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Computational fluid dynamics evaluation of the cross-limb stent graft configuration for endovascular aneurysm repair.
MedLine Citation:
PMID:  23363204     Owner:  NLM     Status:  In-Data-Review    
The technique of crossing the limbs of bifurcated modular stent grafts for endovascular aneurysm repair (EVAR) is often employed in the face of splayed aortic bifurcations to facilitate cannulation and prevent device kinking. However, little has been reported about the implications of cross-limb EVAR, especially in comparison to conventional EVAR. Previous computational fluid dynamics studies of conventional EVAR grafts have mostly utilized simplified planar stent graft geometries. We herein examined the differences between conventional and cross-limb EVAR by comparing their hemodynamic flow fields (i.e., in the "direct" and "cross" configurations, respectively). We also added a "planar" configuration, which is commonly found in the literature, to identify how well this configuration compares to out-of-plane stent graft configurations from a hemodynamic perspective. A representative patient's cross-limb stent graft geometry was segmented using computed tomography imaging in Mimics software. The cross-limb graft geometry was used to build its direct and planar counterparts in SolidWorks. Physiologic velocity and mass flow boundary conditions and blood properties were implemented for steady-state and pulsatile transient simulations in ANSYS CFX. Displacement forces, wall shear stress (WSS), and oscillatory shear index (OSI) were all comparable between the direct and cross configurations, whereas the planar geometry yielded very different predictions of hemodynamics compared to the out-of-plane stent graft configurations, particularly for displacement forces. This single-patient study suggests that the short-term hemodynamics involved in crossing the limbs is as safe as conventional EVAR. Higher helicity and improved WSS distribution of the cross-limb configuration suggest improved flow-related thrombosis resistance in the short term. However, there may be long-term fatigue implications to stent graft use in the cross configuration when compared to the direct configuration.
Tina L T Shek; Leonard W Tse; Aydin Nabovati; Cristina H Amon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of biomechanical engineering     Volume:  134     ISSN:  1528-8951     ISO Abbreviation:  J Biomech Eng     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2013-01-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7909584     Medline TA:  J Biomech Eng     Country:  United States    
Other Details:
Languages:  eng     Pagination:  121002     Citation Subset:  IM    
Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, M5S 3G8, Canada.
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