Stent-graft behaviour during complex endografting procedures
<p>Treatment of ascending aorta and aortic arch aneurysms represents one of the most technically challenging subsets of minimally invasive endovascular repair. The complex biomechanics and morphology of the dynamic proximal aorta pose significant challenges to even the most experienced clinic...
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| Format: | Thesis |
| Language: | English |
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2018
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| _version_ | 1797110227652313088 |
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| author | Kwiecinski, J |
| author2 | You, Z |
| author_facet | You, Z Kwiecinski, J |
| author_sort | Kwiecinski, J |
| collection | OXFORD |
| description | <p>Treatment of ascending aorta and aortic arch aneurysms represents one of the most technically challenging subsets of minimally invasive endovascular repair. The complex biomechanics and morphology of the dynamic proximal aorta pose significant challenges to even the most experienced clinical teams. To manage high-risk patients, surgeons have augmented traditional endografting techniques. The use of off-the-shelf devices deployed in a parallel configuration, known as chimney thoracic endovascular aortic repair, has been described to treat patients in both emergent and elective settings. Despite a growing level of experience with these procedures, device related peri- and post-operative complications persist. This thesis is concerned with elucidating the structural device-device and device-artery interactions arising during parallel endografting, to better understand the appropriate management of aortic disease.</p>
<p>To investigate stent-graft mechanics, two categories of sophisticated analysis tools have been developed. In the first, a computational framework based on the finite element method has been established for predicting device behaviour in a virtual environment. The simulation techniques have been elaborated to a cardiac modelling platform, enabling numerical analysis of stent-graft behaviour in a realistic manner. In the second, experimental methods have been employed to physically characterise parallel endografting in both a benchtop and an in vitro model of the aortic vasculature. Using these tools, the behaviour of stent-grafts has been quantified using metrics analogous to clinically reported complications, namely endoleak and graft lumen compression.</p>
<p>Structural interactions during parallel endografting are shown here to be significantly affected by device design and configuration. It has been demonstrated that increased aortic wall loading, likelihood of endoleak, and excessive device deformations are dominated by the radial stiffness of endografts. Furthermore, these phenomena are both spatially and temporally dependent. Indeed, careful selection of both endograft combination and configuration is necessary to improve long-term treatment outcomes associated with the chimney technique.</p> |
| first_indexed | 2024-03-07T07:52:10Z |
| format | Thesis |
| id | oxford-uuid:d0effeec-27ba-40d6-8c3a-d0d81adeb173 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:52:10Z |
| publishDate | 2018 |
| record_format | dspace |
| spelling | oxford-uuid:d0effeec-27ba-40d6-8c3a-d0d81adeb1732023-07-18T08:46:50ZStent-graft behaviour during complex endografting proceduresThesishttp://purl.org/coar/resource_type/c_db06uuid:d0effeec-27ba-40d6-8c3a-d0d81adeb173Medical devicesBiomedical engineeringEnglishHyrax Deposit2018Kwiecinski, JYou, ZChatzis, MBressloff, N<p>Treatment of ascending aorta and aortic arch aneurysms represents one of the most technically challenging subsets of minimally invasive endovascular repair. The complex biomechanics and morphology of the dynamic proximal aorta pose significant challenges to even the most experienced clinical teams. To manage high-risk patients, surgeons have augmented traditional endografting techniques. The use of off-the-shelf devices deployed in a parallel configuration, known as chimney thoracic endovascular aortic repair, has been described to treat patients in both emergent and elective settings. Despite a growing level of experience with these procedures, device related peri- and post-operative complications persist. This thesis is concerned with elucidating the structural device-device and device-artery interactions arising during parallel endografting, to better understand the appropriate management of aortic disease.</p> <p>To investigate stent-graft mechanics, two categories of sophisticated analysis tools have been developed. In the first, a computational framework based on the finite element method has been established for predicting device behaviour in a virtual environment. The simulation techniques have been elaborated to a cardiac modelling platform, enabling numerical analysis of stent-graft behaviour in a realistic manner. In the second, experimental methods have been employed to physically characterise parallel endografting in both a benchtop and an in vitro model of the aortic vasculature. Using these tools, the behaviour of stent-grafts has been quantified using metrics analogous to clinically reported complications, namely endoleak and graft lumen compression.</p> <p>Structural interactions during parallel endografting are shown here to be significantly affected by device design and configuration. It has been demonstrated that increased aortic wall loading, likelihood of endoleak, and excessive device deformations are dominated by the radial stiffness of endografts. Furthermore, these phenomena are both spatially and temporally dependent. Indeed, careful selection of both endograft combination and configuration is necessary to improve long-term treatment outcomes associated with the chimney technique.</p> |
| spellingShingle | Medical devices Biomedical engineering Kwiecinski, J Stent-graft behaviour during complex endografting procedures |
| title | Stent-graft behaviour during complex endografting procedures |
| title_full | Stent-graft behaviour during complex endografting procedures |
| title_fullStr | Stent-graft behaviour during complex endografting procedures |
| title_full_unstemmed | Stent-graft behaviour during complex endografting procedures |
| title_short | Stent-graft behaviour during complex endografting procedures |
| title_sort | stent graft behaviour during complex endografting procedures |
| topic | Medical devices Biomedical engineering |
| work_keys_str_mv | AT kwiecinskij stentgraftbehaviourduringcomplexendograftingprocedures |