JVS - Vascular Science (Jan 2021)
Computational analysis of endovascular aortic repair proximal seal zone preservation with endoanchors: A case study in cylindrical neck anatomy
Abstract
Background: Endovascular aortic repair is the common approach for abdominal aortic aneurysms, but endoleaks remain a significant problem with long-term success. Endoanchors have been found to reduce the incidence of type 1A endoleaks and can treat intraoperative type 1a endoleaks. However, little is known about the optimal number and position of endoanchors to achieve the best outcome. Methods: Using image segmentation and a computational model derived from a reconstructed native patient abdominal aortic aneurysm geometry, the stability of the proximal seal zone was examined through finite element analysis in Abaqus (Dassault Systèmes, Providence, RI). The biomechanical parameter of contact area was compared for varying numbers (0, 2, 4, 8) and positions (proximal, medial, distal) of endoanchors under different adhesion strengths and physiologic pressure conditions. Results: In every simulation, an increase in adhesion strength is associated with maintenance of proximal seal. For biologically plausible adhesion strengths, under conditions of normal blood pressure (120 mm Hg), the addition of any number of endoanchors increases the stability of the endograft-wall interface at the proximal seal zone by approximately 10% compared with no endoanchors. At hypertensive pressures (200 mm Hg), endoanchors increase the stability of the interface by 20% to 60% compared with no endoanchors. The positioning of endoanchors within the proximal seal zone has a greater effect at hypertensive pressures, with proximal positioning increasing stability by 15% compared with medial and distal positioning and 30% compared with no endoanchors. Conclusions: Endoanchors improve fixation within the proximal seal zone particularly under conditions of high peak systolic pressure. Seal zone stabilization provides a mechanism through which endoanchor addition may translate into lower rates of type 1a endoleaks for patients. : Clinical Relevance: Endovascular aortic repairs are commonly used to treat abdominal aortic aneurysms. Type 1a endoleaks threaten the long-term durability of repairs. Endoanchors have been found to reduce the incidence of this complication. Herein, we examine parameters surrounding optimal endoanchor number and positioning to reduce endovascular aortic repair failure. The computational modeling allowed for testing of endoanchors in varied adhesion strength between the endograft and the aorta, as well as hemodynamic conditions to mimic normotension vs hypertension. The results of the finite element analysis suggest that the addition of any number of endoanchors in the proximal seal zone is beneficial, especially with hypertensive loading.
