Comparison of stent displacement and displacement force after endovascular aneurysm repair with cross-limb or parallel-limb stent_Journal of Biomedical Engineering

Authors：

YUE Jianjin ¹ , ZHAO Yiming ¹ , WANG Jiarong ² ,  FAN Yubo ³ ,  ZHENG Tinghui ¹

1. School of Architecture and Environment, Sichuan University, Chengdu 610065, P. R. China;
2. West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
3. School of Medical Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, P. R. China;

Corresponding author：

FAN Yubo, Email: yubofan@buaa.edu.cn; ZHENG Tinghui, Email: tinghuizh@scu.edu.cn

Keywords：

Endovascular aneurysm repair; Cross-limb endovascular aneurysm repair; Parallel-limb endovascular aneurysm repair; Stent displacement; Displacement force

DOI：

10.7507/1001-5515.202107038

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This study aims to investigate whether displacement force on stents can accurately represents the displacement of the stent after endovascular aneurysm repair (EVAR) by comparing the measured stent displacement with the displacement forces calculated by computational fluid dynamics (CFD). And the effect of cross-limb and parallel-limb EVAR on stent displacements is further studied. Based on our objective, in this study, ten cross-limb EVAR patients and ten parallel-limb EVAR patients in West China Hospital of Sichuan University were enrolled. Patient-specific models were first reconstructed based on the computed tomography angiography images, then the stent displacements were measured, and the displacement forces acting on the stents were calculated by CFD. Finally, the value of the angle between the displacement force and the displacement vector was used to analyze the matching degree between the displacement and the displacement force. The results showed that the displacement forces on cross-limb stents and parallel-limb stents were (2.67 ± 2.14) N and (1.36 ± 0.48) N, respectively. Displacements of stent gravity center, stent displacements relative to vessel, and vessel displacements of cross-limb and parallel-limb stents were (4.43 ± 2.81) mm and (6.39 ± 2.62) mm, (0.88 ± 0.67) mm and (1.11 ± 0.71) mm, (3.55 ± 2.88) mm and (5.28 ± 2.52) mm, respectively. The mean for cross-limb and parallel-limb stents were 0.02 ± 0.66 and − 0.10 ± 0.73, respectively. This study indicates that the displacement force on the stent can’t accurately represent the displacement of the stent after EVAR. In addition, the cross-limb EVAR is probably safer and more stable than the parallel-limb EVAR.

Citation： YUE Jianjin, ZHAO Yiming, WANG Jiarong, FAN Yubo, ZHENG Tinghui. Comparison of stent displacement and displacement force after endovascular aneurysm repair with cross-limb or parallel-limb stent. Journal of Biomedical Engineering, 2022, 39(4): 645-650. doi: 10.7507/1001-5515.202107038 Copy

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2.	Boyd A, Kuhn D, Lozowy R, et al. Low wall shear stress predominates at sites of abdominal aortic aneurysm rupture. J Vasc Surg, 2015, 63(6): 1613-1619.
3.	Holt P, Poloniecki J, Loftus I, et al. Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005. Brit J Surg, 2007, 94(4): 441-448.
4.	Tanweer O, Wilson T, Metaxa E, et al. A comparative review of the hemodynamics and pathogenesis of cerebral and abdominal aortic aneurysms: lessons to learn from each other. J Cerebrovasc Endovasc Neuro, 2014, 16(4): 335-349.
5.	Prinssen M, Verhoeven E, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. New Engl J Med, 2004, 351(16): 1607-1618.
6.	Ramaiah V, Thompson C, Shafique S, et al. Crossing the limbs: an useful adjunct for successful deployment of the AneuRx stent-graft. J Endovasc Ther, 2002, 9(5): 583-586.
7.	Fernandez-Gibello A, Moroni S, Camunas G, et al. Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndromePart II. Surg Radiol Anat, 2019, 41(1): 43-51.
8.	胡孙君, 陈舰, 陈杰, 等. Morton神经瘤的诊治进展. 中国矫形外科杂志, 2009, 23(17): 1796-1799.
9.	Victory J, Rizvi S, Ascher E, et al. Ruptured abdominal aortic aneurysm after endovascular aortic aneurysm repair thrombosis. Vascular, 2017, 25(3): 333-345.
10.	Schuurmann R, Noort K, Overeem S P, et al. Determination of endograft apposition, position, and expansion in the aortic neck predicts type Ia endoleak and migration after endovascular aneurysm repair. J Endovasc Ther, 2018, 25(3): 366-375.
11.	孙岩, 王玉涛, 张十一, 等. 3D打印辅助开窗支架及分支支架技术治疗累及内脏动脉区胸腹主动脉瘤的效果分析. 中国胸心血管外科临床杂志, 2022, 29(1): 90-94.
12.	Georgakarakos E, Xenakis A, Manopoulos C, et al. Modeling and computational analysis of the hemodynamic effects of crossing the limbs in an aortic endograft (‘‘Ballerina’’ position). J Endovasc Ther, 2012, 19(4): 549-557.
13.	Stefanov F, Mcgloughlin T, Morris L, et al. A computational assessment of the hemodynamic effects of crossed and non-crossed bifurcated stent-graft devices for the treatment of abdominal aortic aneurysms. Med Eng Phys, 2016, 38(12): 1458-1473.
14.	Gimber L H, Melville D, Bocian D A, et al. Ultra-sound evaluation of Morton neuroma before and after laser therapy. Am J Roentgenol, 2017, 208(2): 380-385.
15.	Kung E, Figueroa C, Medina F, et al. Validation of finite element analysis of blood flow in deformable models. Ann Biomed Eng, 2011, 39(7): 1947-1960.
16.	Oliveira N, Goncalves B, Vries D, et al. Mid-term results of EVAR in severe proximal aneurysm neck angulation. Eur J Vasc Endovasc Surg, 2015, 49(1): 19-27.
17.	Kandail H, Hamady M, Xu X, et al. Patient-specific analysis of displacement forces acting on fenestrated stent grafts for endovascular aneurysm repair. J Biomech, 2014, 47(14): 3546-3554.
18.	Figueroa C, Taylor C, Yeh V. Preliminary 3D computational analysis of the relationship between aortic displacement force and direction of endograft movement. J Vasc Surg, 2010, 51(6): 1488-1497.
19.	Welborn M, McDaniel H, Johnson C, et al. Early clinical outcomes of the active seal technology of the AFX endovascular aortic aneurysm system with the VELA cuff for patients with a conical proximal neck. J Vasc Surg, 2014, 60(4): 876-884.
20.	Shek T, Tse L, Nabovati A, et al. Computational fluid dynamics evaluation of the cross-limb stent graft configuration for endovascular aneurysm repair. J Biomech Eng, 2012, 134(12): 1002-1004.

1. Chaikof E, Ronald L, Eskandari M, et al. The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
2. Boyd A, Kuhn D, Lozowy R, et al. Low wall shear stress predominates at sites of abdominal aortic aneurysm rupture. J Vasc Surg, 2015, 63(6): 1613-1619.
3. Holt P, Poloniecki J, Loftus I, et al. Epidemiological study of the relationship between volume and outcome after abdominal aortic aneurysm surgery in the UK from 2000 to 2005. Brit J Surg, 2007, 94(4): 441-448.
4. Tanweer O, Wilson T, Metaxa E, et al. A comparative review of the hemodynamics and pathogenesis of cerebral and abdominal aortic aneurysms: lessons to learn from each other. J Cerebrovasc Endovasc Neuro, 2014, 16(4): 335-349.
5. Prinssen M, Verhoeven E, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. New Engl J Med, 2004, 351(16): 1607-1618.
6. Ramaiah V, Thompson C, Shafique S, et al. Crossing the limbs: an useful adjunct for successful deployment of the AneuRx stent-graft. J Endovasc Ther, 2002, 9(5): 583-586.
7. Fernandez-Gibello A, Moroni S, Camunas G, et al. Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndromePart II. Surg Radiol Anat, 2019, 41(1): 43-51.
8. 胡孙君, 陈舰, 陈杰, 等. Morton神经瘤的诊治进展. 中国矫形外科杂志, 2009, 23(17): 1796-1799.
9. Victory J, Rizvi S, Ascher E, et al. Ruptured abdominal aortic aneurysm after endovascular aortic aneurysm repair thrombosis. Vascular, 2017, 25(3): 333-345.
10. Schuurmann R, Noort K, Overeem S P, et al. Determination of endograft apposition, position, and expansion in the aortic neck predicts type Ia endoleak and migration after endovascular aneurysm repair. J Endovasc Ther, 2018, 25(3): 366-375.
11. 孙岩, 王玉涛, 张十一, 等. 3D打印辅助开窗支架及分支支架技术治疗累及内脏动脉区胸腹主动脉瘤的效果分析. 中国胸心血管外科临床杂志, 2022, 29(1): 90-94.
12. Georgakarakos E, Xenakis A, Manopoulos C, et al. Modeling and computational analysis of the hemodynamic effects of crossing the limbs in an aortic endograft (‘‘Ballerina’’ position). J Endovasc Ther, 2012, 19(4): 549-557.
13. Stefanov F, Mcgloughlin T, Morris L, et al. A computational assessment of the hemodynamic effects of crossed and non-crossed bifurcated stent-graft devices for the treatment of abdominal aortic aneurysms. Med Eng Phys, 2016, 38(12): 1458-1473.
14. Gimber L H, Melville D, Bocian D A, et al. Ultra-sound evaluation of Morton neuroma before and after laser therapy. Am J Roentgenol, 2017, 208(2): 380-385.
15. Kung E, Figueroa C, Medina F, et al. Validation of finite element analysis of blood flow in deformable models. Ann Biomed Eng, 2011, 39(7): 1947-1960.
16. Oliveira N, Goncalves B, Vries D, et al. Mid-term results of EVAR in severe proximal aneurysm neck angulation. Eur J Vasc Endovasc Surg, 2015, 49(1): 19-27.
17. Kandail H, Hamady M, Xu X, et al. Patient-specific analysis of displacement forces acting on fenestrated stent grafts for endovascular aneurysm repair. J Biomech, 2014, 47(14): 3546-3554.
18. Figueroa C, Taylor C, Yeh V. Preliminary 3D computational analysis of the relationship between aortic displacement force and direction of endograft movement. J Vasc Surg, 2010, 51(6): 1488-1497.
19. Welborn M, McDaniel H, Johnson C, et al. Early clinical outcomes of the active seal technology of the AFX endovascular aortic aneurysm system with the VELA cuff for patients with a conical proximal neck. J Vasc Surg, 2014, 60(4): 876-884.
20. Shek T, Tse L, Nabovati A, et al. Computational fluid dynamics evaluation of the cross-limb stent graft configuration for endovascular aneurysm repair. J Biomech Eng, 2012, 134(12): 1002-1004.

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