A Numerical Preoperative Planning Model to Predict Arterial Deformations in Endovascular Aortic Aneurysm Repair
- 139 Downloads
Endovascular aneurysm repair is rapidly emerging as the primary preferred method for treating abdominal aortic aneurysm. In this image-guided interventional procedure, to obtain the roadmap and decrease contrast injections, preoperative CT images are overlaid onto live fluoroscopy images using various 2D/3D image fusion techniques. However, the structural changes due to the insertion of stiff tools degrade the fusion accuracy. To correct the mismatch and quantify the intraoperative deformations, we present a patient-specific biomechanical model of the aorto-iliac structure and its surrounding tissues. The predictive capability of the model was evaluated against intraoperative data for a group of four patients. Incorporating the perivascular tissues into the model significantly improved the results and the mean distance between the real and simulated endovascular tools was 2.99 ± 1.78 mm on the ipsilateral side and 4.59 ± 3.25 mm on the contralateral side. Moreover, the distance between the deformed iliac ostia and their corresponding landmarks on intraoperative images was 2.99 ± 2.48 mm.
KeywordsEndovascular aneurysm repair (EVAR) Endovascular navigation Image registration Patient-specific Simulation Surrounding tissues Intraoperative Preoperative
We thank the FQRNT (Fonds de recherche du Québec – Nature et technologies). The research project were funded by the Nature Sciences and Engineering Research Council of Canada (NSERC) collaborative research and development grant, in partnership with Siemens Healthineers, CAE Healthcare, and the Medteq consortium.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Brown, L. C., E. A. Brown, R. M. Greenhalgh, J. T. Powell, and S. G. Thompson. Renal function and abdominal aortic aneurysm (AAA): the impact of different management strategies on long-term renal function in the UK EndoVascular Aneurysm Repair (EVAR) Trials. Ann. Surg. 251:966–975, 2010.CrossRefPubMedGoogle Scholar
- 7.Dubuisson M. P. and A. K. Jain. A modified Hausdorff distance for object matching. In: Proceedings of 12th International Conference on Pattern Recognition 1994, pp. 566–568 vol. 561.Google Scholar
- 9.Fung, Y.-C. Biomechanics: Mechanical Properties of Living Tissues. New York: Springer, 2013.Google Scholar
- 11.Gindre, J., A. Bel-Brunon, A. Kaladji, A. Duménil, M. Rochette, A. Lucas, P. Haigron, and A. Combescure. 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. Int. J. Num. Methods Biomed. Eng. 31:e02716, 2015.CrossRefGoogle Scholar
- 12.Gindre, J., A. Bel-Brunon, M. Rochette, A. Lucas, A. Kaladji, P. Haigron, and A. Combescure. Patient-specific finite-element simulation of the insertion of guidewire during an EVAR procedure: guidewire position prediction validation on 28 cases. IEEE Trans. Biomed. Eng. 64:1057–1066, 2017.CrossRefPubMedGoogle Scholar
- 13.Gupta A., S. Sett, S. Varahoor and B. Wolf. Investigation of interaction between guidewire and native vessel using finite element analysis. In: Proceedings of the 2010 Simulia Customer Conference 2010Google Scholar
- 14.Hallquist, J. O. LS-DYNA Theory Manual. San Diego: Livermore Software Technology Corporation, pp. 25–31, 2006.Google Scholar
- 17.Kauffmann, C., F. Douane, E. Therasse, S. Lessard, S. Elkouri, P. Gilbert, N. Beaudoin, M. Pfister, J. F. Blair, and G. Soulez. Source of errors and accuracy of a two-dimensional/three-dimensional fusion road map for endovascular aneurysm repair of abdominal aortic aneurysm. J. Vasc. Interv. Radiol. 26:544–551, 2015.CrossRefPubMedGoogle Scholar
- 30.Roy, D. Mechanical Simulation of the Endovascular Repair of Abdominal Aortic Aneurysms. Montréal: Université de Montréal, 2015.Google Scholar
- 33.Sommer, G., M. Eder, L. Kovacs, H. Pathak, L. Bonitz, C. Mueller, P. Regitnig, and G. A. Holzapfel. Multiaxial mechanical properties and constitutive modeling of human adipose tissue: a basis for preoperative simulations in plastic and reconstructive surgery. Acta Biomater. 9:9036–9048, 2013.CrossRefPubMedGoogle Scholar
- 34.Toth D., M. Pfister, A. Maier, M. Kowarschik and J. Hornegger. Adaption of 3D Models to 2D X-Ray Images during Endovascular Abdominal Aneurysm Repair. In: Medical Image Computing and Computer-Assisted Intervention – MICCAI 20152015, pp. 339–346Google Scholar