Skip to main content
SpringerLink
Log in

Comparative analysis of custom-made endograft simulation techniques: physical prototypes versus numerical simulations

  • original article
  • Published:
European Surgery Aims and scope Submit manuscript

Summary

Background

The technical success of fenestrated endovascular aortic repair (FEVAR) relies on the exact fit of the custom-made endograft in the patient. Numerical simulation software has been made available (PLANOP™, PrediSurge) to digitally test the intended endograft design.

Methods

The distance between opposite peaks of the proximal endograft sealing ring were measured on computed tomography (CT) scans of the test implantation within a 3D printed model, on numerical simulation software, and on postoperative CT (reference). Two types of modeling were used for the aorta in the numerical simulation software: rigid and deformable. This resulted in four measurements: (1) CT scan of the physical endograft prototype implanted in a rigid printed silicone model of the aorta, (2) rigid numerical or finite element (FE) simulation of the endograft implanted in a rigid aortic model, (3) numerical or FE simulation with a deformable virtual aortic model, and (4) patient postoperative CT.

Results

Ten patients were included in the study. The mean distance between peaks was 26.8 mm in the postoperative CT scan (reference). The distance in the rigid printed model was 23.8 ± 2.0 mm p < 0.003). The FE analysis with rigid aorta measured 23.8 ± 1.5 mm (p < 0.006). Measurements performed on CT of the physical prototype test implanted in the printed silicone model of the aorta, and measurements from FE analysis with rigid modeling, were not significantly different. Measurements in a simulated deformable aorta were 27.4 ± 2.1 mm (p  < 0.521). A high correlation (r = 0.81, p < 0.01) was found between measurements on postoperative CT and deformable aorta FE analysis.

Conclusion

Numerical simulation with a rigid aorta may be a suitable substitute for traditional test implantation of a non-sterile prototype within a 3D aortic model. This may help reduce time for graft planning and fabrication. The FE analysis with a deformable aorta was able to predict peak-to-peak distances at the proximal sealing ring more reliably. The effect on clinical outcomes and endoleak occurrence remains to be elucidated in future trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Karelis A, Haulon S, Sonesson B, Adam D, Kolbel T, Oderich G, et al. Editor’s choice—multicentre outcomes of redo fenestrated/branched endovascular aneurysm repair to rescue failed fenestrated endografts. Eur J Vasc Endovasc Surg. 2021;62(5):738–45.

    Article  PubMed  Google Scholar 

  2. Oderich GS, Greenberg RK, Farber M, Lyden S, Sanchez L, Fairman R, et al. Results of the United States multicenter prospective study evaluating the Zenith fenestrated endovascular graft for treatment of juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2014;60(6):1420–8.e1–5.

    Article  PubMed  Google Scholar 

  3. Falkensammer J, Taher F, Plimon M, Kliewer M, Walter C, Pelanek E, et al. Assessment of pull-out forces in TEVAR and ANACONDA FEVAR combination and early clinical results: creation of a proximal landing zone for FEVAR in patients with extent I and extent IV TAAas. Ann Vasc Surg. 2020;66:160–70.

    Article  PubMed  Google Scholar 

  4. de Niet A, Zeebregts CJ, Reijnen M, Fenestrated Anaconda Study group. Outcomes after treatment of complex aortic abdominal aneurysms with the fenestrated Anaconda endograft. J Vasc Surg. 2020;72(1):25–35.e1.

    Article  PubMed  Google Scholar 

  5. Oderich GS, Farber MA, Schneider D, Makaroun M, Sanchez LA, Schanzer A, et al. Final 5‑year results of the United States Zenith fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms. J Vasc Surg. 2021;73(4):1128–38.e2.

    Article  PubMed  Google Scholar 

  6. Taher F, Assadian A, Strassegger J, Duschek N, Koulas S, Senekowitsch C, et al. Pararenal aortic ulcer repair. Eur J Vasc Endovasc Surg. 2016;51(4):504–10.

    Article  CAS  PubMed  Google Scholar 

  7. Taher F, Falkensammer J, McCarte J, Strassegger J, Uhlmann M, Schuch P, et al. The influence of prototype testing in three-dimensional aortic models on fenestrated endograft design. J Vasc Surg. 2017;65(6):1591–7.

    Article  PubMed  Google Scholar 

  8. Kliewer ME, Bordet M, Chavent B, Reijnen M, Frisch N, Midy D, et al. Assessment of fenestrated anaconda stent graft design by numerical simulation: results of a European prospective multicenter study. J Vasc Surg. 2022;75(1):99–108.e2.

    Article  PubMed  Google Scholar 

  9. de Niet A, Donselaar EJ, Holewijn S, Tielliu IFJ, Lardenoije J, Zeebregts CJ, et al. Endograft conformability in fenestrated endovascular aneurysm repair for complex abdominal aortic aneurysms. J Endovasc Ther. 2020;27(5):848–56.

    Article  PubMed  Google Scholar 

  10. Banno H, Kobeiter H, Brossier J, Marzelle J, Presles E, Becquemin JP. Inter-observer variability in sizing fenestrated and/or branched aortic stent-grafts. Eur J Vasc Endovasc Surg. 2014;47(1):45–52.

    Article  CAS  PubMed  Google Scholar 

  11. Malkawi AH, Resch TA, Bown MJ, Manning BJ, Poloniecki JD, Nordon IM, et al. Sizing fenestrated aortic stent-grafts. Eur J Vasc Endovasc Surg. 2011;41(3):311–6.

    Article  CAS  PubMed  Google Scholar 

  12. Derycke L, Senemaud J, Perrin D, Avril S, Desgranges P, Albertini JN, et al. Patient specific computer modelling for automated sizing of fenestrated stent grafts. Eur J Vasc Endovasc Surg. 2020;59(2):237–46.

    Article  PubMed  Google Scholar 

  13. Demanget N, Duprey A, Badel P, Orgeas L, Avril S, Geindreau C, et al. Finite element analysis of the mechanical performances of 8 marketed aortic stent-grafts. J Endovasc Ther. 2013;20(4):523–35.

    Article  PubMed  Google Scholar 

  14. Derycke L, Perrin D, Cochennec F, Albertini JN, Avril S. Predictive numerical simulations of double branch stent-graft deployment in an aortic arch aneurysm. Ann Biomed Eng. 2019;47(4):1051–62.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, Hospital Ottakring Vienna, Montleartstr. 37, Pav. 30b, 1160, Vienna, Austria

    Fadi Taher M.D., Miriam Kliewer M.D., Corinna Walter M.D., Markus Plimon M.D. & Afshin Assadian M.D.

  2. Department of Vascular Surgery, CHU Saint-Etienne, Saint-Etienne, France

    Jean-Noel Albertini M.D.

  3. PrediSurge, Saint-Etienne, France

    Joris Vermunt PhD & Raphael Doustaly MSc

  4. Department of Vascular Surgery, Barmherzige Brueder Hospital, Linz, Austria

    Jürgen Falkensammer M.D.

  5. Department of Radiology, Hospital Ottakring Vienna, Vienna, Austria

    Herbert Langenberger M.D.

Authors
  1. Fadi Taher M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miriam Kliewer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Noel Albertini M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joris Vermunt PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raphael Doustaly MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Corinna Walter M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Markus Plimon M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jürgen Falkensammer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Herbert Langenberger M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Afshin Assadian M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fadi Taher M.D..

Ethics declarations

Conflict of interest

M. Kliewer, A. Assadian, and J. Falkensammer are proctors for Terumo Aortic. J.N. Albertini is co-founder and chief medical officer of PrediSurge; J. Vermunt is employed as production manager at PrediSurge; R. Doustaly is employed as product manager at PrediSurge. The remaining authors, F. Taher, C. Walter, M. Plimon and H. Langenberger, declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Taher, F., Kliewer, M., Albertini, JN. et al. Comparative analysis of custom-made endograft simulation techniques: physical prototypes versus numerical simulations. Eur Surg 56, 27–32 (2024). https://doi.org/10.1007/s10353-023-00819-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-023-00819-6

Keywords

Search

Navigation