What if you stretch the IFU? A mechanical insight into stent graft Instructions For Use in angulated proximal aneurysm necks

S De Bock; F Iannaccone; M De Beule; F Vermassen; P Segers; B Verhegghe

doi:10.1016/j.medengphy.2014.08.003

What if you stretch the IFU? A mechanical insight into stent graft Instructions For Use in angulated proximal aneurysm necks

Med Eng Phys. 2014 Dec;36(12):1567-76. doi: 10.1016/j.medengphy.2014.08.003. Epub 2014 Sep 10.

Authors

S De Bock¹, F Iannaccone², M De Beule³, F Vermassen⁴, P Segers², B Verhegghe³

Affiliations

¹ IBiTech, bioMMeda, iMinds future health department,Ghent University, De Pintelaan 185, Ghent, Belgium. Electronic address: [email protected].
² IBiTech, bioMMeda, iMinds future health department,Ghent University, De Pintelaan 185, Ghent, Belgium.
³ IBiTech, bioMMeda, iMinds future health department,Ghent University, De Pintelaan 185, Ghent, Belgium; Feops BVBA, Zwijnaarde, Belgium.
⁴ Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.

PMID: 25217007
DOI: 10.1016/j.medengphy.2014.08.003

Abstract

Endovascular treatment for patients with a proximal neck anatomy outside instructions for use is an ongoing topic of debate in endovascular aneurysm repair. This paper employs the finite element method to offer insight into possible adverse effects of deploying a stent graft into an angulated geometry. The effect of angulation, straight neck length and device oversize was investigated in a full factorial parametric analysis. Stent apposition, area reduction of the graft, asymmetry of contact forces and the ability to find a good seal were investigated. Most adverse effects are expected for combinations of high angulation and short straight landing zones. Higher oversize has a beneficiary effect, but not enough to compensate the adverse effects of (very) short and angulated angles. Our analysis shows that for an angle between the suprarenal aorta and proximal neck above 60°, proximal kinking of the device can occur. The method used offers a engineering view on the morphological limits of EVAR for a clinically used device.

Keywords: Abdominal aortic aneurysm; Finite element; Instructions for use; Proximal neck; Stent graft; Zenith.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Algorithms
Aortic Aneurysm, Abdominal / pathology
Aortic Aneurysm, Abdominal / surgery*
Blood Vessel Prosthesis* / adverse effects
Computer Simulation
Endovascular Procedures* / adverse effects
Finite Element Analysis
Humans
Models, Cardiovascular
Prosthesis Design
Stents* / adverse effects