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Customized stent-grafts for endovascular aneurysm repair with challenging necks: A numerical proof of concept.
International Journal for Numerical Methods in Biomedical Engineering ( IF 2.2 ) Pub Date : 2020-03-09 , DOI: 10.1002/cnm.3316 André Hemmler 1 , Andrew Lin 2 , Nikolaus Thierfelder 3 , Thomas Franz 4 , Michael W Gee 1 , Deon Bezuidenhout 2
International Journal for Numerical Methods in Biomedical Engineering ( IF 2.2 ) Pub Date : 2020-03-09 , DOI: 10.1002/cnm.3316 André Hemmler 1 , Andrew Lin 2 , Nikolaus Thierfelder 3 , Thomas Franz 4 , Michael W Gee 1 , Deon Bezuidenhout 2
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Endovascular aortic repair (EVAR) is a challenging intervention whose long‐term success strongly depends on the appropriate stent‐graft (SG) selection and sizing. Most off‐the‐shelf SGs are straight and cylindrical. Especially in challenging vessel morphologies, the morphology of off‐the‐shelf SGs is not able to meet the patient‐specific demands. Advanced manufacturing technologies facilitate the development of highly customized SGs. Customized SGs that have the same morphology as the luminal vessel surface could considerably improve the quality of the EVAR outcome with reduced likelihoods of EVAR related complications such as endoleaks type I and SG migration. In this contribution, we use an in silico EVAR methodology that approximates the deployed state of the elastically deformable SG in a hyperelastic, anisotropic vessel. The in silico EVAR results of off‐the‐shelf SGs and customized SGs are compared qualitatively and quantitatively in terms of mechanical and geometrical parameters such as stent stresses, contact tractions, SG fixation forces and the SG‐vessel attachment. In a numerical proof of concept, eight different vessel morphologies, such as a conical vessel, a barrel shaped vessel and a curved vessel, are used to demonstrate the added value of customized SGs compared to off‐the‐shelf SGs. The numerical investigation has shown large benefits of the highly customized SGs compared to off‐the‐shelf SGs with respect to a better SG‐vessel attachment and a considerable increase in SG fixation forces of up to 50% which indicate decreased likelihoods of EVAR related complications. Hence, this numerical proof of concept motivates further research and development of highly customized SGs for the use in challenging vessel morphologies.
中文翻译：
用于具有挑战性颈部的血管内动脉瘤修复的定制支架植入物：概念的数字证明。
血管内主动脉修复（EVAR）是一项具有挑战性的干预措施，其长期成功在很大程度上取决于适当的支架植入物（SG）的选择和尺寸。大多数现成的SG是直的和圆柱形的。尤其是在具有挑战性的血管形态中，现成的SG形态无法满足患者的特定需求。先进的制造技术促进了高度定制化SG的开发。具有与管腔表面形态相同形态的定制SG可以显着提高EVAR结果的质量，同时降低EVAR相关并发症（如内漏I型和SG迁移）的可能性。在此贡献中，我们使用计算机模拟EVAR方法，该方法近似于超弹性各向异性容器中可弹性变形SG的部署状态。根据机械和几何参数（例如支架应力，接触牵引力，SG固定力和SG血管附着），定性和定量地比较了现成SG和定制SG的计算机EVAR结果。在概念上的数值证明中，使用了八种不同的容器形态，例如圆锥形容器，桶形容器和弯曲容器，以展示定制SG与现成SG相比的附加值。数值研究表明，与现成的SG相比，高度定制的SG具有更好的SG血管附着能力，并且SG固定力显着提高了50％，这表明EVAR相关并发症的可能性降低了。因此，
更新日期：2020-03-09
中文翻译：
用于具有挑战性颈部的血管内动脉瘤修复的定制支架植入物：概念的数字证明。
血管内主动脉修复（EVAR）是一项具有挑战性的干预措施，其长期成功在很大程度上取决于适当的支架植入物（SG）的选择和尺寸。大多数现成的SG是直的和圆柱形的。尤其是在具有挑战性的血管形态中，现成的SG形态无法满足患者的特定需求。先进的制造技术促进了高度定制化SG的开发。具有与管腔表面形态相同形态的定制SG可以显着提高EVAR结果的质量，同时降低EVAR相关并发症（如内漏I型和SG迁移）的可能性。在此贡献中，我们使用计算机模拟EVAR方法，该方法近似于超弹性各向异性容器中可弹性变形SG的部署状态。根据机械和几何参数（例如支架应力，接触牵引力，SG固定力和SG血管附着），定性和定量地比较了现成SG和定制SG的计算机EVAR结果。在概念上的数值证明中，使用了八种不同的容器形态，例如圆锥形容器，桶形容器和弯曲容器，以展示定制SG与现成SG相比的附加值。数值研究表明，与现成的SG相比，高度定制的SG具有更好的SG血管附着能力，并且SG固定力显着提高了50％，这表明EVAR相关并发症的可能性降低了。因此，
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