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endovascular aneurysm repair simulation

Jie Li, Xiaopeng Tian, Zhenze Wang, Jiang Xiong, Yubo Fan, Xiaoyan Deng, Anqiang Sun, Xiao Liu
BACKGROUND: Abdominal aortic aneurysm (AAA) is a kind of dangerous aortic vascular disease, which is characterized by abdominal aorta partial enlargement. At present, endovascular aneurysm repair (EVAR) is one of the main treatments of abdominal aortic aneurysm. However for some patients after EVAR the aneurysm re-expanded and even ruptured, leading to poor postoperative effect. The stent-graft endoleak after EVAR was realized to influence the AAA in-sac pressure and contribute to the aneurysm re-enlargement...
December 28, 2016: Biomedical Engineering Online
Jyy Li, Y C Chan, K X Qing, S W Cheng
We reported a case of spontaneous retroperitoneal hematoma (SRH) simulating a ruptured infrarenal aortic aneurysm. A 72-year-old man with a history of infrarenal aortic aneurysm and end-stage renal disease on hemodialysis presented with malaise and nonspecific central abdominal pain and left loin discomfort. An emergency computed tomography scan showed a large retroperitoneal hematoma and clinical suspicion of ruptured infrarenal aortic aneurysm. However, the hematoma was discontinuous with the aneurysm sac and raised the clinical suspicion on dual pathology...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
A Saratzis, T Calderbank, D Sidloff, M J Bown, R S Davies
BACKGROUND: Endovascular aneurysm repair (EVAR) requires a high-level of technical-competency to avoid device-related complications. Virtual reality simulation-based training (SBT) may offer an alternative method of psychomotor skill acquisition; however, its role in EVAR training is undefined. This study aimed to: a) benchmark competency levels using EVAR SBT, and b) investigate the impact of supervised SBT on trainee performance. METHODS: EVAR procedure-related metrics were benchmarked by six experienced consultants using a Simbionix Angiomentor EVAR simulator...
December 18, 2016: European Journal of Vascular and Endovascular Surgery
Florian Stefanov, Tim McGloughlin, Liam Morris
There are several issues attributed with abdominal aortic aneurysm endovascular repair. The positioning of bifurcated stent-grafts (SG) may affect SG hemodynamics. The hemodynamics and geometrical parameters of crossing or non-crossing graft limbs have not being totally accessed. Eight patient-specific SG devices and four pre-operative cases were computationally simulated, assessing the hemodynamic and geometrical effects for crossed (n= 4) and non-crossed (n= 4) configurations. SGs eliminated the occurrence of significant recirculations within the sac prior treatment...
October 20, 2016: Medical Engineering & Physics
S A Crawford, M Itkina, M G Doyle, L W Tse, C H Amon, G Roche-Nagle
BACKGROUND: Endovascular aneurysm repair is a minimally-invasive method for the treatment of abdominal aortic aneurysms. For aneurysms that involve the visceral arteries, a custom-made stent graft with fenestrations for the branch arteries is required. The purpose of the current study is to evaluate the structural impact of misaligned fenestrations with respect to luminal patency and proximal aortic neck apposition in an in vitro model. METHODS: A custom apparatus was used to evaluate seven Anaconda and three Zenith fenestrated stent grafts...
September 1, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
D Mazzaccaro, M Sciarrini, G Nano
AIM: One of the technical problems which can be encountered during the endovascular repair (EVAR) of abdominal aortic aneurysms, is represented by the challenge of cannulation of the contralateral gate after the opening of the main body of the endograft, especially in case of tortuous aorta-iliac anatomy. Aim of this work is to propose a hypothesis of simplification, verifying the possibility to maximize the area available for the cannulation of the contralateral gate by simulating an oblique distal end of the leg of the most used devices, without affecting the correct sealing between the main body and the iliac extension...
September 2016: Medical Hypotheses
Florian Stefanov, Liam Morris, Ala Elhelali, Edel P Kavanagh, Violet Lundon, Niamh Hynes, Sherif Sultan
OBJECTIVE: Aortic arch aneurysms and thoracoabdominal aortic arch aneurysms are technically challenging to manage by established surgical and endovascular methods. The Streamliner Multilayer Flow Modulator device (Cardiatis, Isnes, Brussels, Belgium) offers an unorthodox option for these high-risk cases. The Streamliner device for aortic arch repair (STAR) study investigated complex aneurysm cases managed by the Streamliner Multilayer Flow Modulator device and offers an analytic solution for a clinical dilemma...
November 2016: Journal of Thoracic and Cardiovascular Surgery
Juliette Gindre, Aline Bel-Brunon, Michel Rochette, Antoine Lucas, Adrien Kaladji, Pascal Haigron, Alain Combescure
OBJECTIVE: Validation of a numerical method to compute arterial deformations under the insertion of an "extra-siff" guidewire during Endovascular Repair of Abdominal Aortic Aneurysm. METHODS: We propose the validation of a previously developed simulation method. The model is calibrated using anatomical hypothesis and intraoperative observations. Simulation results are blindly evaluated against 3D imaging data acquired during the surgical procedure on 28 patients, based on the predicted position of the intraoperative guidewire...
July 7, 2016: IEEE Transactions on Bio-medical Engineering
B M Doorschodt, H L Brom, A C de Vries, C Meers, M J Jacobs
OBJECTIVE: The aim of the study was to evaluate the feasibility and mid-term biological behavior of the novel customized aortic repair (CAR) method for endovascular aneurysm treatment. METHODS: CAR consists of exclusion of an aneurysm from the circulation using a custom-designed dog bone-shaped balloon, followed by aneurysm sac filling with an in situ curing polymer. After curing and balloon deflation, the circulation is restored through a patent cast neolumen. A liquid two-component polymer was injected via a small bore catheter under X-ray control into a surgically created aneurysm...
August 2016: European Journal of Vascular and Endovascular Surgery
David Perrin, Pierre Badel, Laurent Orgeas, Christian Geindreau, Sabine Rolland du Roscoat, Jean-Noël Albertini, Stéphane Avril
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...
October 2016: Journal of the Mechanical Behavior of Biomedical Materials
L T Burgers, A C Vahl, J L Severens, A M Wiersema, P W M Cuypers, H J M Verhagen, W K Redekop
OBJECTIVE/BACKGROUND: The aim of this study was to estimate the lifetime cost-effectiveness of endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in the Netherlands, based on recently published literature. METHODS: A model was developed to simulate a cohort of individuals (age 72 years, 87% men) with an abdominal aortic aneurysm (AAA) diameter of at least 5.5 cm and considered fit for both repairs. The model consisted of two sub-models that estimated the lifetime cost-effectiveness of EVAR versus OSR: (1) a decision tree for the first 30 post-operative days; and (2) a Markov model for the period thereafter (31 days-30 years)...
July 2016: European Journal of Vascular and Endovascular Surgery
Jun Wen, Ding Yuan, Qingyuan Wang, Yao Hu, Jichun Zhao, Tinghui Zheng, Yubo Fan
Hybrid visceral-renal debranching procedures with endovascular repair have been proposed as an appealing technique to treat conventional thoracoabdominal aortic aneurysm (TAAA). This approach, however, still remained controversial because of the non-physiological blood flow direction of its retrograde visceral revascularization (RVR) which is generally constructed from the aortic bifurcation or common iliac artery. The current study carried out the numerical simulation to investigate the effect of RVR on the hemodynamics of abdominal aorta...
March 31, 2016: Scientific Reports
Ann H Kim, Daniel E Kendrick, Pamela A Moorehead, Anil Nagavalli, Claire P Miller, Nathaniel T Liu, John C Wang, Vikram S Kashyap
BACKGROUND: The use of simulators for endovascular aneurysm repair (EVAR) is not widespread. We examined whether simulation could improve procedural variables, including operative time and optimizing proximal seal. For the latter, we compared suprarenal vs infrarenal fixation endografts, right femoral vs left femoral main body access, and increasing angulation of the proximal aortic neck. METHODS: Computed tomography angiography was obtained from 18 patients who underwent EVAR at a single institution...
July 2016: Journal of Vascular Surgery
Paul Philipp Heinisch, Bernhard Winkler, Rolf Weidenhagen, Rolf Klaws, Thierry Carrel, Ali Khoynezhad, Rene Bombien
OBJECTIVE: Type A aortic dissection is a life-threatening disease requiring immediate surgical treatment. With emerging catheter-based technologies, endovascular stent-graft implantation to treat aneurysms and dissections has become a standardized procedure. However, endovascular treatment of the ascending aorta remains challenging. Thus we designed an ascending aortic dissection model to allow simulation of endovascular treatment. METHODS: Five formalin-fixed human aortas were prepared...
May 2016: Asian Cardiovascular & Thoracic Annals
M Zarrouk, A Lundqvist, J Holst, T Troëng, A Gottsäter
OBJECTIVES: Screening for abdominal aortic aneurysm (AAA) among 65 year old men has been proven cost-effective, but nowadays is conducted partly under new conditions. The prevalence of AAA has decreased, and endovascular aneurysm repair (EVAR) has become the predominant surgical method for AAA repair in many centers. At the Malmö Vascular Center pharmacological secondary prevention with statins, antiplatelet therapy, and blood pressure reduction is initiated and given to all patients with AAA...
June 2016: European Journal of Vascular and Endovascular Surgery
Guido H W van Bogerijen, Jip L Tolenaar, Michele Conti, Ferdinando Auricchio, Francesco Secchi, Francesco Sardanelli, Frans L Moll, Joost A van Herwaarden, Vincenzo Rampoldi, Santi Trimarchi
In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta...
August 2013: Aorta (Stamford, Conn.)
David Roy, Sophie Lerouge, Karina Inaekyan, Claude Kauffmann, Rosaire Mongrain, Gilles Soulez
Although the endovascular repair of abdominal aortic aneurysms is a less invasive alternative than classic open surgery, complications such as endoleak and kinking still need to be addressed. Numerical simulation of endovascular repair is becoming a valuable tool in stent-graft (SG) optimization, patient selection and surgical planning. The experimental and numerical forces required to produce SG deformations were compared in a range of in vivo conditions in the present study. The deformation modes investigated were: bending as well as axial, transversal and radial compressions...
December 2016: International Journal for Numerical Methods in Biomedical Engineering
Hila Ben Gur, Gabor Kosa, Moshe Brand
This paper presents a numerical analysis of the hemodynamics in an abdominal aorta (AA) with an aneurysm repaired by a stent graft (SG) system using the chimney technique. Computational fluid dynamics (CFD) simulations were conducted in a model of an AA repaired with a chimney stent graft (CSG) inserted into a renal artery parallel to an aortic SG and a model of a healthy AA. Comparing the simulation results of these two cases suggests that the presence of the CSG in the AA causes changes in average wall shear stress (WSS), potentially damaging recirculation zones, and additional changes in flow patterns...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Nicola Mangialardi, Mario Lachat, Andrea Esposito, Gilberte Puippe, Matteo Orrico, Vittorio Alberti, Stefano Fazzini, Sonia Ronchey
INTRODUCTION: Staged endovascular treatment of thoracoabdominal aortic aneurysms (TAAA) has been proved to be an effective strategy to reduce the risk of spinal cord ischemia (SCI). Several techniques have been described: some imply the staged coverage of the aorta, other the temporarily perfusion of the sac through a branch left unstented or a dedicated branch that will be occluded later. The aim of those is to facilitate the expansion of the collateral network that perfuses the spinal cord...
March 2016: Catheterization and Cardiovascular Interventions
M Horn, J Nolde, J P Goltz, J Barkhausen, W Schade, C Waltermann, J Modersitzki, J Olesch, N Papenberg, T Keck, M Kleemann
INTRODUCTION: Over the last decade endovascular stenting of aortic aneurysm (EVAR) has been developed from single centre experiences to a standard procedure. With increasing clinical expertise and medical technology advances treatment of even complex aneurysms are feasible by endovascular methods. One integral part for the success of this minimally invasive procedure is innovative and improved vascular imaging to generate exact measurements and correct placement of stent prosthesis. One of the greatest difficulty in learning and performing this endovascular therapy is the fact that the three-dimensional vascular tree has to be overlaid with the two-dimensional angiographic scene by the vascular surgeon...
October 2015: Zentralblatt Für Chirurgie
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