Displacement Forces in Stent Grafts: Influence of Diameter Variation and Curvature Asymmetry

Roos, Håkan; Tokarev, M. P.; Chernoray, Valery; Ghaffari, Mostaffa; Falkenberg, Mårten; Jeppsson, Anders; Nilsson, Håkan

doi:10.1016/j.ejvs.2016.04.014

Cited by 27 publications

(23 citation statements)

References 27 publications

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“…The force applied on the flared iliac limb and the hemodynamic pattern is not the same as in a straight limb which can influence the outcome presented in an experimental study. 21 Limb graft oversizing can induce or accelerate iliac vessel degeneration as described in a report as well. 17 Technical success and immediate results are good in the present study but the occurrence of the type Ib endoleak is to be expected in a mid-and long-term follow-up period.…”

Section: Discussionmentioning

confidence: 83%

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Duvnjak

Balezantis

2019

Int J Angiol

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Endovascular abdominal aneurysm repair (EVAR) relies on the quality of the proximal and distal landing zone. Reinterventions are higher in patients with suboptimal landing zone. The study aimed to evaluate reintervention rate after endovascular treatment of an aorta-iliac aneurysm using the flared iliac limbs.The retrospective study included 179 patients treated with EVAR at a single university hospital institution from January 2011 to January 2014 of which 75 patients (42%) were treated with flared iliac limb stent graft and 104 patients (58%) were treated with a nonflared iliac limb stent graft. There were 165 male patients (92%), mean age was 75.8 ± 6.6 years.Thirty-six patients underwent secondary treatment accounting for overall reintervention rate of 20%. Endoleak type 1b occurred in 13 patients (7%), followed by endoleak type 1a in six patients (3%). Endoleak type 2 occurred in seven patients (4%) requiring the treatment due to abdominal aortic aneurysm (AAA) enlargement, endoleak type 3 in three patients (2%), and leg stent graft thrombosis in seven patients (4%). In 143 patients (80%), there were no secondary interventions during the follow-up period. Reintervention due to endoleak type 1b was statistically significantly higher in a flared iliac limb group (p < 0.02) with the rate of 7.2% compared with 1.9% rate in nonflared iliac limb group. The mean follow-up was 44.3 ± 20.4. Overall mortality was 33%.Flared iliac limb with a distal diameter of ≥ 20 mm, show a higher rate of iliac limb reintervention in a follow-up period due to endoleak type 1b.

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Section: Discussionmentioning

confidence: 83%

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Duvnjak

Balezantis

2019

Int J Angiol

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“…Our results also showed that the displacement force would increase as the taper degree increased, when considering the taper feature. Roos et al also investigated the effects of perfusion pressure and the taper feature on displacement force through in vitro experiments [ 32 ]. The displacement force waveforms were seen to have similar temporal behavior to those of the perfusion pressure waveform.…”

Section: Discussionmentioning

confidence: 99%

Numerical and Experimental Investigation of Novel Blended Bifurcated Stent Grafts with Taper to Improve Hemodynamic Performance

Liu

Wang

Sun

et al. 2018

Computational and Mathematical Methods in Medicine

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The typical helical flow within the human arterial system is widely used when designing cardiovascular devices, as this helical flow can be generated using the “crossed limbs” strategy of the bifurcated stent graft (BSG) and enhanced by the tapered structure of arteries. Here, we propose the use of a deflected blended bifurcated stent graft (BBSG) with various tapers, using conventional blended BSGs with the same degree of taper as a comparison. Hemodynamic performances, including helical strength and wall shear stress- (WSS-) based indicators, were assessed. Displacement forces that may induce stent-graft migration were assessed using numerical simulations and in vitro experiments. The results showed that as the taper increased, the displacement force, helicity strength, and time-averaged wall shear stress (TAWSS) within the iliac grafts increased, whereas the oscillating shear index (OSI) and relative residence time (RRT) gradually decreased for both types of BBSGs. With identical tapers, deflected BBSGs, compared to conventional BBSGs, exhibited a wider helical structure and lower RRT on the iliac graft and lower displacement force; however, there were no differences in hemodynamic indicators. In summary, the presence of tapering facilitated helical flow and produced better hemodynamic performance but posed a higher risk of graft migration. Conventional and deflected BBSGs with taper might be the two optimal configurations for endovascular aneurysm repair, given the helical flow. The deflected BBSG provides a better configuration, compared to the conventional BBSG, when considering the reduction of migration risk.

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“…Roos et al . [4] discussed the complex factors influencing migration of stents. They indicated that the distal displacement forces are significantly increased in the bell-bottom-shaped stent.…”

Section: Discussionmentioning

confidence: 99%

Pitfalls of stenting coarctation of an angulated right circumflex aortic arch in Goldenhar syndrome

et al. 2017

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We report stenting of coarctation of an angulated right circumflex aortic arch (RCAA) using four Cheatham Platinum stents in a child with Goldenhar syndrome. Difficulties in measuring the accurate length of the curved and narrowed transverse aortic arch marked discrepancy between the luminal diameters of the long narrow transverse arch and wide descending thoracic aorta, increased displacement force caused by the 90° bend between the two parts resulted in repeated stent migrations. We discuss the tips to avoid distal stent migration in the setting of an angulated RCAA.

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Displacement Forces in Stent Grafts: Influence of Diameter Variation and Curvature Asymmetry

Cited by 27 publications

References 27 publications

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Endovascular Treatment of Aorta-Iliac Aneurysms with a Flared Iliac Limb

Numerical and Experimental Investigation of Novel Blended Bifurcated Stent Grafts with Taper to Improve Hemodynamic Performance

Pitfalls of stenting coarctation of an angulated right circumflex aortic arch in Goldenhar syndrome

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