Finite Element Analysis of the Mechanical Performances of 8 Marketed Aortic Stent-Grafts

Demanget, Nicolas; Duprey, Ambroise; Badel, Pierre; Orgéas, Laurent; Avril, Stéphane; Geindreau, Christian; Albertini, Jean Noël; Favre, Jean‐Pierre

doi:10.1583/12-4063.1

Cited by 85 publications

(92 citation statements)

References 33 publications

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“…At the moment, simulation results could be post-processed to estimate luminal areas along the vessel centreline (De Bock et al, 2012;Demanget et al, 2013) and stents apposition defects (De Bock et al, 2014;Perrin et al, 2015b). These estimates could point out possible SG kink, gap between SG and arterial wall or collateral artery coverage, and thus potential risk of thrombosis, endoleak or artery occlusion.…”

Section: Discussionmentioning

confidence: 99%

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Perrin

Badel

Orgéas

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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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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Section: Discussionmentioning

confidence: 99%

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Perrin

Badel

Orgéas

et al. 2016

Journal of the Mechanical Behavior of Biomedical Materials

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“…Gandini et al 12 reported a case of successful use of the Ovation stent graft in a challenging case of aortoiliac anatomy combining a narrow (14 mm) calcified bifurcation with a calcified, narrow iliac 21 The combination of these features enhances the flexibility of the iliac limbs and may attribute to the optimal clinical performance of Ovation to confront challenging iliac anatomies, providing better stent interlocking during bending and, thus, lower luminal reduction. 22,23 Therefore, although the IFU of the particular endograft suggest an inner iliac wall diameter of 8 mm, the reported results in the literature advocate the use in much smaller diameters. The lack of nitinol support from the main body and iliac limb gates may render the contralateral iliac limb of the endograft prone to compromisation or collapse against the AAA sac wall in cases of a tight endoluminal space due to narrow aortoiliac bifurcation and eccentric intraluminal thrombus, complicating its catheterization and increasing the intraprocedural difficulties.…”

Section: Discussionmentioning

confidence: 94%

Initial Single-Center Experience with the Ovation Stent-Graft System in the Treatment of Abdominal Aortic Aneurysms: Application to Challenging Iliac Access Anatomies

Trellopoulos

Georgakarakos

Pelekas

et al. 2015

Annals of Vascular Surgery

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“…More intriguingly, as modeling techniques evolve, finite element analysis can be performed for direct comparisons of the mechanical stresses and strains acting on a number of commerciallyavailable device components under a variety of angulations, depicting potential advantages or drawbacks between them. 23 …”

Section: Biomechanical Approach Of Aortic Stent-grafts: What Is To Bementioning

confidence: 99%

Applying Findings of Computational Studies in Vascular Clinical Practice: Fact, Fiction, or Misunderstanding?

Georgakarakos

Gasser

Xenos

et al. 2014

Journal of Endovascular Therapy

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Computational mechanics and simulations comprise a promising tool used in current medical research to explore complex problems, and it is critically important to improving and individualizing services and products. 1 Computational simulations are particularly useful for investigating scientific queries that are difficult (or impossible) to approach with studies performed in human subjects or animal models. Today, this experimental approach has either partly or completely replaced laboratory testing. The computational sequence requires fundamentally three distinct work steps: (1) geometry reconstruction of the study model from medical images, (2) biomechanical simulation (finite element or fluidstructure interaction computation), and (3) interpretation of biomechanical parameters. Computational simulations have gained wider recognition in vascular practice as relates to rupture-risk prediction of abdominal aortic aneurysms (AAA) and the hemodynamic performance of stents and endografts used in the treatment of aortic aneurysms, as explained below.

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Finite Element Analysis of the Mechanical Performances of 8 Marketed Aortic Stent-Grafts

Abstract: 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.

Cited by 85 publications

References 33 publications

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts

Initial Single-Center Experience with the Ovation Stent-Graft System in the Treatment of Abdominal Aortic Aneurysms: Application to Challenging Iliac Access Anatomies

Applying Findings of Computational Studies in Vascular Clinical Practice: Fact, Fiction, or Misunderstanding?

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