Analysis of Endovascular Graft Features Affecting Endotension Following Endovascular Aneurysm Repair

Authors: Zeinab Hooshyar, Alireza Mehdizadeh

Abstract:

Endovascular aneurysm repair is a new and minimally invasive repair for patients with abdominal aortic aneurysm (AAA). This method has potential advantages that are incomparable with other repair methods. However, the enlargement of aneurysm in the absence of endoleak, which is known as endotension, may occur as one of post-operative compliances of this method. Typically, endotension is mainly as a result of pressure transmitted to aneurysm sac by endovascular installed graft. After installation of graft the aneurysm sac reduces significantly but remains non-zero. There are some factors which affect this pressure transmitted. In this study, the geometry features of installed vascular graft have been considered. It is inferred that graft neck angle and iliac bifurcation angle are two factors which can affect the drag force on graft and consequently the pressure transmitted to aneurysm.

Keywords: Endovascular graft, transmitted pressure, Drag force, Finite Element Modeling, neck angle, iliac bifurcation angle.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1074353

References:

[1] Ian M. Nordon, Robert J. Hinchliffe, Ian M. Loftus & Matt M. Thompson, "Pathophysiology and epidemiology of abdominal aortic aneurysms", Published online 16 November 2010
[2] Legs For Life, "national screening for vascular disease"
[3] Drury D, Michaels JA, Jones L, Ayiku L.. "Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm" Academic Vascular Unit, Northern General Hospital, Sheffield, UK.), 2005 Aug;92(8):937-46
[4] R Magennis, Dmrd, Fr, Joekes, Md, j Martin, Dcr(R), Pg Dip, Msc, 1d White, Dcr(R) And 1r G Mcwilliams, Frcs, Frcr, "Pictorial review Complications following endovascular abdominal aortic aneurysm repair" Departments of 1Radiology and 2Vascular Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK )
[5] Gilling-Smith GL, Brennan JA, Harris PL, Bakran A, Gould DA, McWilliams RG. "Endotension after endovascular aneurysm repair: definition, classification and strategies for surveillance and intervention". J EndovascSurg 1999;6:305-7)
[6] .. Jackson RS, Chang DC, Freischlag JA,"Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries "JAMA. 2012 Apr 18;307 (15):1621-8. Department of Surgery, Georgetown University Hospital, 3800 Reservoir Rd, Washington, DC 20007, USA. [email protected])
[7] White, GH, May, J., "How should endotension be definedHistory of a concept and evolution of a new term". J Endovasc Ther 2000; 7: 435- 438
[8] Dubenec, SR, White, GH, Pasenau, J, Tzilalis, V, Choy, E,Erdelez, L. "Endotension. A review of current views onpathophysiology and treatment". J Cardio vasc. Surg 2003;44: 553-557.
[9] Ruurda, JP, Rijbroek, A, Vermeulen, EG, Wisselink, W,Rauwerda, JA. "Continuing expansion of internal iliacartery aneurysms after surgical exclusion of the inflow. A report of two cases." J Cardio vascular Surg. (Torino) 2001; 42:389-392.
[10] Lin, PH, Bush, RL, Katzman, JB, "Delayed aortic aneurysm enlargement due to endotension after endovascular abdominal aortic aneurysm repair. J VascSurg 2003;38: 840-842.
[11] White, GH, May, J, Petrasek, P, Waugh, R, Stephen, M,Harris, J. "Endotension: an explanation for continuedAAA growth after successful endoluminal repair". J EndovascSurg 1999; 6: 308-315.
[12] Parodi, JC, Berguer, R, Ferreira, LM, La Mura, R,Schermerhorn, ML. "Intra-aneurysmal pressure after incomplete endovascular exclusion". J VascSurg 2001; 34: 909-914.
[13] Meier, GH, Parker, FM, Godziachvili, V, Demasi, RJ,Parent, FN, Gayle, RG. "Endotension after endovascular repair: the Ancure experience". J VascSurg 2001; 34: 421-426.
[14] White, GH, Yu, W, May, J, Chaufour, X, Stephen, MS."Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management". J Endo vasc Surg 1997; 4:152-168.
[15] Wever, JJ, Blankensteijn, JD, Eikelboom, BC. "Secondary endoleak or missed endoleak". Eur J VascEndovascSurg1999; 18: 458-460.
[16] Lorelli, DR, Jean-Claude, JM, Fox, CJ, "Response of plasma matrix metalloproteinase-9 to conventional abdominal aortic aneurysm repair or endovascular exclusion" :implications for endoleak. J VascSurg 2002; 35:916-922.
[17] Bernhard, VM, Mitchell, RS, Matsumura, JS. "Rupture abdominal aortic aneurysm after endovascular repair." J VascSurg 2003; 35: 1155-1162.
[18] Naoki Toya, Tetsuji Fujita, Yuji Kanaoka and Takao Ohki, "Endotension following endovascular aneurysm repair", Vasc Med 2008 13: 305, DOI: 10.1177/1358863X08094850
[19] Wissam N Raad, MD, Nada M Shaban, MD, Dragh S Moneley, MD, Mark C Given, MBBCh, Frank J McGrath, MD, Cathal J Kelly, MCH, "Endotension Following Endovascular Aneurysm Repair", Original Article , July 2010
[20] Zhonghua Li a, Clement Kleinstreuer , "Blood flow and structure interactions in a stented abdominal aortic aneurysm model, Medical Engineering & Physics" 27 (2005) 369-382
[21] Z. Li, C. Kleinstreuer, M. Farber, "Computational analysis of biomechanical contributors to possible endovascular graft failure," Biomech Model Mechanbiol (2005) 4: 221-234DOI 10.1007/s10237- 005-0003-0
[22] William Joseph Jenkins, "Endotension Distribution in Finite Element Models of Abdominal Aortic Aneurysm Following Endovascular Exclusion", University of Tennessee - Knoxville, 2002
[23] C. Kleinstreuer, Z. Li, C.A. Basciano, S. Seelecke, M.A. "Farber, computational mechanics of Nitinol stent grafts", Journal of Biomechanics 41 (2008) 2370-2378
[24] Edwald Edner Joviliano, Marcelo Bellini Dalio, José Geraldo Ciscato Junior, Nei Rodrigues AlvesDezotti, Takachi Moriya, Carlos Eli Piccinato, "Endovascular treatment of endotension with dacron stent graft reinforcement and femorofemoral crossover bypass - therapeutic challenge", 2010, Endovascular treatment of endotension
[25] A. Gebert de Uhlenbrock, C. Wintzerb, H. Imigc, M.M. Morlock, "Fluid transfer as a mechanism leading to endotension, Medical Engineering & Physics", 32 (2010) 914-920
[26] Suzuki, K., Ishiguchi, T., Kawatsu, S., Iwai, H., Maruyama, K. Ishigaki, T., "Dilatation of stent-grafts by luminal pressures experimental evaluation of polytetrafluorothylene (PTFE) and woven polyester grafts. Cardiovascular and Interventional Radiology", 2001 24, 94-98.
[27] Meter, O., "Numerical simulation and experimental validation of blood flow in arteries with structured-tree outflow conditions. Annals of Biomedical Engineering ", 2000, 28, 1281-1299.