the first clinical results after abdominal and thoracic endovascular repair (EVAR). Stent graft motion was measured at 30 (stereo) frames per second, during the cardiac cycle and in the patient after abdominal EVAR, due to respiratory action. Translational motions of the center of mass, diameter change, and rotational and axial motion could be measured. Quantification of 3D motion was not available until now. FRSA can provide crucial information on the forces exerted on stent grafts and will, therefore, provide essential information for improvements in stent graft design.
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Affiliation(s)
- Olivier H J Koning
- Department of Surgery, Division of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Muhs BE, Verhagen HJM. Commentary: AAA Rupture Prediction: The Potential Benefit of Dynamic (ECG-Gated) 64-Slice CTA to Assess Aortic Pathology. J Endovasc Ther 2009; 16:320-1. [DOI: 10.1583/08-2625c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lin PH, Bechara C, Kougias P, Huynh TT, LeMaire SA, Coselli JS. Assessment of aortic pathology and peripheral arterial disease using multidetector computed tomographic angiography. Vasc Endovascular Surg 2008; 42:583-98. [PMID: 18621886 DOI: 10.1177/1538574408320029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The development of multidetector computed tomography represents a remarkable diagnostic advancement because this imaging modality has been widely used in the evaluation of the cardiovascular system. With scanner-adjusted image acquisition and contrast medium administration, multidetector computed tomographic angiography provides a cost-effective and accurate imaging assessment in patients with aortic pathologies or peripheral arterial occlusive disease. Multidetector computed tomographic angiography is associated with several advantages, including high image spatial resolution and rapid imaging acquisition speed. This diagnostic methodology allows accurate detection of a variety of intravascular lesions in the carotid artery, thoracic and abdominal aorta, renal arteries, and peripheral arterial systems. This article provides an overview of multidetector computed tomographic angiography in the assessment of arterial disease and reviews current literature about this diagnostic technology in the evaluation of aortic and peripheral arterial pathologies.
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Affiliation(s)
- Peter H Lin
- Division of Vascular Surgery and Endovascular Therapy, Houston, Texas, USA.
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