Abstract
Thoracic endovascular aortic repair (TEVAR) has evolved as a first-line therapy for trauma patients. Most trauma patients are young, and their aortas are compliant and longitudinally pre-stretched. We have developed a method to include longitudinal pre-stretch in computational models of human thoracic aortas of different ages before and after TEVAR. Finite element models were built using computerized tomography angiography data obtained from human subjects in 6 age groups 10–69 years old. Aortic properties were determined with planar biaxial testing, and pre-stretch was simulated using a series of springs. GORE C-Tag stent-graft was computationally deployed in aortas with and without pre-stretch, and the stress–strain fields were compared. Pre-stretch had significant qualitative and quantitative effects on the aortic stress–strain state before and after TEVAR. Before TEVAR, mean intramural aortic stresses with and without pre-stretch decreased with age from 108 kPa and 83 kPa in the youngest age group, to 60 kPa in the oldest age group. TEVAR increased intramural stresses by an average of 73 ± 15 kPa and 48 ± 10 kPa for aortas with and without pre-stretch and produced high stress concentrations near the aortic isthmus. Inclusion of pre-stretch in young aortas increased intramural stresses by 30%, while in > 50-year-old subjects it did not change the results. Computational modeling of aorta-stent-graft interaction that includes pre-stretch can be instrumental for device design and assessment of its long-term performance, and in the future may help more accurately determine the stress–strain characteristics associated with TEVAR complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Arthurs ZM, Starnes BW, Sohn VY et al (2009) Functional and survival outcomes in traumatic blunt thoracic aortic injuries: an analysis of the National Trauma Databank. J Vasc Surg 49:988–994. https://doi.org/10.1016/j.jvs.2008.11.052
Atkins MD, Marrocco CJ, Bohannon WT, Bush RL (2009) Stent-graft repair for blunt traumatic aortic injury as the new standard of care: is there evidence? J Endovasc Ther 16(Suppl 1):I53–I62. https://doi.org/10.1583/08-2669.1
Bellini C, Ferruzzi J, Roccabianca S et al (2014) A microstructurally motivated model of arterial wall mechanics with mechanobiological implications. Ann Biomed Eng 42:488–502. https://doi.org/10.1007/s10439-013-0928-x
Burdess A, Mani K, Tegler G, Wanhainen A (2018) Stent-graft induced new entry tears after type B aortic dissection: how to treat and how to prevent? J Cardiovasc Surg (Torino) 59:789–796. https://doi.org/10.23736/S0021-9509.18.10570-2
Bussmann A, Heim F, Delay C et al (2017) Textile aging characterization on new generations of explanted commercial endoprostheses: a preliminary study. Eur J Vasc Endovasc Surg. https://doi.org/10.1016/j.ejvs.2017.06.004
Canaud L, Gandet T, Sfeir J et al (2019) Risk factors for distal stent graft-induced new entry tear after endovascular repair of thoracic aortic dissection. J Vasc Surg. https://doi.org/10.1016/j.jvs.2018.07.086
Cheng D, Martin J, Shennib H et al (2010) Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 55:986–1001
Cocciolone AJ, Hawes JZ, Staiculescu MC et al (2018) Elastin, arterial mechanics, and cardiovascular disease. Am J Physiol Circ Physiol. https://doi.org/10.1152/ajpheart.00087.2018
Cuomo F, Roccabianca S, Dillon-Murphy D et al (2017) Effects of age-associated regional changes in aortic stiffness on human hemodynamics revealed by computational modeling. PLoS ONE 12:e0173177. https://doi.org/10.1371/journal.pone.0173177
Demanget N, Avril S, Badel P et al (2012) Computational comparison of the bending behavior of aortic stent-grafts. J Mech Behav Biomed Mater 5:272–282. https://doi.org/10.1016/j.jmbbm.2011.09.006
Demanget N, Duprey A, Badel P et al (2013) Finite element analysis of the mechanical performances of 8 marketed aortic stent-grafts. J Endovasc Ther 20:523–535. https://doi.org/10.1583/12-4063.1
Evans JA, van Wessem KJP, McDougall D et al (2010) Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 34:158–163. https://doi.org/10.1007/s00268-009-0266-1
Ferruzzi J, Di Achille P, Tellides G, Humphrey JD (2018) Combining in vivo and in vitro biomechanical data reveals key roles of perivascular tethering in central artery function. PLoS ONE 13:1–21. https://doi.org/10.1371/journal.pone.0201379
Figueroa CA, Taylor CA, Yeh V et al (2009) Effect of curvature on displacement forces acting on aortic endografts: a 3-dimensional computational analysis. J Endovasc Ther 16:284–294
Fung GSK, Lam SK, Cheng SWK, Chow KW (2008) On stent-graft models in thoracic aortic endovascular repair: a computational investigation of the hemodynamic factors. Comput Biol Med 38:484–489. https://doi.org/10.1016/j.compbiomed.2008.01.012
Gonçalves FB, Ultee KHJ, Hoeks SE et al (2016) Life expectancy and causes of death after repair of intact and ruptured abdominal aortic aneurysms Presented in the Plenary Rapid Pace Session at the 2015 Vascular Annual Meeting of the Society for Vascular Surgery, Chicago, Ill, June 17–20, 2015. J Vasc Surg 63:610–616. https://doi.org/10.1016/j.jvs.2015.09.030
Goyal VK (1982) Changes with age in the aorta of man and mouse. Exp Gerontol 17:127–132. https://doi.org/10.1016/0531-5565(82)90046-8
Hartford JM, Fayer RL, Shaver TE et al (1986) Transection of the thoracic aorta: assessment of a trauma system. Am J Surg 151:224–229
Haskett D, Johnson G, Zhou A et al (2010) Microstructural and biomechanical alterations of the human aorta as a function of age and location. Biomech Model Mechanobiol 9:725–736. https://doi.org/10.1007/s10237-010-0209-7
Herrera CMG, Celentano DJ, Cruchaga MA et al (2010) Mechanical characterization of the human thoracic descending aorta Experiments and modelling. Comput Methods Biomech Biomed Eng 15:185–193
Holzapfel Ga, Gasser TC (2007) Computational stress-deformation analysis of arterial walls including high-pressure response. Int J Cardiol 116:78–85. https://doi.org/10.1016/j.ijcard.2006.03.033
Holzapfel GA, Gasser TC, Ogden RW (2000) A new constitutive framework for arterial wall mechanics and a comparative study of material models. J Elast 61:1–48
Horny L, Adamek T, Gultova E et al (2011) Correlations between age, prestrain, diameter and atherosclerosis in the male abdominal aorta. J Mech Behav Biomed Mater 4:2128–2132. https://doi.org/10.1016/j.jmbbm.2011.07.011
Horny L, Adamek T, Kulvajtova M (2013) Analysis of axial prestretch in the abdominal aorta with reference to post mortem interval and degree of atherosclerosis. J Mech Behav Biomed Mater. https://doi.org/10.1016/j.jmbbm.2013.01.033
Horný L, Netušil M, Voňavková T (2013) Axial prestretch and circumferential distensibility in biomechanics of abdominal aorta. Biomech Model Mechanobiol 13:783–799. https://doi.org/10.1007/s10237-013-0534-8
Horný L, Adámek T, Kulvajtová M (2016) A comparison of age-related changes in axial prestretch in human carotid arteries and in human abdominal aorta. Biomech Model Mechanobiol. https://doi.org/10.1007/s10237-016-0797-y
Hughes GC (2019) Stent graft–induced new entry tear (SINE): intentional and NOT. J Thorac Cardiovasc Surg 157:101.e3–106.e3. https://doi.org/10.1016/j.jtcvs.2018.10.060
Humphrey JD (2012) Possible mechanical roles of glycosaminoglycans in thoracic aortic dissection and associations with dysregulated transforming growth factor-β. J Vasc Res 50:1–10. https://doi.org/10.1159/000342436
Humphrey JD, Eberth JF, Dye WW, Gleason RL (2009) Fundamental role of axial stress in compensatory adaptations by arteries. J Biomech 42:1–8. https://doi.org/10.1016/j.jbiomech.2008.11.011.Fundamental
Jadidi M, Desyatova A, MacTaggart J, Kamenskiy A (2019) Mechanical stresses associated with flattening of human femoropopliteal artery specimens during planar biaxial testing and their effects on the calculated physiologic stress–stretch state. Biomech Model Mechanobiol Accepted. https://doi.org/10.1007/s10237-019-01162-0
Jonker FHW, Schlosser FJV, Geirsson A et al (2010) Endograft collapse after thoracic endovascular aortic repair. J Endovasc Ther 17:725–734. https://doi.org/10.1583/10-3130.1
Kamenskiy A, Pipinos I, Dzenis Y et al (2014a) Passive biaxial mechanical properties and in vivo axial pre-stretch of the diseased human femoropopliteal and tibial arteries. Acta Biomater 10:1301–1313. https://doi.org/10.1016/j.actbio.2013.12.027
Kamenskiy AVA, Dzenis YYA, Kazmi SAJSAJ et al (2014b) Biaxial mechanical properties of the human thoracic and abdominal aorta, common carotid, subclavian, renal and common iliac arteries. Biomech Model Mechanobiol 13:1341–1359. https://doi.org/10.1007/s10237-014-0576-6
Kamenskiy A, Miserlis D, Adamson P et al (2015) Patient demographics and cardiovascular risk factors differentially influence geometric remodeling of the aorta compared with the peripheral arteries. Surgery. https://doi.org/10.1016/j.surg.2015.05.013
Kamenskiy A, Seas A, Bowen G et al (2016) In situ longitudinal pre-stretch in the human femoropopliteal artery. Acta Biomater 32:231–237. https://doi.org/10.1016/j.actbio.2016.01.002
Kamenskiy A, Seas A, Deegan P et al (2017) Constitutive description of human femoropopliteal artery aging. Biomech Model Mechanobiol 16:681–692. https://doi.org/10.1007/s10237-016-0845-7
Kleinstreuer C, Li Z, Basciano CA et al (2008) Computational mechanics of Nitinol stent grafts. J Biomech 41:2370–2378
Learoyd BM, Taylor MG (1966) Alterations with age in the viscoelastic properties of human arterial walls. Circ Res 18:278–292. https://doi.org/10.1161/01.RES.18.3.278
Li Z, Kleinstreuer C, Farber M (2005) Computational analysis of biomechanical contributors to possible endovascular graft failure. Biomech Model Mechanobiol 4:221–234. https://doi.org/10.1007/s10237-005-0003-0
Ma T, Dong ZH, Wang S et al (2018) Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg 68:14S–21S. https://doi.org/10.1016/j.jvs.2018.06.008
MacTaggart JNJN, Poulson WEWE, Akhter M et al (2016) Morphometric roadmaps to improve accurate device delivery for fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 80:941–946. https://doi.org/10.1097/TA.0000000000001043
Miller LE (2012) Potential long-term complications of endovascular stent grafting for blunt thoracic aortic injury. Sci World J 2012:897489. https://doi.org/10.1100/2012/897489
Mithieux SM, Weiss AS (2005) Elastin. Adv Protein Chem 70:437–461. https://doi.org/10.1016/S0065-3233(05)70013-9
Muhs BE, Balm R, White GH, Verhagen HJM (2007) Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture. J Vasc Surg 45:655–661. https://doi.org/10.1016/j.jvs.2006.12.023
Parmley LF, Mattingly TW, Manion WC, Jahnke EJ (1958) Nonpenetrating traumatic injury of the aorta. Circulation 17:1086–1101. https://doi.org/10.1161/01.CIR.17.6.1086
Pasta S, Cho J-S, Dur O et al (2013) Computer modeling for the prediction of thoracic aortic stent graft collapse. J Vasc Surg. https://doi.org/10.1016/j.jvs.2012.09.063
Pasta S, Scardulla F, Rinaudo A et al (2016) An in vitro phantom study on the role of the bird-beak configuration in endograft infolding in the aortic arch. J Endovasc Ther 23:172–181. https://doi.org/10.1177/1526602815611888
Perrin D, Badel P, Orgéas L et al (2015a) Patient-specific numerical simulation of stent-graft deployment: validation on three clinical cases. J Biomech 48:1868–1875. https://doi.org/10.1016/j.jbiomech.2015.04.031
Perrin D, Demanget N, Badel P et al (2015b) Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool. Int J Numer Method Biomed Eng 31:e02698. https://doi.org/10.1002/cnm.2698
Prasad A, To LK, Gorrepati ML et al (2011) Computational analysis of stresses acting on intermodular junctions in thoracic aortic endografts. J Endovasc Ther 18:559–568. https://doi.org/10.1583/11-3472.1
Reuben BC, Whitten MG, Sarfati M, Kraiss LW (2007) Increasing use of endovascular therapy in acute arterial injuries: analysis of the National Trauma Data Bank. J Vasc Surg 46:1222–1226. https://doi.org/10.1016/j.jvs.2007.08.023
Rinaudo A, Raffa GM, Scardulla F et al (2015) Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair. Comput Biol Med 66:235–241. https://doi.org/10.1016/j.compbiomed.2015.09.011
Roccabianca S, Figueroa CA, Tellides G, Humphrey JD (2014) Quantification of regional differences in aortic stiffness in the aging human. J Mech Behav Biomed Mater 29:618–634. https://doi.org/10.1016/j.jmbbm.2013.01.026
Romarowski RM, Faggiano E, Conti M et al (2018) A novel computational framework to predict patient-specific hemodynamics after TEVAR: integration of structural and fluid-dynamics analysis by image elaboration. Comput Fluids. https://doi.org/10.1016/j.compfluid.2018.06.002
Saini A, Berry C, Greenwald S (1995) Effect of age and sex on residual stress in the aorta. J Vasc Res 32:398–405. https://doi.org/10.1159/000159115
Sauaia A, Moore FA, Moore EE et al (1995) Epidemiology of trauma deaths: a reassessment. J Trauma 38:185–193
Schumacher H, Böckler D, von Tengg-Kobligk H, Allenberg J-R (2006) Acute traumatic aortic tear: open versus stent-graft repair. Semin Vasc Surg 19:48–59. https://doi.org/10.1053/j.semvascsurg.2005.11.008
Sugawara J, Hayashi K, Yokoi T, Tanaka H (2008) Age-associated elongation of the ascending aorta in adults. JACC Cardiovasc Imaging 1:739–748. https://doi.org/10.1016/j.jcmg.2008.06.010
Van Loon P, Klip W, Bradley E (1977) Length-force and volume-pressure relationships of arteries. Biorheology 14:181–201
Wolf YG, Tillich M, Lee Wa et al (2001) Impact of aortoiliac tortuosity on endovascular repair of abdominal aortic aneurysms: evaluation of 3D computer-based assessment. J Vasc Surg 34:594–599. https://doi.org/10.1067/mva.2001.118586
Xenos ES, Abedi NN, Davenport DL et al (2008) Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 48:1343–1351. https://doi.org/10.1016/j.jvs.2008.04.060
Acknowledgements
The authors wish to acknowledge Live On Nebraska for their help and support and thank tissue donors and their families for making this study possible.
Funding
Research reported in this publication was supported in part by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Numbers HL124905, HL147128, and HL125736.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This manuscript does not study living human or animal subjects. Cadaveric specimens were obtained after receiving consent from next of kin.
Conflict of interest
Authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Desyatova, A., MacTaggart, J. & Kamenskiy, A. Effects of longitudinal pre-stretch on the mechanics of human aorta before and after thoracic endovascular aortic repair (TEVAR) in trauma patients. Biomech Model Mechanobiol 19, 401–413 (2020). https://doi.org/10.1007/s10237-019-01217-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10237-019-01217-2