A Computational Study of the Magnitude and Direction of Migration Forces in Patient-specific Abdominal Aortic Aneurysm Stent-Grafts

Molony, D.S.; Kavanagh, E.G.; Madhavan, P.; Walsh, M.T.; McGloughlin, T.M.

doi:10.1016/j.ejvs.2010.06.001

« Previous Next »European Journal of Vascular & Endovascular Surgery
Volume 40, Issue 3 , Pages 332-339, September 2010

A Computational Study of the Magnitude and Direction of Migration Forces in Patient-specific Abdominal Aortic Aneurysm Stent-Grafts

D.S. Molony
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering and Materials and Surface Science Institute, University of Limerick, Ireland
E.G. Kavanagh
- Department of Vascular Surgery, Mid-Western Regional Hospital, Limerick, Ireland
P. Madhavan
- Department of Vascular and Endovascular Surgery, St. James Hospital, Dublin, Ireland
M.T. Walsh
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering and Materials and Surface Science Institute, University of Limerick, Ireland
T.M. McGloughlin
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering and Materials and Surface Science Institute, University of Limerick, Ireland
- Corresponding author. Tel.: +353 61 202217; fax: +353 61 202944.

Received 9 October 2009; accepted 3 June 2010. published online 23 June 2010.

Abstract

Objectives

Endovascular aneurysm repair for abdominal aortic aneurysm (AAA) is now a widely adopted treatment. Several complications remain to be fully resolved and perhaps the most significant of these is graft migration. Haemodynamic drag forces are believed to be partly responsible for migration of the device. The objective of this work was to investigate the drag forces in patient-specific AAA stent-grafts.

Methods

CT scan data was obtained from 10 post-operative AAA patients treated with stent-grafts. 3D models of the aneurysm, intraluminal thrombus and stent-graft were created. The drag forces were determined by fluid-structure interaction simulations. A worst case scenario was investigated by altering the aortic waveforms.

Results

The median resultant drag force was 5.46 N (range: 2.53–10.84). An increase in proximal neck angulation resulted in an increase in the resultant drag force (p = 0.009). The primary force vector was found to act in an anterior caudal direction for most patients. The worst case scenario simulation resulted in a greatest drag force of 16 N.

Conclusions

Numerical methods can be used to determine patient-specific drag forces which may help determine the likelihood of stent-graft migration. Anterior–posterior neck angulation appears to be the greatest determinant of drag force magnitude. Graft dislodgement may occur anteriorally as well as caudally.

Keywords: Abdominal aortic aneurysm, EVAR, Drag forces, Graft migration