Secondary interventions after endovascular repair of abdominal aortic aneurysms are frequent because stent-graft (SG) related complications may occur (mainly endoleak and SG thrombosis). Complications have been related to insufficient SG flexibility, especially when devices are deployed in tortuous arteries. Little is known on the relationship between SG design and flexibility. Therefore, the aim of this study was to simulate numerically the bending of two manufactured SGs (Aorfix--Lombard Medical (A) and Zenith--Cook Medical Europe (Z)) using finite element analysis (FEA). Global SG behavior was studied by assessing stent spacing variation and cross-section deformation. Four criteria were defined to compare flexibility of SGs: maximal luminal reduction rate, torque required for bending, maximal membrane strains in graft and maximal Von Mises stress in stents. For angulation greater than 60°, values of these four criteria were lower with A-SG, compared to Z-SG. In conclusion, A-SG was more flexible than Z-SG according to FEA. A-SG may decrease the incidence of complications in the setting of tortuous aorto-iliac aneurysms. Our numerical model could be used to assess flexibility of further manufactured as well as newly designed SGs.

Stent design strongly influences mechanical performances of aortic stent-grafts. Spiral and circular stents provide greater flexibility, as well as lower stress values than Z-stents, and thus better durability.

The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications.

Stent-grafts (SGs) are commonly used for treating abdominal aortic aneurysms (AAAs) and numerical models tend to be developed for predicting the biomechanical behavior of these devices. However, due to the complexity of SGs, it is important to validate the models. In this work, a validation of the numerical model developed in Demanget et al. (J. Mech. Behav. Biomed. Mater. 5:272-282, 2012) is presented. Two commercially available SGs were subjected to severe bending tests and their 3D geometries in undeformed and bent configurations were imaged from X-ray microtomography. Dedicated image processing subroutines were used in order to extract the stent centerlines from the 3D images. These skeletons in the undeformed configurations were used to set up SG numerical models that are subjected to the boundary conditions measured experimentally. Skeletons of imaged and deformed stents were then quantitatively compared to the numerical simulations. A good agreement is found between experiments and simulations. This validation offers promising perspectives to implementing the numerical models in a computer-aided tool and simulating the endovascular treatments.

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