Abstract
This chapter describes experimental investigations of parameters which are likely to reduce the ability of an implanted stent-graft for the treatment of Abdominal Aortic Aneurysm (AAA) to resist migration. Idealised AAA analogues were manufactured with realistic wall properties. Both proximal stents and complete stent-graft devices were deployed inside these models and the force required to cause migration during physiological flow was investigated. The effect of stent-graft morphology on the columnar rigidity generated by a stent-graft and on the migration force transmitted to the proximal end of the device was also investigated. Lower wall compliance and pulsatile wall motions due to physiological flow were seen to reduce the fixation of an implanted proximal stent from 8.4 ± 0.32 to 3.7 ± 0.06 N. The results also show that high systolic pressure or low proximal fixation length reduce the force required to migrate a graft from 4.62 ± 0.25 to 2.57 ± 0.11 N in a flexible stent-graft with little longitudinal rigidity. In a fully stented device these correlations were less clear due to the complex compressive behaviour of the device and the increase in iliac fixation when the proximal fixation length was reduced. Longitudinal rigidity was measured in terms of the amount of force to cause 5 mm compression of the graft and was found to provide up to 11.53 N of resistance to migration in a fully stented device which is greater than the resistance afforded by passive proximal stents alone. Even the flexible stent-graft was shown to require up to 5.88 N of compressive force to cause 5 mm of device compression due to internal pressure assisting the device in holding its shape. Increasing iliac bifurcation angle or placing the devices in a tortuous configuration was found to reduce the longitudinal rigidity of both devices. The results also showed that the drag force acting on a stent-graft may be somewhat attenuated by compressive forces set up in a non rigid stent-graft model. Both an increase in iliac bifurcation angle and tortuosity was found to increase the migration force on the proximal end of the device from 2.56 to 4.92 N. Tortuosity and higher iliac leg angle were both found to have the double disadvantage of increasing the migration force and decreasing device longitudinal rigidity, while longitudinal rigidity was shown to be crucial to the success of passively fixated stent-grafts. The test methods described in this chapter could be useful in the future preclinical evaluation of stent-grafts and could be useful in the design phase of next generation EVAR devices.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Albertini, J.N., Macierewicz, J.A., Yusuf, S.W., Wenham, P.W., Hopkinson, B.R.: Pathophysiology of proximal perigraft endoleak following endovascular repair of abdominal aortic aneurysms: a study using a flow model. Eur. J. Vasc. Endovasc. Surg. 22, 53–56 (2001)
Arko, F.R., Heikkinen, M., Lee, E.S., Bass, A., Alsac, J.M., Zarins, C.K.: Iliac fixation length and resistance to in vivo stent-graft displacement. J. Vasc. Surg. 41, 644–671 (2005)
Brunkwall, J.: How to design the optimal stent graft—what have we learnt? Scand. J. Surg. 97, 191–194 (2008)
Chong, C.K., How, T.V., Harris, P.L.: Flow visualization in a model of a bifurcated stent-graft. J. Endovasc. Ther. 12(4), 435–445 (2005)
Chong, C.K., How, T.V., Gilling-Smith, G.L., Harris, P.L.: Modelling endoleaks and collateral reperfusion following endovascular AAA exclusion. J. Endovasc. Ther. 10(3), 424–432 (2003)
Chuter, T.A.M.: Stent graft design: the good, the bad and the ugly. Cardiovasc. Surg. 10, 7–13 (2002)
Conners, M.S., Sternbergh, W.C., Carter, G., Tonnessen, B.H., Yoselevitz, M., Money, S.R.: Endograft migration one to four years after endovascular abdominal aortic aneurysm repair with the AneuRx device: a cautionary note. J. Vasc. Surg. 36, 476–484 (2002)
Corbett, T.J., Doyle, B.J., Callanan, A., Walsh, M.T., McGloughlin, T.M.: Engineering silicone rubbers for in vitro studies: creating AAA models and ILT analogues with physiological properties. J. Biomech. Eng. 132(1), 011008 (2010). doi:10.1115/1.4000156
Corbett, T.J., Molony, D.S., Callanan, A., McGloughlin, T.M.: The effect of vessel material properties and pulsatile wall motion on the fixation of a proximal stent of an endovascular graft. Med. Eng. Phys. (2010 in press)
Corbett, T.J., Callanan, A., O’Donnell, M.R., McGloughlin, T.M.: An improved methodology for investigating the parameters influencing migration resistance or abdominal aortic stent-grafts. J. Endovasc. Ther. 17(1), 95–107 (2010)
Corbett, T.J., Callanan, A., McGloughlin, T.M.: In vitro measurement of the axial migration force on the proximal end of a bifurcated abdominal aortic aneurysm stent-graft model. Proc. Inst. Mech. Eng. Part H: J. Eng. Med. (2010, in press)
Doyle, B.J.: Rupture behaviour of abdominal aortic aneurysms: a computational and experimental investigation. Ph.D. Thesis, University of Limerick (2009)
Doyle, B.J., Corbett, T.J., Callanan, A., Walsh, M.T., Vorp, D.A., McGloughlin, T.M.: An experimental and numerical comparison of the rupture locations of an abdominal aortic aneurysm. J. Endovasc. Ther. 16(3), 322–335 (2009)
Doyle, B.J., Morris, L.G., Callanan, A., Kelly, P., Vorp, D.A., McGloughlin, T.M.: 3D reconstruction and manufacture of real abdominal aortic aneurysms: from CT scan to silicone model. J. Biomech. Eng. 130(3), 034501-1–034501-5 (2008)
DuBost, C., Allary, M., Oeconomos, N.: Resection of an aneurysm of the abdominal aorta: reestablishment of the continuity by a preserved human arterial graft, with result after five months. Arch. Surg. 64, 405–408 (1952)
Fairman, R.M., Velazquez, O.C., Carpenter, J.P., Woo, E., Baum, R.A., Golden, M.A., Kritpracha, B., Criado, F.: Midterm pivotal trial results of the talent low profile system for repair of abdominal aortic aneurysm: analysis of complicated versus uncomplicated aortic necks. J. Vasc. Surg. 40, 1074–1082 (2004)
Fransen, G.A.J., Desgranges, P., Laheij, R.J.F., Harris, P.L., Becquemin, J.P.: Frequency, predictive factors, and consequences of stent graft kink following endovascular AAA repair. J. Endovasc. Ther. 10, 913–918 (2003)
Fraser, K., Meagher, S., Blake, J.R., Easson, W.J., Hoskins, P.R.: Characterization of an abdominal aortic velocity waveform in patients with abdominal aortic aneurysm. Ultrasound Med. Biol. 34, 73–80 (2008)
Gawenda M, Knez P, Winter S, Jaschke G, Wassmer G, Schmitz-Rixen T, Brunkwall J.: Endotension is influenced by wall compliance in a latex aneurysm model. Eur. J. Vasc. Endovasc. Surg. 27(1), 45–50 (2004)
Hinnen, J.W., Rixen, D.J., Koning, O.H., van Bockel, J.H., Hamming, J.F.: Development of fibrinous thrombus analogue for in vitro abdominal aortic aneurysm studies. J. Biomech. 40(2), 289–295 (2007)
How, T.V., Guidoin, R., Young, S.K.: Engineering design of vascular prostheses. Proc. Inst. Mech. Eng. Part H. J. Eng. Med. 206(2), 61–71 (1992)
Hyun, S., Hyun, Y.E., Klyachkin, M.: Effects of Endovascular Graft Morphology on the Migration Force. Paper # 192887 Proc. 10th American Society of Mechanical Engineers (ASME) Summer Bioengineering Conference Marco Island, Florida, USA; June 25–29, (2008)
Kratzberg, J.A., Golzarian, J., Raghavan, M.L.: Role of graft oversizing in the fixation strength of barbed endovascular grafts. J. Vasc. Surg. 49, 1543–1553 (2009)
Laheij, R., Van Marrewijk, C., Buth, J.: Progress report including the data of the overall patient cohort. EUROSTAR Data Registry Centre, p. 8, January (2001)
Lambert, A.W., Williams, D.J., Budd, J.S., Horroks, M.: Experimental assessment of proximal stent-graft (InterVascularTM) fixation in human cadaveric infrarenal aortas. Eur. J. Vasc. Endovasc. Surg. 17, 60–65 (1999)
Li, Z., Kleinstreur, C.: Effects of major endoleaks on a stented abdominal aortic aneurysm. J. Biomech. Eng. 128, 59–68 (2006)
Li, Z., Kleinstreur, C.: Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model. J. Biomech. 39, 2264–2273 (2006)
Li Z, Kleinstreur C (2006) Computational analysis of type II endoleaks in a stented abdominal aortic aneurysm model. J. Biomech. 39(14), 2573–2582.
Li, Z., Kleinstreur C.: Fluid-structure interaction effects on sac-blood pressure and wall stress in a stented aneurysm. J. Biomech. Eng. 127, 662–671(2005)
Li, Z., Kleinstreur, C.: Blood flow and structure interactions in a stented abdominal aortic aneurysm model. Med. Eng. Phys. 27, 369–382 (2005)
Li, Z., Kleinstreur, C.: Computational analysis of biomechanical contributors to possible endovascular graft failure. Biomech. Mod. Mechanobiol. 4, 221–234 (2005)
Liffman, K., Lawerence Brown, M.M.D., Semmens, J.B., Bui, A., Rudman, M., Hartley, D.E.: Analytical modelling and numerical simulation of forces in an endoluminal graft. J. Endovasc. Ther. 8, 358–371 (2001)
Major, A., Guidoin, R., Soulez, G., Gaboury, L.A., Cloutier, G., Saproval, M., Douville, Y., Dionne, G., Geelkerken, R.H., Petrasek, P., Lerouge, S.: Implant degradation and poor healing after endovascular repair of abdominal aortic aneurysms: an analysis of explanted stent-grafts. J. Endovasc. Ther. 13, 457–467 (2006)
Malina, M., Lindblad, B., Ivancev, K., Lindh, M., Malina, J., Brunkwall, J.: Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration? J. Endovasc. Surg. 5, 310–317 (1998)
Mohan, I.V., Harris, P.L., van Marrewijk, C.J., Laheij, R.J., How, T.V.: Factors and forces influencing stent-graft migration after endovascular aortic aneurysm repair. J. Endovasc. Ther. 9, 748–755 (2002)
Molony, D.S., Callanan, A., Walsh, M.T., Kavanagh, E.K., McGloughlin, T.M.: Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft. BioMed. Eng. OnLine 8, 24 (2009). doi:10.1186/1475-925X-8-24
Molony, D.S., Callanan, A., Morris, L.G., Doyle, B.J., Walsh, M.T., McGloughlin, T.M.: Geometrical enhancements for abdominal aortic stent-grafts. J. Endovasc. Ther. 15, 518–529.
Morris, L., Delassus, P., Grace, P., Wallis, F., Walsh, M., McGloughlin, T.: Effects of flat, parabolic and realistic steady flow inlet profiles on idealised and realistic stent graft fits through abdominal aortic aneurysms (AAA). Med. Eng. Phys. 28, 19–26 (2006)
Morris, L., O’Donnell, P., Delassus, P., McGloughlin, T.: Experimental assessment of stress patterns in abdominal aortic aneurysms using the photoelastic method. Strain 40(4), 165–172 (2004)
Morris, L., Delassus, P., Walsh, M., McGloughlin, T.: A mathematical model to predict the in vivo pulsatile drag forces acting on bifurcated stent grafts used in endovascular treatment of abdominal aortic aneurysm (AAA). J. Biomech. 37, 1087–1095 (2004)
Morris, L.G.: Numerical and experimental investigation of mechanical factors in the treatment of abdominal aortic aneurysms. Ph.D. Thesis, University of Limerick (2004)
Mullins, L.: Softening of rubber by deformation. Rubber Chem. Technol. 42(1), 339–362 (1969)
Murphy, E.H., Johnson, E.D., Arko, F.R.: Device-specific resistance to in vivo displacement of stent-grafts implanted with maximum iliac fixation. J. Endovasc. Ther. 14, 585–592 (2007)
O’ Brien, T.P., Walsh, M.T., Morris, L.G., Grace, P.A., Kavanagh, E.G., McGloughlin, T.M.: Numerical and Experimental Techniques for the Study of Biomechanics in the Arterial System. in Biomechanical Systems Technology. World Scientific Publishing Company, pp. 233–270, Singapore, Chap. 7 (2008)
O’ Brien, T., Morris, L., McGloughlin, T.: Evidence suggests rigid aortic grafts increase systolic blood pressure: results of a preliminary study. Med. Eng. Phys. 30(1), 109–115 (2007)
O’ Brien, T., Morris, L., O’ Donnell, M., Walsh, M., McGloughlin, T.: Injection-moulded models of major and minor arteries: the variability of model wall thickness owing to casting technique. Proc. Inst. Mech. Eng. Part H: J. Eng. Med. 219(5), 381–386 (2005)
Petrini, L., Migliavacca, F., Massarotti, P., Schievano, S., Dubini, G., Auricchio, F.: Computational studies of shape memory alloy behaviour in biomedical applications. J. Biomech. Eng. 127, 716–725 (2005)
Raghavan, M.L., Webster, M.W., Vorp, D.A.: Ex vivo biomechanical behaviour of abdominal aortic aneurysm: assessment using a new mathematical model. Ann. Biomed. Eng. 24, 573–582 (1996)
Ramaiah, V.G., Thompson, C.S., Shafique, S., Rodriguez, J.A., Ravi, R., DiMungo, L., Diethrich, E.B.: (2002) Crossing the Limbs: A Useful Adjunct for Successful Deployment of the AneuRx Stent-Graft. J. Endovasc. Ther. 9(5):583–586
Resch, T., Malina, M., Lindblad, B., Brunkwall, J., Ivancev, K.: The impact of stent design on proximal stent-graft fixation in the abdominal aorta: an experimental study. Eur. J. Vasc. Endovasc. Surg. 20, 190–195 (2000)
Roy, S.A., West, K., Rontala, R.S., Greenberg, R.K., Banerjee, R.K.: In vitro measurement and calculation of drag force on iliac limb stent-graft in a compliant arterial wall model. Mol. Cell Biomech. 4, 211–226 (2007)
Sonesson, B., Hansen, F., Lanne, T.: Abdominal aortic aneurysm: a general defect in the vasculature with focal manifestations in the abdominal aorta? J. Vasc. Surg. 26, 247–254 (1997)
Sonesson, B., Lanne, T., Vernersson, E., Hansen, F.: Sex difference in the mechanical properties of the abdominal aorta in human beings. J. Vasc. Surg. 20(6):959–969 (1994)
Sampaio, S.M., Panneton, J.M., Mozes, G., Andrews, J.C., Noel, A.A., Kalra, M., Bower, T.C., Cherry, K.J., Sullivan, T.M., Gloviczki, P.: AneuRx device migration: incidence, risk factors, and consequences. Ann. Vasc. Surg. 19, 178–185 (2005)
Sternbergh, W.C., Money, S.R., Greenberg, R.K., Chuter, T.A.: Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J. Vasc. Surg. 39, 20–26 (2004)
Sutalo, I.D., Liffman, K., Lawerence Brown, M.M.D., Semmens, J.B.: Experimental force measurement on a bifurcated endoluminal stent-graft model: comparison with theory. Vascular 13, 98–106 (2005)
Vad, S., Eskinazi, A., Corbett, T., McGloughlin, T., Vande Geest, J.: Determination of coefficient of friction for self expanding stent-grafts. J. Biomech. Eng. 132, 121007 (2010) doi:10.1115/1.4002798
Vallabhaneni, S.R., Gilling-Smith, G.L., How, T.V., Carter, S.D., Brennan, J.A., Harris, P.L.: Heterogeneity of tensile strength and matrix metalloproteinase activity in the wall of abdominal aortic aneurysms. J. Endovasc. Ther. 11(4), 494–502 (2004)
Veerapen, R., Dorandeu, A., Serre, I., Berthet, J.P., Marty-Ane, C.H., Mary, H., Alric, P.: Improvement in proximal aortic endograft fixation: an experimental study using different stent-grafts in human cadaveric aortas. J. Endovasc. Ther. 10, 1101–1109 (2003)
Volodos, N.L., Karpovich, I.P., Troyan, V.I., Kalashnikova, Yu.V., Shekhanin, V.E., Ternyuk, N.E., Neoneta, A.S., Ustinov, N.I., Yakovenko, L.F.: Clinical experience of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral artery and as intraoperative endoprosthesis for aorta reconstruction. VASA Suppl. 33, 93–95 (1991)
Vorp, D.A., Mandarino, M., Webster, M.W., Gorcsan, J.: Potential influence of intraluminal thrombus on abdominal aortic aneurysm as assessed by a new non-invasive method. Cardiovasc. Surg. 4(6), 732–739 (1996)
Wu, W., Qi, M., Liu, X.P., Yang, D.Z., Wang, W.Q.: Delivery and release of nitinol stent in carotid artery and their interactions: a finite element analysis. J. Biomech. 40, 3034–3040 (2007)
Zhou, S.N., How, T.V., Black, R.A., Vallabhaneni, S.R., Mcwilliams, R., Brennan, J.A.: Measurement of pulsatile haemodynamic forces in a model of a bifurcated stent-graft for abdominal aortic aneurysm repair. Proc. Inst. Mech. Eng. Part H: J. Eng. Med. 222, 543–549 (2008)
Zhou, S.S., How, T.V., Rao Vallabhaneni, S., Gilling-Smith, G.L., Brennan, J.A., Harris, P.L., McWilliams, R.: Comparison of the fixation strength of standard and fenestrated stent-grafts for endovascular abdominal aortic aneurysm repair. J. Endovasc. Ther. 14, 168–175 (2007)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Corbett, T., Molony, D., Kavanagh, E., Grace, P., Walsh, M., McGloughlin, T. (2011). Experimental Analysis of Endovascular Treatment of AAA and Predictors of Long Term Outcomes. In: McGloughlin, T. (eds) Biomechanics and Mechanobiology of Aneurysms. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 7. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8415_2011_74
Download citation
DOI: https://doi.org/10.1007/8415_2011_74
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-18094-1
Online ISBN: 978-3-642-18095-8
eBook Packages: EngineeringEngineering (R0)