A study of mechanical damage in aortic media induced by stent graft_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Wenzhen ¹ , GUO Baolei ² ,  LIU Haofei ¹

1. Department of Mechanics, Tianjin University, Tianjin, 300350, P. R. China;
2. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;

Corresponding author：

LIU Haofei, Email: hfliu@tju.edu.cn

Keywords：

Aortic dissection; virtual deployment; stent graft; damage

DOI：

10.7507/1007-4848.202405077

Video：

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Objective To develop a quantitative methodology for assessing the aortic media damage induced by stent-grafted by integrating mechanical experimentation, continuous damage theory, and finite element analysis, and focus on the influence of various oversizing ratios on the integrity of the aortic media. Methods Utilizing uniaxial tensile testing datum from aortic walls of patients with TEVAR, the material parameters of aortic wall's constitutive equation, inclusive of damage parameters, were meticulously determined. A finite element model was constructed to simulate the deployment process of stent-grafted. Damage factor was delineated to scrutinize the stress distribution and the resultant damage within aortic media under a spectrum of oversizing ratios of stent-grafted. Results The damage factor exhibited a distribution congruent with that of the Von Mises stress, with both peaking at the convex aspect near the aortic arch. Additionally, stress concentration was observed in the distal anchoring region of aortic wall. An escalation in oversizing ratio was correlated with a proportional increase in both peak values. At oversizing ratios of 10%, 15%, and 20%, the Von Mises stress maxima were recorded as 469 kPa, 480 kPa, and 580 kPa, respectively, reflecting increments of 2.3% and 20.8%. Correspondingly, the damage factor maxima were 0.01, 0.011, and 0.014, marking an elevation of 10% and 27.3%. Conclusion The findings suggest that an increment in oversizing ratio is associated with a pronounced increase in the peak value of the damage factor, indicating a more severe impact on the vascular media. The distribution of the damage factor aligns closely with that of the Von Mises stress, with both exhibiting peak values at the convex side of the aortic arch. This correlation underscores the damage factor's efficacy as a reliable indicator of the aortic media's integrity, thereby providing a robust theoretical framework for the subsequent assessment of endovascular interventional treatment risks through damage factor analysis.

1.	中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
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3.	Pantaleo A, Jafrancesco G, Buia F, et al. Distal stent graft-induced new entry: An emerging complication of endovascular treatment in aortic dissection. Ann Thorac Surg, 2016, 102(2): 527-532.
4.	董智慧, 符伟国, 王玉琦. StanfordB型夹层腔内修复术后并发逆行性A型夹层的分型与防治. 中国血管外科杂志(电子版), 2010, 2(3): 136-139.
5.	Chen Y, Zhang S, Liu L, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: A systematic review and meta-analysis. J Am Heart Assoc, 2017, 6(9): e004649.
6.	刘鹏飞, 邓小燕, 孙安强. 支架植入后趋直现象对血管壁局部生物力学环境的影响. 医用生物力学, 2018, 33(6): 483-489.
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8.	Kan X, Ma T, Dong Z, et al. Patient-specific virtual stent-graft deployment for type B aortic dissection: A pilot study of the impact of stent-graft length. Front Physiol, 2021, 12: 718140.
9.	Kan X, Ma T, Lin J, et al. Patient-specific simulation of stent-graft deployment in type B aortic dissection: Model development and validation. Biomech Model Mechanobiol, 2021, 20(6): 2247-2258.
10.	Ortiz M, Pandolfi A. Finite-deformation irreversible cohesive elements for three-dimensional crack-propagation analysis. Int J Numer Meth Engngm, 1999, 44: 1267-1282.
11.	Wang L, Hill NA, Roper SM, et al. Modelling peeling- and pressure-driven propagation of arterial dissection. J Eng Math, 2018, 109(1): 227-238.
12.	Li K, Holzapfel GA. Multiscale modeling of fiber recruitment and damage with a discrete fiber dispersion method. J Mech Phys Solid, 2019, 126: 226-244.
13.	Boufi M, Guivier-Curien C, Loundou AD, et al. Morphological analysis of healthy aortic arch. Eur J Vasc Endovasc Surg, 2017, 53(5): 663-670.
14.	Rylski B, Muñoz C, Beyersdorf F, et al. How does descending aorta geometry change when it dissects? Eur J Cardiothorac Surg, 2018, 53(4): 815-821.
15.	Genovese K, Humphrey JD. Multimodal optical measurement in vitro of surface deformations and wall thickness of the pressurized aortic arch. J Biomed Opt, 2015, 20(4): 046005.
16.	Mensel B, Quadrat A, Schneider T, et al. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol, 2014, 24(9): 2038-2044.
17.	Kleinstreuer C, Li Z, Basciano CA, et al. Computational mechanics of Nitinol stent grafts. J Biomech, 2008, 41(11): 2370-2378.
18.	Gasser TC, Ogden RW, Holzapfel GA. Hyperelastic modelling of arterial layers with distributed collagen fibre orientations. J R Soc Interface, 2006, 3(6): 15-35.
19.	Simo JC. On a fully three-dimensional finite-strain viscoelastic damage model: Formulation and computational aspects. Comput Method Appl Mech Eng, 1987, 60: 153-173.
20.	Peña E. Damage functions of the internal variables for soft biological fibred tissues. Mech Res Commun, 2011, 38: 610-615.
21.	Sherifova S, Sommer G, Viertler C, et al. Failure properties and microstructure of healthy and aneurysmatic human thoracic aortas subjected to uniaxial extension with a focus on the media. Acta Biomater, 2019, 99: 443-456.
22.	Dong Z, Fu W, Wang Y, et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg, 2010, 52(6): 1450-1457.
23.	Ma T, Dong ZH, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S.
24.	杨帅星, 张明, 戴向晨, 等. 支架作用下主动脉血管壁应力分析. 医用生物力学, 2021, 36(1): 14-21.
25.	Weng SH, Weng CF, Chen WY, et al. Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection. J Vasc Surg, 2013, 57(1): 64-71.
26.	Ma T, Dong ZH, Fu WG, et al. Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair. J Vasc Surg, 2018, 67(4): 1026-1033.
27.	Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.

1. 中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
2. 景在平, 陆清声, 冯家烜. 主动脉夹层腔内隔绝术后并发症. 中国血管外科杂志 (电子版), 2012, 4(4): 196-198.
3. Pantaleo A, Jafrancesco G, Buia F, et al. Distal stent graft-induced new entry: An emerging complication of endovascular treatment in aortic dissection. Ann Thorac Surg, 2016, 102(2): 527-532.
4. 董智慧, 符伟国, 王玉琦. StanfordB型夹层腔内修复术后并发逆行性A型夹层的分型与防治. 中国血管外科杂志(电子版), 2010, 2(3): 136-139.
5. Chen Y, Zhang S, Liu L, et al. Retrograde type A aortic dissection after thoracic endovascular aortic repair: A systematic review and meta-analysis. J Am Heart Assoc, 2017, 6(9): e004649.
6. 刘鹏飞, 邓小燕, 孙安强. 支架植入后趋直现象对血管壁局部生物力学环境的影响. 医用生物力学, 2018, 33(6): 483-489.
7. Meng Z, Ma T, Cai Y, et al. Numerical modeling and simulations of type B aortic dissection treated by stent-grafts with different oversizing ratios. Artif Organs, 2020, 44(11): 1202-1210.
8. Kan X, Ma T, Dong Z, et al. Patient-specific virtual stent-graft deployment for type B aortic dissection: A pilot study of the impact of stent-graft length. Front Physiol, 2021, 12: 718140.
9. Kan X, Ma T, Lin J, et al. Patient-specific simulation of stent-graft deployment in type B aortic dissection: Model development and validation. Biomech Model Mechanobiol, 2021, 20(6): 2247-2258.
10. Ortiz M, Pandolfi A. Finite-deformation irreversible cohesive elements for three-dimensional crack-propagation analysis. Int J Numer Meth Engngm, 1999, 44: 1267-1282.
11. Wang L, Hill NA, Roper SM, et al. Modelling peeling- and pressure-driven propagation of arterial dissection. J Eng Math, 2018, 109(1): 227-238.
12. Li K, Holzapfel GA. Multiscale modeling of fiber recruitment and damage with a discrete fiber dispersion method. J Mech Phys Solid, 2019, 126: 226-244.
13. Boufi M, Guivier-Curien C, Loundou AD, et al. Morphological analysis of healthy aortic arch. Eur J Vasc Endovasc Surg, 2017, 53(5): 663-670.
14. Rylski B, Muñoz C, Beyersdorf F, et al. How does descending aorta geometry change when it dissects? Eur J Cardiothorac Surg, 2018, 53(4): 815-821.
15. Genovese K, Humphrey JD. Multimodal optical measurement in vitro of surface deformations and wall thickness of the pressurized aortic arch. J Biomed Opt, 2015, 20(4): 046005.
16. Mensel B, Quadrat A, Schneider T, et al. MRI-based determination of reference values of thoracic aortic wall thickness in a general population. Eur Radiol, 2014, 24(9): 2038-2044.
17. Kleinstreuer C, Li Z, Basciano CA, et al. Computational mechanics of Nitinol stent grafts. J Biomech, 2008, 41(11): 2370-2378.
18. Gasser TC, Ogden RW, Holzapfel GA. Hyperelastic modelling of arterial layers with distributed collagen fibre orientations. J R Soc Interface, 2006, 3(6): 15-35.
19. Simo JC. On a fully three-dimensional finite-strain viscoelastic damage model: Formulation and computational aspects. Comput Method Appl Mech Eng, 1987, 60: 153-173.
20. Peña E. Damage functions of the internal variables for soft biological fibred tissues. Mech Res Commun, 2011, 38: 610-615.
21. Sherifova S, Sommer G, Viertler C, et al. Failure properties and microstructure of healthy and aneurysmatic human thoracic aortas subjected to uniaxial extension with a focus on the media. Acta Biomater, 2019, 99: 443-456.
22. Dong Z, Fu W, Wang Y, et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg, 2010, 52(6): 1450-1457.
23. Ma T, Dong ZH, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S.
24. 杨帅星, 张明, 戴向晨, 等. 支架作用下主动脉血管壁应力分析. 医用生物力学, 2021, 36(1): 14-21.
25. Weng SH, Weng CF, Chen WY, et al. Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection. J Vasc Surg, 2013, 57(1): 64-71.
26. Ma T, Dong ZH, Fu WG, et al. Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair. J Vasc Surg, 2018, 67(4): 1026-1033.
27. Canaud L, Ozdemir BA, Patterson BO, et al. Retrograde aortic dissection after thoracic endovascular aortic repair. Ann Surg, 2014, 260(2): 389-395.

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