title: Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts.
abstract: The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to help practitioners plan their intervention.
authors.affiliation: Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France.
authors.forename: David
authors.initials: D
authors.lastname: Perrin
authors.affiliation: Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Badel
authors.affiliation: CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Orgeas
authors.affiliation: CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Geindreau
authors.affiliation: CNRS, 3SR Lab, F-38000 Grenoble, France; Univ. Grenoble Alpes, 3SR Lab, F-38000 Grenoble, France.
authors.forename: Sabine Rolland
authors.initials: SR
authors.lastname: du Roscoat
authors.affiliation: INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France; CHU Hôpital Nord Saint-Etienne, Department of CardioVascular Surgery, Saint-Etienne F-42055, France.
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Albertini
authors.affiliation: Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, SAINBIOSE, F-42023 Saint-Etienne, France; INSERM U1059, SAINBIOSE, F-42023 Saint-Etienne, France; Université de Lyon, F-69000 Lyon, France. Electronic address: avril@emse.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Avril
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D003198:Computer Simulation; D057510:Endovascular Procedures; D020342:Finite Element Analysis; D006801:Humans; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055114:X-Ray Microtomography
keywords: Abdominal aortic aneurysm; Endovascular repair; Finite-element analysis; Patient-specific; Stent-graft