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Finite element modeling to predict procedural success of thoracic endovascular aortic repair in type A aortic dissection
- Source :
- JTCVS Techniques
- Publication Year :
- 2020
- Publisher :
- Elsevier, 2020.
-
Abstract
- Objective Thoracic endovascular aortic repair (TEVAR) is recommended for type B aortic dissection and recently has even been used in selected cases of proximal (Stanford type A) aortic dissections in scenarios of prohibitive surgical risk. However, mechanical interactions between the native aorta and stent-graft are poorly understood, as some cases ended in failure. The aim of this study is to explore and better understand biomechanical changes after TEVAR and predict the result via virtual stenting. Methods A case of type A aortic dissection was considered inoperable and selected for TEVAR. The procedure failed due to stent-graft migration even with precise deployment. A novel patient-specific virtual stent-graft deployment model based on finite element method was employed to analyze TEVAR-induced changes under such conditions. Two landing positions were simulated to investigate the reason for stent-graft migration immediately after TEVAR and explore options for optimization. Results Simulation of the actual procedure revealed that the proximal bare metal stent pushed the lamella into the false lumen and led to further stent-graft migration during the launch phase. An alternative landing position has reduced the local deformation of the dissection lamella and avoided stent-graft migration. Higher maximum principal stress (>20 KPa) was found on the lamella with deployment at the actual position, while the alternative strategy would have reduced the stress to Conclusions Virtual stent-graft deployment simulation based on finite element model could be helpful to both predict outcomes of TEVAR and better plan future endovascular procedures.
- Subjects :
- Pulmonary and Respiratory Medicine
Aortic dissection
Bare-metal stent
medicine.medical_specialty
Aorta
TEVAR
Computer science
virtual stent-graft deployment
False lumen
finite element analysis
Aortic repair
medicine.disease
Finite element method
CT, computed tomography
TEVAR, thoracic endovascular aortic repair
Dissection
surgical procedures, operative
medicine.artery
medicine
Surgery
ECG, electrocardiogram
Radiology
Simulation based
Adult: Aorta
type A aortic dissection
Subjects
Details
- Language :
- English
- ISSN :
- 26662507
- Volume :
- 4
- Database :
- OpenAIRE
- Journal :
- JTCVS Techniques
- Accession number :
- edsair.doi.dedup.....da73f37ea6fc43b287cccab8f63b1143