Abdominal Stent Graft Numerical Models to Virtually Simulate Endovascular Aortic Repair: A Scoping Review

Area of Science:

• Biomedical Engineering
• Computational Mechanics
• Medical Simulation

Background:

• Endovascular aortic repair (EVAR) is a common treatment for abdominal aortic aneurysms.
• Assessing EVAR's surgical applicability and credibility requires advanced analytical methods.
• Numerical simulations offer a perspective on structural and fluid dynamic aspects of EVAR.

Purpose of the Study:

• To conduct a scoping review of numerical methods for analyzing EVAR.
• To identify and categorize computational approaches used in EVAR research.
• To evaluate the current state and methodologies of in silico EVAR analysis.

Main Methods:

• Systematic literature search of PubMed, Scopus, and Web of Science.
• Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.
• Data extraction, summarization in tables, and quality assessment using a 14-item rubric.

Main Results:

• Identified 28 articles from the last 10 years, mostly of intermediate to good quality.
• Seventeen articles (61%) focused on post-EVAR hemodynamics using computational fluid dynamics (CFD).
• Six articles (21%) developed finite element analysis (FEA) methods for EVAR simulation; five (18%) used fluid-structure interaction (FSI).
• CFD studies showed homogeneous approaches, while FEA and FSI methods exhibited heterogeneity in strategies and material property selection.
• All FSI studies used Newtonian blood models and velocity waveform inlet conditions, but structural components showed variability.

Conclusions:

• Computational models for EVAR are in developmental stages with limited clinical validation.
• Existing simulation techniques show promise but need enhancement for translational value.
• Future research should integrate clinically relevant outcomes to improve model credibility.