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Morphological and stent design risk factors to prevent migration phenomena for a thoracic aneurysm: a numerical
H-E Altnji1, B Bou-Saïd1, H Walter-Le Berre1
1Laboratoire de Mécanique des Contacts et des Structures, INSA de Lyon, 18-20 rue des Sciences, 69621 Villeurbanne, France.
Abstract:
The primary mechanically related problems of endovascular aneurysm repair are migration and type Ia endoleaks. They occur when there is no effective seal between the proximal end of the stent-graft and the vessel. In this work, we have developed several deployment simulations of parameterized stents using the finite element method (FEM) to investigate the contact stiffness of a nitinol stent in a realistic Thoracic Aortic Aneurysm (TAA). Therefore, we evaluated the following factors associated with these complications: (1) Proximal Attachment Site Length (PASL), (2) stent oversizing value (O%), (3) different friction conditions of the stent/aorta contact, and (4) proximal neck angulation α. The simulation results show that PASL>18 mm is a crucial factor to prevent migration at a neck angle of 60°, and the smoothest contact condition with low friction coefficient (μ=0.05). The increase in O% ranging from 10% to 20% improved the fixation strength. However, O%≥25% at 60° caused eccentric deformation and stent collapse. Higher coefficient of friction μ>0.01 considerably increased the migration risk when PASL=18 mm. No migration was found in an idealized aorta model with a neck angle of 0°, PASL=18 mm and μ=0.05. Our results suggest carefully considering the stent length and oversizing value in this neck morphology to strengthen the contact and prevent migration.
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