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Assessing calcification effects in TEVAR procedures: a computational analysis.

Giulia De Campo1, Anna Ramella1,2, Sara Barati1,2

  • 1Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico Di Milano, Milan, Italy.

Biomechanics and Modeling in Mechanobiology
|September 12, 2025
PubMed
Summary
This summary is machine-generated.

Calcifications in the aorta do not negatively impact stent graft placement during thoracic endovascular aortic repair (TEVAR). These calcifications may even reduce stress on the aorta, potentially lowering the risk of aneurysm rupture.

Keywords:
Finite element analysis (FEA)In silico medicineStent graftThoracic endovascular aortic repair

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Area of Science:

  • Biomedical Engineering
  • Computational Fluid Dynamics
  • Medical Imaging

Background:

  • Thoracic endovascular aortic repair (TEVAR) is a crucial procedure for aortic pathologies.
  • Clinical guidelines sometimes contraindicate TEVAR in cases with significant aortic calcifications or thrombus.
  • The precise impact of calcifications on TEVAR outcomes remains incompletely understood.

Purpose of the Study:

  • To computationally investigate the effect of aortic calcifications on stent graft displacement and behavior after TEVAR.
  • To analyze the influence of calcification location and material properties on stent graft stability and stress distribution.
  • To compare outcomes in patient-specific models with and without calcifications.

Main Methods:

  • Development of patient-specific computational models of the aorta, including a penetrating aortic ulcer (PAU).
  • Creation of four models with idealized calcifications, varying in location and material properties (Young's modulus).
  • Simulation of TEVAR procedure and analysis of stent graft opening area, von Mises stresses, and contact pressures.

Main Results:

  • No significant changes in stent graft apposition were observed between calcified (Ca) and non-calcified (noCa) models.
  • Opening area was reduced in Ca models compared to noCa models, with no significant differences among Ca models.
  • Calcifications acted as load-bearing structures, reducing von Mises stresses on the aorta; this effect diminished with lower calcification stiffness.
  • Higher contact pressures were observed with increased calcification stiffness, exceeding those in the noCa model.

Conclusions:

  • Stent graft placement appears stable within the aorta even with the presence of calcifications.
  • Aortic calcifications may offer a protective effect by reducing stress on the aortic wall, potentially decreasing rupture risk.
  • Computational modeling provides valuable insights into the biomechanical interactions during TEVAR in complex anatomies.