scholarly journals Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis

2021 ◽  
pp. 1-27
Author(s):  
Fahmida Ashraf ◽  
Tehmina Ambreen ◽  
Cheol Woo Park ◽  
Dong-ik Kim
Keyword(s):  
Shear Stress ◽  
Renal Artery ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Stress Index ◽  
Main Body ◽  
Top Down ◽  
Bottom Up ◽  
Abdominal Aortic ◽  
Aneurysm Repair

PURPOSE: Cross limb stent graft (SG) configuration technique for endovascular aneurysm repair (EVAR) is employed for splayed aortic bifurcations to avoid device kinking and smoothen cannulation. The present study investigates three types of stent graft (SG) configurations for endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm. A computational fluid dynamic analysis was performed on the pulsatile non-Newtonian flow characteristics in three ideally modeled geometries of abdominal aortic (AA) SG configurations. METHODS: The three planar and crosslimb SG configurations were ideally modeled, namely, top-down nonballet-type, top-down ballet-type, and bottom-up nonballet-type configurations. In top-down SG configuration, most of the device is deployed in the main body in the vicinity of renal artery and the limbs are extended to the iliac artery. While in the bottom-up configuration, some of the SG device is deployed in the main body, the limbs are deployed in aortic bifurcation, and the extra stent graft of the main body is extended to the proximal aorta until the below of the renal artery. The effects of non-Newtonian pulsatile flow on the wall stresses and flow patterns of the three models were investigated and compared. Moreover, the average wall shear stress (AWSS), oscillatory shear stress index (OSI), absolute helicity, pressure distribution, graft displacement and flow visualization plots were analyzed. RESULTS: The top-down ballet-type showed less branch blockage effect than the top-down nonballet-type models. Furthermore, the top-down ballet-type configuration showed an increased tendency to sustain high WSS and higher helicity characteristics than that of the bottom-up and top-down non-ballet type configurations. However, displacement forces of the top-down ballet-type configuration were 40%and 9.6%higher than those of the bottom-up and top-down nonballet-type configurations, respectively. CONCLUSIONS: Some complications such as graft tearing, thrombus formation, limb disconnection during long term follow up periods might be relevant to hemodynamic characteristics according to the configurations of EVAR. Hence, the reported data required to be validated with the clinical results.

Modification of a Bifurcated Stent Graft for Aortouniiliac Endovascular Aneurysm Repair in a Renal Transplant Patient

2012 ◽  
Vol 46 (5) ◽  
pp. 405-409 ◽  
Author(s):  
Henrietta Poon ◽  
Martin J. Duddy ◽  
Alok Tiwari ◽  
Jonathan D. Hopkins
Keyword(s):  
Renal Transplant ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
External Iliac Artery ◽  
Stent Migration ◽  
Modular System ◽  
Main Body ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Introduction. We describe a case of aortouniiliac (AUI) endovascular aortic aneurysm repair (EVAR) using combined iliac limb and bifurcated body stent graft modular system. Case report. This technique is demonstrated in a 58-year-old man with a 6-cm abdominal aortic aneurysm suitable for EVAR. The patient has a functioning cadaveric renal transplant anastamosed to the mid right external iliac artery, an occluded left iliac system and stenosed right iliac system. The renal allograft was protected with minimal passage across the transplant artery origin using this modified approach. The patient was successfully treated with a bifurcated main body deployed within a contralateral limb endoprosthesis. Subsequent scans confirmed no endoleaks or stent migration. Conclusions. The AUI conversion from existing Gore excluder stent graft system is safe and should be considered when faced with challenging anatomy of a pelvic renal transplant, slender access, and contralateral iliac occlusion.

Hepatorenal Revascularization Enables Endovascular Aneurysm Repair on a Patient with Abdominal Aortic Aneurysm and an Ectopic Right Renal Artery

2018 ◽  
Vol 52 ◽  
pp. 316.e1-316.e5 ◽  
Author(s):  
Andreas M. Lazaris ◽  
Konstantinos Moulakakis ◽  
Georgios Mantas ◽  
Katerina Poulou ◽  
Evangelos Alexiou ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Renal Artery Coverage During Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

2020 ◽  
Vol 62 ◽  
pp. 63-69 ◽  
Author(s):  
Adam Tanious ◽  
Laura T. Boitano ◽  
Linda J. Wang ◽  
Murray L. Shames ◽  
Jason T. Lee ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Abdominal Aortic Stent Graft Mechanics: Sizing Them Up

2013 ◽  
Author(s):  
S. De Bock ◽  
F. Iannaccone ◽  
M. De Beule ◽  
F. Vermassen ◽  
P. Segers ◽  
...  
Keyword(s):  
Stent Graft ◽  
Structural Integrity ◽  
Endovascular Aneurysm Repair ◽  
Preventive Treatment ◽  
Metallic Stent ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Downward Displacement ◽  
Aneurysm Repair

An abdominal aortic aneurysm (AAA) of the aorta is a local widening of the aorta in a region between the renal arteries and the aortic bifurcation. The disease impacts the structural integrity of the AAA wall, weakening the tissue and predisposing it to rupture. Preventive treatment of the disease is often performed minimally invasive with endovascular repair by stent graft deployment, as an alternative to open surgical repair. During endovascular aneurysm repair, a metallic stent, covered with a polymer membrane is first crimped and mounted onto the delivery system and inserted through the iliac artery. It is advanced to the AAA region, and expanded to cover the weakened, ballooning aorta. The technique has excellent clinical outcome, yet it is still associated with long term problems such as migration, a downward displacement of the device, and endoleakage, with blood reentering and pressurizing the aneurismal sack.

Fatal Complications of New-Onset Complicated Type B Aortic Dissection After Endovascular Abdominal Aortic Aneurysm Repair: Report of 2 Cases and Literature Review

2018 ◽  
Vol 53 (3) ◽  
pp. 255-258 ◽  
Author(s):  
Yoshikatsu Nomura ◽  
Kanetsugu Nagao ◽  
Shota Hasegawa ◽  
Motoharu Kawashima ◽  
Takanori Tsujimoto ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
New Onset

New-onset antegrade Stanford type B aortic dissection (TBAD) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is rare. The extension of aortic dissection leads to various symptoms and affects the stent graft. Moreover, various symptoms may arise owing to a stent graft being present. We describe 2 cases of complicated acute TBAD occurring after EVAR, which were ultimately fatal. The case in which rupture occurred could not be treated and the patient died. In another case with bilateral lower extremity malperfusion caused by collapse and occlusion of the endograft, extra-anatomical bypass was performed. Although the collapsed endograft gradually re-expanded, the patient ultimately died because of multiorgan failure. We have reviewed the literature and analyzed the treatment of complicated TBAD after EVAR.

Spiral CT Angiography versus Aortography in the Assessment of Aortoiliac Length in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair

1998 ◽  
Vol 5 (3) ◽  
pp. 222-227 ◽  
Author(s):  
Matthew P. Armon ◽  
Simon C. Whitaker ◽  
Roger H.S. Gregson ◽  
Peter W. Wenham ◽  
Brian R. Hopkinson
Keyword(s):  
Renal Artery ◽  
Large Diameter ◽  
Endovascular Aneurysm Repair ◽  
Spiral Ct ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Aortic Bifurcation ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Level Of Agreement

Purpose: To compare measurements of aortoiliac length obtained with spiral computed tomographic angiography (CTA) and aortography in patients undergoing endovascular aneurysm repair. Methods: The distances from the lower-most renal artery to the aortic bifurcation and from the aortic bifurcation to the common iliac artery (CIA) bifurcation were measured using both CTA and aortography in 108 patients with abdominal aortic aneurysms. Results: The level of agreement between CTA and aortography was high, with 69% of aortic and 76% of iliac measurements within 1 cm and > 90% within 2 cm of each other. Mean differences were −0.35 ± 1.20 cm and 0.25 ± 1.10 cm, respectively, for aortic and iliac lengths. Aortography overestimated renal artery to aortic bifurcation length in comparison to CTA (p = 0.003), particularly in patients with large aneurysms (> 6.5 cm) and lumen diameters > 4.5 cm (p < 0.0001). Measurements of CIA length were shorter by aortography than CTA (p = 0.02). Conclusions: There is a high level of agreement between CTA and aortography in the measurement of aortoiliac length, but aortography overestimates renal artery to aortic bifurcation length in patients with large-diameter aneurysms and wide aneurysm lumens. CTA is sufficiently accurate in the majority of cases to be used as the sole basis for the construction of endovascular grafts.

3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair

Vascular ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 442-446 ◽  
Author(s):  
Jianhua Huang ◽  
Gan Li ◽  
Wei Wang ◽  
Keming Wu ◽  
Tianming Le
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
3D Printing ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Novel Approach ◽  
Abdominal Aortic ◽  
Bilateral Renal Artery ◽  
Aneurysm Repair ◽  
Aneurysm Model

Objective To describe a novel approach, 3D printing guiding stent graft fenestration, for fenestration during endovascular aneurysm repair for juxtarenal abdominal aortic aneurysm. Methods A 69-year-old male with juxtarenal abdominal aortic aneurysm underwent endovascular aneurysm repair with “off the label” fenestrated stent graft. To precisely locate the fenestration position, we reconstructed a 3D digital abdominal aortic aneurysm model and created a skin template covering this abdominal aortic aneurysm model. Then the skin template was physically printed and the position of the visceral vessel was hollowed out, thereby helping in locating the fenestration on stent graft. Results and conclusions With the help of this 3D printed skin template, we fenestrated the stent graft accurately and rebuilt the bilateral renal artery successfully. This is the first clinical case that used 3D printing guiding stent graft fenestration, which is a novel approach for precise fenestration on stent graft on the table during endovascular aneurysm repair.

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