Patient-Specific Simulation of Devices-Tissues Interactions for Endovascular Aneurysm Repair

2013 ◽  
Author(s):  
A. Duménil ◽  
J. Gindre ◽  
A. Kaladji ◽  
P. Haigron ◽  
D. Perrin ◽  
...  
Keyword(s):  
Stent Graft ◽  
Eligible Patient ◽  
Endovascular Aneurysm Repair ◽  
Length Of Hospital Stay ◽  
Patient Specific ◽  
Predictive Tool ◽  
Complex Anatomy ◽  
Aortic Neck ◽  
Fenestrated Stent Graft ◽  
Aneurysm Repair

The endovascular treatment of abdominal aortic aneurysm (EVAR) consists of inserting a delivery system through intravascular pathway and deploying one or several stent-grafts at the aneurysm site in order to exclude it. This procedure has proven to have a high success rate for eligible patient population and benefits in terms of reduced blood loss, intraoperative morbidity and length of hospital stay. As the selection criteria for EVAR extend progressively due to enhancements in the devices and delivery systems, clinicians are confronted with cases becoming increasingly difficult and demanding procedures with steep learning curve (aortic dissection, branched and fenestrated stent-graft, and complex anatomy with high tortuosity or short aortic neck). In this context patient-specific Finite Element Modeling (FEM) could provide a predictive tool to support endovascular device assessment and selection as well as intervention planning. Given the lack of dedicated solutions, the aim of this study was to assess the feasibility of simulating the main steps of EVAR procedure, from guidewire insertion to stent-graft deployment.

scholarly journals EndoAnchors Minimize Endoleaks in Chimney-Graft Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms

2019 ◽  
Vol 46 (3) ◽  
pp. 183-188 ◽  
Author(s):  
Edgar Luis Galiñanes ◽  
Eduardo A. Hernandez-Vila ◽  
Zvonimir Krajcer
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Graft Thrombosis ◽  
Complex Anatomy ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Type Ia ◽  
Aneurysm Repair ◽  
Chimney Graft

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11–18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.

Impact of Insertion Technique and Iliac Artery Anatomy on Fenestrated Endovascular Aneurysm Repair

2019 ◽  
Vol 26 (6) ◽  
pp. 797-804
Author(s):  
Sean A. Crawford ◽  
Matthew G. Doyle ◽  
Cristina H. Amon ◽  
Thomas L. Forbes
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Flexural Rigidity ◽  
Endovascular Aneurysm Repair ◽  
Patient Specific ◽  
Bending Rigidity ◽  
Insertion Technique ◽  
3 Dimensional ◽  
Aneurysm Repair

Purpose: To develop a mechanically realistic aortoiliac model to evaluate anatomic variables associated with stent-graft rotation and to assess common deployment techniques that may contribute to rotation. Materials and Methods: Idealized aortoiliac geometries were constructed either through direct 3-dimensional (3D) printing (rigid) or through casting with polyvinyl alcohol using 3D-printed molds (flexible). Flexible model bending rigidity was controlled by altering wall thickness. Three flexible patient-specific models were also created based on the preoperative computed tomography angiograms. Zenith infrarenal and fenestrated devices were used in this study. The models were pressurized to 100 mm Hg with normal saline. Deployments were performed under fluoroscopy at 37°C. Rotation was calculated by tracking the change in position of gold markers affixed to the devices. Results: In the rigid idealized models, stent-graft rotation increased with increasing torsion; torsion levels of 1.6, 2.6, and 3.6 mm−1 had mean rotations of 5.2°±0.03°, 11.2°±4.8°, and 27.6°±13.0°, respectively (p<0.001). In the flexible models, the highest rotation (58°±3.0°) was observed in models with high torsion and high rigidity (7.5 mm−1 net torsion and 254 N·m2 flexural rigidity). No rotation was observed in the absence of torsion. Applying torque to the device during insertion significantly increased stent-graft rotation by an average of 28° across all levels of torsion (p<0.01). Multiple device insertions prior to deployment did not change the observed device rotation. The patient-specific models accurately predicted the degree of rotation seen intraoperatively to within 5°. Conclusion: Insertion technique plays an important role in the degree of stent-graft rotation during deployment. Our model suggests that in vivo correction of device orientation can increase the observed rotation and supports the concept of fully removing the device, adjusting the orientation, and subsequently reinserting. Additionally, increasing iliac artery torsion in the presence of increased vessel rigidity results in stent-graft rotation.

Influence of Different Self-Expanding Stent-Graft Types on Remodeling of the Aortic Neck After Endovascular Aneurysm Repair

2010 ◽  
Vol 17 (6) ◽  
pp. 677-684 ◽  
Author(s):  
Alexander Oberhuber ◽  
Alexander Schwarz ◽  
Martin H. Hoffmann ◽  
Oliver Klass ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aortic Neck ◽  
Aneurysm Repair

scholarly journals The Correlation of Aortic Neck Length to Late Outcomes After Endovascular Aneurysm Repair With the Ovation Stent Graft

2020 ◽  
Vol 72 (1) ◽  
pp. e72-e73
Author(s):  
Asma Mathlouthi ◽  
Andrew Barleben ◽  
Omar Al-Nouri ◽  
Mahmoud B. Malas
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Neck Length ◽  
Aortic Neck ◽  
Aneurysm Repair

scholarly journals Open: Precannulated Fenestrated Endovascular Aneurysm Repair using Guidewire Fixator

2017 ◽  
Vol 12 (4) ◽  
pp. 265-268 ◽  
Author(s):  
Linus Bosaeus ◽  
Kevin Mani ◽  
Anders Wanhainen ◽  
Krister Liungman
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Fenestrated Stent Graft ◽  
Aneurysm Repair

Objective By using a guidewire fixator, the distal guidewire position can be secured in an artery. This new principle enables a method for fenestrated endovascular aortic repair where the connection between the aortic branches and the stent graft fenestrations is made before inserting and deploying the stent graft. Methods This is conducted using a fenestrated stent graft with preloaded catheters, through which the prepositioned and distally secured guidewires from the branches are inserted. Results This report covers the method when implementing a single fenestration stent graft in pig. Conclusions Successful tests with single and dual fenestrated grafts have been conducted in pigs.

scholarly journals Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft)

2015 ◽  
Vol 62 (6) ◽  
pp. 1473-1478 ◽  
Author(s):  
Shinichi Iwakoshi ◽  
Shigeo Ichihashi ◽  
Hirofumi Itoh ◽  
Nobuoki Tabayashi ◽  
Shoji Sakaguchi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Fenestrated Stent Graft ◽  
Thoracic Endovascular Aneurysm Repair ◽  
Aneurysm Repair

Aortic Neck Dilatation and Graft Migration after Endovascular Aneurysm Repair with the Ovation Stent Graft

2020 ◽  
Vol 231 (4) ◽  
pp. S341
Author(s):  
Asma Mathlouthi ◽  
Andrew Barleben ◽  
Rebecca Ann Marmor ◽  
Hanaa Dakour-Aridi ◽  
Omar Al-Nouri ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aortic Neck ◽  
Aneurysm Repair ◽  
Graft Migration

scholarly journals Midterm Results of Proximal Aneurysm Sealing With the Ovation Stent-Graft According to On- vs Off-Label Use

2017 ◽  
Vol 24 (2) ◽  
pp. 191-197 ◽  
Author(s):  
Gianmarco de Donato ◽  
Francesco Setacci ◽  
Luciano Bresadola ◽  
Patrizio Castelli ◽  
Roberto Chiesa ◽  
...  
Keyword(s):  
Stent Graft ◽  
Morphological Changes ◽  
Endovascular Aneurysm Repair ◽  
Neck Length ◽  
Off Label ◽  
Aortic Neck ◽  
Type Ia ◽  
Instructions For Use ◽  
Aneurysm Repair

Purpose: To compare the use of the Ovation stent-graft according to the ≥7-mm neck length specified by the original instructions for use (IFU) vs those treated off-label (OL) for necks <7 mm long. Methods: A multicenter retrospective registry (TriVascular Ovation Italian Study) database of all patients who underwent endovascular aneurysm repair with the Ovation endograft at 13 centers in Italy was interrogated to identify patients with a minimum computed tomography (CT) follow-up of 24 months, retrieving records on 89 patients (mean age 76.4±2.4 years; 84 men) with a mean follow-up of 32 months (range 24–50). Standard CT scans (preoperative, 1-month postoperative, and latest follow-up) were reviewed by an independent core laboratory for morphological changes. For analysis, patients were stratified into 2 groups based on proximal neck length ≥7 mm (IFU group, n=57) or <7 mm (OL group, n=32). Outcome measures included freedom from type Ia endoleak, any device-related reintervention, migration, and neck enlargement (>2 mm). Results: At 3 years, there was no aneurysm-related death, rupture, stent-graft migration, or neck enlargement. There were no differences in terms of freedom from type Ia endoleak (98.2% IFU vs 96.8% OL, p=0.6; hazard ratio [HR] 0.55, 95% CI 0.02 to 9.71 or freedom from any device-related reintervention (92.8% IFU vs 96.4% OL, p=0.4; HR 2.42, 95% CI 0.34 to 12.99). In the sealing zone, the mean change in diameters was −0.05±0.8 mm in the IFU group and −0.1±0.5 mm in the OL group. Conclusion: Use of the Ovation stent-graft in patients with neck length <7 mm achieved midterm outcomes similar to patients with ≥7-mm-long necks. These midterm data show that the use of the Ovation system for the treatment of infrarenal abdominal aortic aneurysm is not restricted by the conventional measurement of aortic neck length, affirming the recent Food and Drug Administration–approved changes to the IFU.

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