P373. Utilizing numerical simulations to prevent complications during thoracic endovascular aortic repair
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives: Numerical computational simulations (CS) of thoracic endovascular aortic repair (TEVAR) can be integrated into the preoperative workflow when credible and reliable. For this, the methodological mechanical definition of endografts is essential. We explored the potential of TEVAR simulation in predicting technical outcomes and identifying potential adverse events.
Methods: In this process, four different steps were performed, including: 1) experimental test to characterize stent-graft materials and reconstruction of the anatomical conditions , 2) experimental test in 3D printed aortic models to assess deployment of the stent-grafts, 3) Finite Element Analysis (FEA) simulations and comparison with CT-scan experiments, and 4) pre-operative planning. In this study, two cases on preoperative CS before TEVAR are described.
Results: The first case involves an 82-year-old female, presenting with a penetrating atherosclerotic ulcer in the left hemiarch. The patient was submitted to TEVAR in zone 2, with previous left common carotid artery to left subclavian artery bypass. During the intervention, kinking of the distal thoracic stent graft occurred. The kinking was resolved by ballooning the area. The simulation was able to reproduce both the kinking and the situation after simulation of the ballooning (fig 1). Postoperative CT-scan was compared to the simulation and a less than 10% difference in opening area for the nitinol rings was found. The second case includes a 76-year-old patient presenting with a descending thoracic aneurysm, type III arch angulations with several aortic calcifications and a previous open thoraco-abdominal type IV repair. The CS showed both the proximal correct deployment without presence of bird-beak and a partial shrinkage of the last stent within the surgical graft (fig. 2).
Conclusion: This report highlights the potential and reliability of TEVAR simulations in predicting perioperative adverse events and short-term postoperative technical results.
Authors
Tim Mandigers (1), Jasper de Kort (1), Anna Ramella (2), Daniele Bissacco (3), Maurizio Domanin (3), Joost van Herwaarden (4), Giulia Luraghi (2), Francesco Migliavacca (2), Santi Trimarchi (5)
Institutions
(1) Policlinico di Milano, Milan, Utrecht, (2) Politecnico di Milano, Milan, (3) Policlinico di Milano, Milan, (4) University Medical Center Utrecht, Utrecht, (5) Policlinico di Milano, Milano
Methods: In this process, four different steps were performed, including: 1) experimental test to characterize stent-graft materials and reconstruction of the anatomical conditions , 2) experimental test in 3D printed aortic models to assess deployment of the stent-grafts, 3) Finite Element Analysis (FEA) simulations and comparison with CT-scan experiments, and 4) pre-operative planning. In this study, two cases on preoperative CS before TEVAR are described.
Results: The first case involves an 82-year-old female, presenting with a penetrating atherosclerotic ulcer in the left hemiarch. The patient was submitted to TEVAR in zone 2, with previous left common carotid artery to left subclavian artery bypass. During the intervention, kinking of the distal thoracic stent graft occurred. The kinking was resolved by ballooning the area. The simulation was able to reproduce both the kinking and the situation after simulation of the ballooning (fig 1). Postoperative CT-scan was compared to the simulation and a less than 10% difference in opening area for the nitinol rings was found. The second case includes a 76-year-old patient presenting with a descending thoracic aneurysm, type III arch angulations with several aortic calcifications and a previous open thoraco-abdominal type IV repair. The CS showed both the proximal correct deployment without presence of bird-beak and a partial shrinkage of the last stent within the surgical graft (fig. 2).
Conclusion: This report highlights the potential and reliability of TEVAR simulations in predicting perioperative adverse events and short-term postoperative technical results.
Authors
Tim Mandigers (1), Jasper de Kort (1), Anna Ramella (2), Daniele Bissacco (3), Maurizio Domanin (3), Joost van Herwaarden (4), Giulia Luraghi (2), Francesco Migliavacca (2), Santi Trimarchi (5)
Institutions
(1) Policlinico di Milano, Milan, Utrecht, (2) Politecnico di Milano, Milan, (3) Policlinico di Milano, Milan, (4) University Medical Center Utrecht, Utrecht, (5) Policlinico di Milano, Milano
Presentation Duration
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