TY - JOUR
T1 - Stent graft performance in the treatment of abdominal aortic aneurysms
T2 - The influence of compliance and geometry
AU - Morris, Liam
AU - Stefanov, Florian
AU - McGloughlin, Tim
N1 - Copyright © 2012 Elsevier Ltd. All rights reserved.
PY - 2013/1/18
Y1 - 2013/1/18
N2 - The long-term success of the endovascular procedure for the treatment of Abdominal Aortic Aneurysms (AAAs ) depends on the secure fixation of the proximal end and the geometry of the stent-graft (SG) device. Variations in SG types can affect proximal fixation and SG hemodynamics. Such hemodynamic variations can have a catastrophic effect on the vascular system and may result from a SG/arterial wall compliance mismatch and the sudden decrease in cross-sectional area at the bifurcation, which may result in decreased distal perfusion, increased pressure wave reflection and increased stress at the interface between the stented and non-stented portion of the vessel. To examine this compliance mismatch, a commercial SG device was tested experimentally under a physiological pressure condition in a silicone AAA model based on computed tomography scans. There was a considerable reduction in compliance of 54% and an increase in the pulse wave velocity of 21%, with a significant amount of the forward pressure wave being reflected. To examine the SG geometrical effects, a commercial bifurcated geometry was compared computationally and experimentally with a geometrical taper in the form of a blended section, which provided a smooth transition from the proximal end to both iliac legs. The sudden contraction of commercial SG at the bifurcation region causes flow separation within the iliac legs, which is known to cause SG occlusion and increased proximal pressure. The blended section along the bifurcation region promotes a greater uniformity of the fluid flow field within the distal legs, especially, during the deceleration phase with reduced boundary layer reversal. In order to reduce the foregoing losses, abrupt changes of cross-section should be avoided. Geometrical tapers could lead to improved clinical outcomes for AAA SGs.
AB - The long-term success of the endovascular procedure for the treatment of Abdominal Aortic Aneurysms (AAAs ) depends on the secure fixation of the proximal end and the geometry of the stent-graft (SG) device. Variations in SG types can affect proximal fixation and SG hemodynamics. Such hemodynamic variations can have a catastrophic effect on the vascular system and may result from a SG/arterial wall compliance mismatch and the sudden decrease in cross-sectional area at the bifurcation, which may result in decreased distal perfusion, increased pressure wave reflection and increased stress at the interface between the stented and non-stented portion of the vessel. To examine this compliance mismatch, a commercial SG device was tested experimentally under a physiological pressure condition in a silicone AAA model based on computed tomography scans. There was a considerable reduction in compliance of 54% and an increase in the pulse wave velocity of 21%, with a significant amount of the forward pressure wave being reflected. To examine the SG geometrical effects, a commercial bifurcated geometry was compared computationally and experimentally with a geometrical taper in the form of a blended section, which provided a smooth transition from the proximal end to both iliac legs. The sudden contraction of commercial SG at the bifurcation region causes flow separation within the iliac legs, which is known to cause SG occlusion and increased proximal pressure. The blended section along the bifurcation region promotes a greater uniformity of the fluid flow field within the distal legs, especially, during the deceleration phase with reduced boundary layer reversal. In order to reduce the foregoing losses, abrupt changes of cross-section should be avoided. Geometrical tapers could lead to improved clinical outcomes for AAA SGs.
KW - Abdominal aortic aneurysms
KW - Bifurcated stent grafts
KW - Blended geometrical taper
KW - Boundary layer
KW - Compliance mismatch
KW - Proximal mixation
KW - Pulse wave velocity
UR - http://www.scopus.com/inward/record.url?scp=84872597567&partnerID=8YFLogxK
U2 - 10.1016/j.jbiomech.2012.11.026
DO - 10.1016/j.jbiomech.2012.11.026
M3 - Article
C2 - 23218139
AN - SCOPUS:84872597567
SN - 0021-9290
VL - 46
SP - 383
EP - 395
JO - Journal of Biomechanics
JF - Journal of Biomechanics
IS - 2
ER -