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research-article

Predicting rotation in fenestrated endovascular aneurysm repair using finite element analysis

[+] Author and Article Information
Ryan Sanford

Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
rsanford@mie.utoronto.ca

Sean / A Crawford

Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
sean.crawford@mail.utoronto.ca

Helen Genis

Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Toronto, Canada
helen.genis@mail.utoronto.ca

Matthew G Doyle

Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada; Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Toronto, Canada
mg.doyle@utoronto.ca

Thomas L Forbes

Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and University of Toronto, Toronto, Canada
Thomas.Forbes@uhn.ca

Cristina H. Amon

Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
cristina.amon@utoronto.ca

1Corresponding author.

ASME doi:10.1115/1.4040124 History: Received August 08, 2017; Revised April 26, 2018

Abstract

Fenestrated endovascular aneurysm repair (FEVAR) is a minimally invasive method of abdominal aortic aneurysm repair utilized in patients with complex vessel anatomies. Stent grafts used in this process contain fenestrations within the device that need to be aligned with the visceral arteries upon successful stent graft deployment. Proper alignment is crucial to maintain blood flow to these arteries and avoid surgical complications. During fenestrated stent graft deployment, rotation of the stent graft can occur during the unsheathing process. This leads to misalignment of the vessels and the fenestrations and is associated with poor clinical outcomes. The aim of this study was to develop a computational model of the FEVAR process to predict stent graft rotation. Six patient specific cases are presented and compared with surgical case data. Realistic material properties, frictional effects, deployment methods, and boundary conditions are included in the model. A mean simulation error of 2° (range 1-4°) was observed. This model was then used to conduct a parameter study of frictional properties to see if rotation could be minimized. This study showed that increasing or decreasing the coefficients of friction between the sheath and the vessel walls would decrease the amount of rotation observed. Our model accurately predicts the amount of stent graft rotation observed during FEVAR and can be used as a preoperative planning tool within the surgical workflow.

Copyright (c) 2018 by ASME
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