title: 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.
abstract: Deformations of the vascular structure due to the insertion of tools during endovascular treatment of aneurysms of the abdominal aorta, unless properly anticipated during the preoperative planning phase, may be the source of intraoperative or postoperative complications. We propose here an explicit finite element simulation method which enables one to predict such deformations. This method is based on a mechanical model of the vascular structure which takes into account the nonlinear behavior of the arterial wall, the prestressing effect induced by the blood pressure and the mechanical support of the surrounding organs and structures. An analysis of the model sensitivity to the parameters used to represent this environment is done. This allows determining the parameters that have the largest influence on the quality of the prediction and also provides realistic values for each of them as no experimental data are available in the literature. Moreover, for the first time, the results are compared with 3D intraoperative data. This is done for a patient-specific case with a complex anatomy in order to assess the feasibility of the method. Finally, the predictive capability of the simulation is evaluated on a group of nine patients. The error between the final simulated and intraoperatively measured tool positions was 2.1 mm after the calibration phase on one patient. It results in a 4.6 ± 2.5 mm in average error for the blind evaluation on nine patients.
authors.affiliation: Université de Lyon, Lyon, F-69000, France.|LaMCoS CNRS UMR5259, INSA-Lyon, Villeurbanne, F-69621, France.|INSERM U1099, Rennes, F-35000, France.|LTSI, Université de Rennes 1, Rennes, F-35000, France.|ANSYS, Villeurbanne, F-69100, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Gindre
authors.affiliation: Université de Lyon, Lyon, F-69000, France.|LaMCoS CNRS UMR5259, INSA-Lyon, Villeurbanne, F-69621, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Bel-Brunon
authors.affiliation: INSERM U1099, Rennes, F-35000, France.|LTSI, Université de Rennes 1, Rennes, F-35000, France.|Department of Vascular Surgery, CHU Rennes, Rennes, F-35000, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Kaladji
authors.affiliation: INSERM U1099, Rennes, F-35000, France.|LTSI, Université de Rennes 1, Rennes, F-35000, France.|THERENVA, Rennes, F-35000, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Duménil
authors.affiliation: ANSYS, Villeurbanne, F-69100, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Rochette
authors.affiliation: INSERM U1099, Rennes, F-35000, France.|LTSI, Université de Rennes 1, Rennes, F-35000, France.|Department of Vascular Surgery, CHU Rennes, Rennes, F-35000, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lucas
authors.affiliation: INSERM U1099, Rennes, F-35000, France.|LTSI, Université de Rennes 1, Rennes, F-35000, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Haigron
authors.affiliation: Université de Lyon, Lyon, F-69000, France.|LaMCoS CNRS UMR5259, INSA-Lyon, Villeurbanne, F-69621, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Combescure
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods*; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D008955:Models, Cardiovascular; D057285:Precision Medicine; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: 3D intraoperative data; Abdominal aortic aneurysm; Endovascular; patient-specific; surrounding organs support