‘Trial of Stiff Guidewire’: A Useful Adjunct to Determining Suitability for Endovascular Aneurysm Repair

Gokani, V.J.; Fishwick, N.G.; Choke, Edward; Bown, Matthew J.; Sayers, Robert D.

doi:10.1016/j.ejvsextra.2012.08.002

Cited by 5 publications

(4 citation statements)

References 1 publication

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“…It is also commonly accepted that the state of calcification of the iliac arteries can influence the deformations created by the endovascular devices . Therefore, two different types of behavior, corresponding, respectively, to a healthy arterial tissue and to a calcified plaque, were assigned to the elements depending on the corresponding voxel density in the CT scan, as described in .…”

Section: Methodsmentioning

confidence: 99%

“…It can also induce major movements of anatomical markers such as the ostia of the digestive arteries, leading, in the most critical cases, to a risk of covering a secondary artery . Conversely, in some cases, the tools are incapable of straightening excessively calcified and tortuous arteries, thus precluding the delivery of the stent graft, which usually leads to an amendment of the procedure or to its cancelation .…”

Section: Introductionmentioning

confidence: 99%

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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

Bel-Brunon

Kaladji

et al. 2015

Numer Methods Biomed Eng

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Deformations of the vascular structure due to the insertion of tools during endovascular treatment of aneurysms of the abdominal aorta, unless properly anticipated during the preoperative planning phase, may be the source of intraoperative or postoperative complications. We propose here an explicit finite element simulation method which enables one to predict such deformations. This method is based on a mechanical model of the vascular structure which takes into account the nonlinear behavior of the arterial wall, the prestressing effect induced by the blood pressure and the mechanical support of the surrounding organs and structures. An analysis of the model sensitivity to the parameters used to represent this environment is done. This allows determining the parameters that have the largest influence on the quality of the prediction and also provides realistic values for each of them as no experimental data are available in the literature. Moreover, for the first time, the results are compared with 3D intraoperative data. This is done for a patient-specific case with a complex anatomy in order to assess the feasibility of the method. Finally, the predictive capability of the simulation is evaluated on a group of nine patients. The error between the final simulated and intraoperatively measured tool positions was 2.1 mm after the calibration phase on one patient. It results in a 4.6 ± 2.5 mm in average error for the blind evaluation on nine patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bel-Brunon

Kaladji

et al. 2015

Numer Methods Biomed Eng

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“…Endovascular aneurysm repairs (EVARs) are undertaken with device delivery over wires of varying stiffness, and guiding wires to achieve an optimal target position. Typically, very stiff wires are used to deliver large aortic endoprostheses during EVAR or thoracic EVAR, 1 , 2 or even to test device deliverability, 3 while wires perceived as being slightly less stiff can be used to delivery auxiliary devices such as an iliac branch endoprosthesis. 4 More than one wire may be necessary to “stiffen” the aorto-iliac system and reduce tortuosity.…”

Section: Introductionmentioning

confidence: 99%

Are All Wires Created the Same? A Quality Assurance Study of the Stiffness of Wires Typically Employed During Endovascular Surgery Using Tension Dynamometry

Chaudhuri

Heim

Chakfe³

2021

EJVES Vascular Forum

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Objective There have only been a few studies on the stiffness and load bearing characteristics of guidewires used to deliver devices during endovascular procedures, particularly endovascular aneurysm repair. The aim of this study was to compare the load bearing characteristics of typical stiff and floppy wires, including in the context of consistency for each wire type. Methods Two sets of stiff guidewires (Lunderquist Extra-Stiff and Amplatz Super Stiff [0.035” × 260 cm]), were compared with a floppy hydrophilic guidewire (Radifocus Stiff M [0.035” × 260 cm]). Radial stiffness was defined as the force (newtons [N]) needed to deform the wires on an electromechanical dynamometer. Tests were repeated with three runs on three sets of the same wire to check for consistency. Data were logged on proprietary dynamometric software and peak load values assessed per wire. Peak deformation forces (PDFs) from straight configuration to midwire deformation at 15 mm was translated into Microsoft Excel for statistical analysis in Minitab 19 for Windows. Results There was good agreement within each wire set, with no difference in PDFs from runs for each wire ( p > .10). Mean ± standard deviation PDFs were 7.83 ± 0.23 N for the Lunderquist, 9.87 ± 0.92 N for the Amplatz, and 7.84 ± 0.52 N for the Radifocus wires. The Amplatz wire exhibited the greatest resistance to deformation vs. both the Lunderquist and Radifocus wires ( p < .001, one way analysis of variance). Both Amplatz and Radifocus wires had non-linear deformation characteristics. Conclusion This study confirmed that the represented hydrophilic wire is more deformable than the stiff wires. The Amplatz wire has complex construction features that yielded surprising baseline stiffness characteristics. The linear stiffness characteristics of the Lunderquist wire possibly contribute to it being the preferred choice for large endograft delivery.

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“… Cercenelli et al (2018) found in their retrospective study on fluoroscopic images that the effect of straightening the common iliac artery due to guidewire insertion is higher in case of greater tortuosity of the vessels, the highest level of iliac deformations has been observed for cases that present severe tortuosity associated with mild calcifications. Moreover, a higher degree of aortoiliac tortuosity is associated with an increased complexity of endovascular aneurysm repair and a greater risk for the development of iliac injuries ( Wolf et al, 2001 ), preventing in some cases to complete the insertion of the stiff guidewire ( Gokani et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Prediction of guidewire-induced aortic deformations during EVAR: a finite element and in vitro study

Emendi,

Støverud,

Tangen

et al. 2023

Front. Physiol.

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Introduction and aims: During an Endovascular Aneurysm Repair (EVAR) procedure a stiff guidewire is inserted from the iliac arteries. This induces significant deformations on the vasculature, thus, affecting the pre-operative planning, and the accuracy of image fusion. The aim of the present work is to predict the guidewire induced deformations using a finite element approach validated through experiments with patient-specific additive manufactured models. The numerical approach herein developed could improve the pre-operative planning and the intra-operative navigation.Material and methods: The physical models used for the experiments in the hybrid operating room, were manufactured from the segmentations of pre-operative Computed Tomography (CT) angiographies. The finite element analyses (FEA) were performed with LS-DYNA Explicit. The material properties used in finite element analyses were obtained by uniaxial tensile tests. The experimental deformed configurations of the aorta were compared to those obtained from FEA. Three models, obtained from Computed Tomography acquisitions, were investigated in the present work: A) without intraluminal thrombus (ILT), B) with ILT, C) with ILT and calcifications.Results and discussion: A good agreement was found between the experimental and the computational studies. The average error between the final in vitro vs. in silico aortic configurations, i.e., when the guidewire is fully inserted, are equal to 1.17, 1.22 and 1.40 mm, respectively, for Models A, B and C. The increasing trend in values of deformations from Model A to Model C was noticed both experimentally and numerically. The presented validated computational approach in combination with a tracking technology of the endovascular devices may be used to obtain the intra-operative configuration of the vessels and devices prior to the procedure, thus limiting the radiation exposure and the contrast agent dose.

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‘Trial of Stiff Guidewire’: A Useful Adjunct to Determining Suitability for Endovascular Aneurysm Repair

Cited by 5 publications

References 1 publication

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

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

Are All Wires Created the Same? A Quality Assurance Study of the Stiffness of Wires Typically Employed During Endovascular Surgery Using Tension Dynamometry

Prediction of guidewire-induced aortic deformations during EVAR: a finite element and in vitro study

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