Finite element simulation of the insertion of guidewires during an EVAR procedure: example of a complex patient case, a first step toward patient‐specific parameterized models

Gindre, Juliette; Bel-Brunon, Aline; Kaladji, Adrien; Dumenil, Aurélien; Rochette, Michel; Lucas, Antoine; Haigron, Pascal; Combescure, Alain

doi:10.1002/cnm.2716

Cited by 38 publications

(42 citation statements)

References 31 publications

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“…Similar studies were performed by Dumenil et al and Gindre et al for the insertion of guidewires during endovascular aneurysm repair . Other studies were dedicated to the insertion of catheter during mini‐invasive treatment of cerebrovascular disease .…”

Section: Discussionsupporting

confidence: 56%

Patient‐specific simulation of guidewire deformation during transcatheter aortic valve implantation

Auffret

Castro

et al. 2018

Numer Methods Biomed Eng

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Transcatheter aortic valve implantation is a recent mini-invasive procedure to implant an aortic valve prosthesis. Prosthesis positioning in transcatheter aortic valve implantation appears as an important aspect for the success of the intervention. Accordingly, we developed a patient-specific finite element framework to predict the insertion of the stiff guidewire, used to position the aortic valve. We simulated the guidewire insertion for 2 patients based on their pre-operative CT scans. The model was designed to primarily predict the position and the angle of the guidewires in the aortic valve, and the results were successfully compared with intraoperative images. The present paper describes extensively the numerical model, which was solved by using the ANSYS software with an implicit resolution scheme, as well as the stabilization techniques which were used to overcome numerical instabilities. We performed sensitivity analysis on the properties of the guidewire (curvature angle, curvature radius, and stiffness) and the conditions of insertion (insertion force and orientation). We also explored the influence of the model parameters. The accuracy of the model was quantitatively evaluated as the distance and the angle difference between the simulated guidewires and the intraoperative ones. A good agreement was obtained between the model predictions and intraoperative views available for 2 patient cases. In conclusion, we showed that the shape of the guidewire in the aortic valve was mainly determined by the geometry of the patient's aorta and by the conditions of insertion (insertion force and orientation).

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Section: Discussionsupporting

confidence: 56%

Patient‐specific simulation of guidewire deformation during transcatheter aortic valve implantation

Auffret

Castro

et al. 2018

Numer Methods Biomed Eng

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“…In the "aneurysmatic" abdominal aortic wall, the collagen fibers are more dispersed and isotropy is a widely used model assumption [70,71,54,31]. Here, the following SEF is applied for the "aneurysmatic" aortic wall…”

Section: Vesselmentioning

confidence: 99%

A methodology for in silico endovascular repair of abdominal aortic aneurysms

Hemmler

Lutz

Reeps

et al. 2018

Biomech Model Mechanobiol

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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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“…As long as registration is based on bony structures (hence with rigid transformations), there will be a mismatch with arterial structures which by nature are soft and deformable, which therefore calls for approaches based on elastic registration (27), for example, or digital simulation approaches that predict deformations using a biomechanical model. We have already published several studies on this simulation approach (10,11), which is integrated into the…”

Section: Limitationsmentioning

confidence: 99%