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Predictive Numerical Simulations of Double Branch Stent-Graft Deployment in an Aortic Arch Aneurysm

  • L. DeryckeEmail author
  • D. Perrin
  • F. Cochennec
  • J.-N. Albertini
  • S. Avril
Article
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Abstract

Total endovascular repair of the aortic arch represents a promising option for patients ineligible to open surgery. Custom-made design of stent-grafts (SG), such as the Terumo Aortic® RelayBranch device (DB), requires complex preoperative measures. Accurate SG deployment is required to avoid intraoperative or postoperative complications, which is extremely challenging in the aortic arch. In that context, our aim is to develop a computational tool able to predict SG deployment in such highly complex situations. A patient-specific case is performed with complete deployment of the DB and its bridging stents in an aneurysmal aortic arch. Deviations of our simulation predictions from actual stent positions are estimated based on post-operative scan and a sensitivity analysis is performed to assess the effects of material parameters. Results show a very good agreement between simulations and post-operative scan, with especially a torsion effect, which is successfully reproduced by our simulation. Relative diameter, transverse and longitudinal deviations are of 3.2 ± 4.0%, 2.6 ± 2.9 mm and 5.2 ± 3.5 mm respectively. Our numerical simulations show their ability to successfully predict the DB deployment in complex anatomy. The results emphasize the potential of computational simulations to assist practitioners in planning and performing complex and secure interventions.

Keywords

Endovascular surgery Aortic endograft Thoracic endovascular aneurysm repair Finite-element analysis Patient-specific model Computational biomechanics 

Abbreviations

BS

Bridging stents

CT

Computed tomography

DB

Terumo Aortic® (formerly Bolton Medical®) RelayBranch device

FEA

Finite-element analysis

SG

Stent-graft

TEVAR

Thoracic Endovascular Aneurysm Repair

VMTK

Vascular Modeling Toolkit

Notes

Acknowledgments

The authors would like to thank Samuel Arbefeuille, Scott Rush and Christian Fletcher from Terumo Aortic® (formerly Bolton Medical®) for their help and support in this study. Funding was provided by Agence Régionale de Santé d’Ile de France (FR).

Conflict of interest

D. Perrin, J.-N. Albertini and S. Avril are cofounders of the company Predisurge SAS. The other authors have no conflict of interest.

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Copyright information

© Biomedical Engineering Society 2019

Authors and Affiliations

  1. 1.Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERMSaint-ÉtienneFrance
  2. 2.Assistance Publique des Hôpitaux de Paris, Hôpital Mondor, Service de Chirurgie VasculaireCréteilFrance
  3. 3.PrediSurgeSaint-ÉtienneFrance
  4. 4.Service de Chirurgie Vasculaire, Centre Hospitalier Régional Universitaire de Saint-EtienneSaint-Priez-en-JarezFrance

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