Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations

Objectives: Formation of bird-beak configuration in thoracic endovascular aortic repair (TEVAR) has been shown to be correlated with the risk of complications such as type Ia endoleaks, stent graft migration, and collapse. The aim of this study was to use patient-specific computational simulations o...

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Main Authors: Negin Shahbazian, PhD, David A. Romero, PhD, Thomas L. Forbes, MD, Cristina H. Amon, ScD
Format: Article
Language:English
Published: Elsevier 2023-01-01
Series:JVS - Vascular Science
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2666350323000123
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author Negin Shahbazian, PhD
David A. Romero, PhD
Thomas L. Forbes, MD
Cristina H. Amon, ScD
author_facet Negin Shahbazian, PhD
David A. Romero, PhD
Thomas L. Forbes, MD
Cristina H. Amon, ScD
author_sort Negin Shahbazian, PhD
collection DOAJ
description Objectives: Formation of bird-beak configuration in thoracic endovascular aortic repair (TEVAR) has been shown to be correlated with the risk of complications such as type Ia endoleaks, stent graft migration, and collapse. The aim of this study was to use patient-specific computational simulations of TEVAR to predict the formation of bird-beak configuration preoperatively. Methods: Patient-specific TEVAR computational simulations are developed using a retrospective cohort of patients treated for thoracic aortic aneurysm. The preoperative computed tomography images were segmented to develop three-dimensional geometry of the thoracic aorta. These geometries were used in finite element simulations of stent graft deployment during TEVAR. Simulated results were compared against the postoperative computed tomography images to assess the accuracy of simulations in predicting the proximal position of a deployed stent graft and presence of bird-beak. In cases with a bird-beak configuration, the length and angle of the bird-beak were measured and compared between the simulated and postoperative results. Results: Twelve TEVAR patient cases were simulated. Computational simulations were able to accurately predict whether the proximal stent graft was fully apposed, proximal bare stents were protruded, or bird-beak configuration was present. In three cases with bird-beak configuration, simulations predicted the length and angle of the bird-beak with less than 10% and 24% error, respectively. Other factors such as a small aortic arch angle, small oversizing value, and landing zones close to the arch apex may have played a role in formation of bird-beak in these patients. Conclusions: Computational simulations of TEVAR accurately predicted the proximal position of a deployed stent graft and the presence of bird-beak preoperatively. The computational models were able to predict the length and angle of bird-beak configurations with good accuracy. These simulations can provide insight into the surgical planning process with the goal of minimizing bird-beak occurrence. : Clinical Relevance: Finite element analysis is a noninvasive method for simulation and prediction of thoracic endovascular aortic repair (TEVAR) outcomes. In this study, a computational approach for patient-specific simulations of TEVAR was implemented to accurately predict bird-beak configuration preoperatively. In addition, the length and angle of bird-beak configurations, which have been shown in previous studies to be correlated with bird-beak adverse events, were predicted with good accuracy. This computational approach is clinically significant as it has the potential to enhance TEVAR surgical planning capabilities with the goal of minimizing bird-beak occurrence. For patients with risk of bird-beaking, additional emphasis can be placed on optimal stent graft oversizing and device selection.
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spelling doaj.art-3415f22a4b344b9a8311bf0bd72a5a3b2023-12-30T04:44:51ZengElsevierJVS - Vascular Science2666-35032023-01-014100108Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulationsNegin Shahbazian, PhD0David A. Romero, PhD1Thomas L. Forbes, MD2Cristina H. Amon, ScD3Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Correspondence: Negin Shahbazian, PhD, Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Rd, Toronto, ON M5S 3G8, CanadaDepartment of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, CanadaDivision of Vascular Surgery, Department of Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, CanadaDepartment of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; Department of Mechanical and Industrial Engineering, Institute of Biomedical Engineering, University of Toronto, Toronto, ON, CanadaObjectives: Formation of bird-beak configuration in thoracic endovascular aortic repair (TEVAR) has been shown to be correlated with the risk of complications such as type Ia endoleaks, stent graft migration, and collapse. The aim of this study was to use patient-specific computational simulations of TEVAR to predict the formation of bird-beak configuration preoperatively. Methods: Patient-specific TEVAR computational simulations are developed using a retrospective cohort of patients treated for thoracic aortic aneurysm. The preoperative computed tomography images were segmented to develop three-dimensional geometry of the thoracic aorta. These geometries were used in finite element simulations of stent graft deployment during TEVAR. Simulated results were compared against the postoperative computed tomography images to assess the accuracy of simulations in predicting the proximal position of a deployed stent graft and presence of bird-beak. In cases with a bird-beak configuration, the length and angle of the bird-beak were measured and compared between the simulated and postoperative results. Results: Twelve TEVAR patient cases were simulated. Computational simulations were able to accurately predict whether the proximal stent graft was fully apposed, proximal bare stents were protruded, or bird-beak configuration was present. In three cases with bird-beak configuration, simulations predicted the length and angle of the bird-beak with less than 10% and 24% error, respectively. Other factors such as a small aortic arch angle, small oversizing value, and landing zones close to the arch apex may have played a role in formation of bird-beak in these patients. Conclusions: Computational simulations of TEVAR accurately predicted the proximal position of a deployed stent graft and the presence of bird-beak preoperatively. The computational models were able to predict the length and angle of bird-beak configurations with good accuracy. These simulations can provide insight into the surgical planning process with the goal of minimizing bird-beak occurrence. : Clinical Relevance: Finite element analysis is a noninvasive method for simulation and prediction of thoracic endovascular aortic repair (TEVAR) outcomes. In this study, a computational approach for patient-specific simulations of TEVAR was implemented to accurately predict bird-beak configuration preoperatively. In addition, the length and angle of bird-beak configurations, which have been shown in previous studies to be correlated with bird-beak adverse events, were predicted with good accuracy. This computational approach is clinically significant as it has the potential to enhance TEVAR surgical planning capabilities with the goal of minimizing bird-beak occurrence. For patients with risk of bird-beaking, additional emphasis can be placed on optimal stent graft oversizing and device selection.http://www.sciencedirect.com/science/article/pii/S2666350323000123TEVARBird-beak configurationThoracic aortic aneurysmComputational simulationsFinite elements
spellingShingle Negin Shahbazian, PhD
David A. Romero, PhD
Thomas L. Forbes, MD
Cristina H. Amon, ScD
Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations
JVS - Vascular Science
TEVAR
Bird-beak configuration
Thoracic aortic aneurysm
Computational simulations
Finite elements
title Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations
title_full Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations
title_fullStr Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations
title_full_unstemmed Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations
title_short Prediction of bird-beak configuration in thoracic endovascular aortic repair preoperatively using patient-specific finite element simulations
title_sort prediction of bird beak configuration in thoracic endovascular aortic repair preoperatively using patient specific finite element simulations
topic TEVAR
Bird-beak configuration
Thoracic aortic aneurysm
Computational simulations
Finite elements
url http://www.sciencedirect.com/science/article/pii/S2666350323000123
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