Evaluation of a multi-scale discrete fiber model for analyzing arterial failure.

So far, the prevalent rupture risk quantification of aortic aneurysms does not consider information of the underlying microscopic mechanisms. Uniaxial tension tests were performed on imaged aorta samples oriented in circumferential and longitudinal directions. To account for local heterogeneity in collagen fiber architecture, SHG imaging was performed on tissues at several locations prior to mechanical testing. This enabled the quantification of micro-scale information including organization of collagen fibers using relevant probability density functions. Two different modeling approaches are presented in this study for the sake of comparison. A multi-scale mechanical model was developed using this micro-structural information with collagen fibers as main components. accounting for non-affine fiber kinematics. Simultaneously, an embedded element model that accounts for affine fiber kinematics was developed in Abaqus using the same micro-structural information. Numerical simulations emulating uniaxial tension experiments were performed on the developed models. Global mechanical response of both models agreed well with the experimental data, although leading to mismatched material properties. The models present a rudimentary yet better than before representation of structure based description of aortic-tissue failure mechanics. reinforcing the importance of structural organization of micro-scale constituents and their kinematics in determining tissue failure.

Effects of cryo-preservation on skeletal muscle tissues mechanical behavior under tensile and peeling tests until rupture.

The most common method to study the mechanical behavior of soft tissue is to test animal specimens, which should be prepared as soon as possible after the death to avoid biological deterioration effects such as rigor mortis. Freezing and cryo-preservation could allow extending the time between procurement and implantation. From a mechanical perspective, tissue preservation could influence mechanical testing results. Therefore, this study focuses on the influence of cryo-preserved samples on their mechanical behavior, especially at the rupture. In order to analyze this aspect, two tests were performed on the porcine abdominal wall. A tensile test to study the elastic behavior of samples and the tensile strength until rupture. A peeling test to more finely investigate the cohesion between muscle fibers. No statistical difference could be observed following tensile test. However, peeling tests between cryo-preserved and control samples showed a clear statistical difference with a p-value of 0.0097 for Gp. Indeed, energy release rate was higher for the Cryo-preserve group than the Control group with Gp = 0.36 ± 0.07 N/mm vs 0.26 ± 0.10 N/mm. This difference suggests that the characterization of rupture energies for muscular tissue should be done without having frozen the samples, even with a cryopreservative agent. These results could also indicate that even if the rupture mode is the same between mechanical tests, a different rupture direction could imply different mechanical preservations for soft tissues. This study could help to understand the difficult mechanical preservation of soft tissues, especially on the rupture behavior. Future studies on skeletal muscles will be necessary to compare our results, especially in peeling.

A Parametric Study on Factors Influencing the Onset and Propagation of Aortic Dissection Using the Extended Finite Element Method.

OBJECTIVE: Aortic dissection is a life-threatening event which starts most of the time with an intimal tear propagating along the aortic wall, while blood enters the medial layer and delaminates the medial lamellar units. Studies investigating the mechanisms underlying the initiation sequence of aortic dissection are rare in the literature, the majority of studies being focused on the propagation event. Numerical models can provide a deeper understanding of the phenomena involved during the initiation and the propagation of the initial tear, and how geometrical and mechanical parameters affect this event. In the present paper, we investigated the primary factors contributing to aortic dissection. METHODS: A two-layer arterial model with an initial tear was developed, representing three different possible configurations depending on the initial direction of the tear. Anisotropic damage initiation criteria were developed based on uniaxial and shear experiments from the literature to predict the onset and the direction of crack propagation. We used the XFEM-based cohesive segment method to model the initiation and the early propagation of the tear along the aorta. A design of experiment was used to quantify the influence of 7 parameters reflecting crack geometry and mechanics of the wall on the critical pressure triggering the dissection and the directions of propagation of the tear. RESULTS: The results showed that the obtained critical pressures (mean range from 206 to 251 mmHg) are in line with measurement from the literature. The medial tensile strength was found to be the most influential factor, suggesting that a medial degeneration is needed to reach a physiological critical pressure and to propagate a tear in an aortic dissection. The geometry of the tear and its location inside the aortic wall were also found to have an important role not only in the triggering of tear propagation, but also in the evolution of the tear into either aortic rupture or aortic dissection. A larger and deeper initial tear increases the risk of aortic dissection. CONCLUSION: The numerical model was able to reproduce the behaviour of the aorta during the initiation and propagation of an aortic dissection. In addition to confirm multiple results from the literature, different types of tears were compared and the influence of several geometrical and mechanical parameters on the critical pressure and direction of propagation was evaluated with a parametric study for each tear configuration. SIGNIFICANCE: Although these results should be experimentally validated, they allow a better understanding of the phenomena behind aortic dissection and can help in improving the diagnosis and treatment of this disease.

Hamstring muscles rupture under traction, peeling and shear lap tests: A biomechanical study in rabbits.

Lesions of the Musculotendinous Unit (MTU, i.e. tendon, myotendinous junction, muscle, aponeurosis and myoaponeurotic junction) are a common injury and a leading cause of functional impairment, long-term pain, and/or physical disability worldwide. Though a large effort has been devoted to macroscopic failure evaluation, these injuries suffer from a lack of knowledge of the underlying tissue-scale micro-mechanisms triggering such lesions. More specifically, there is a strong need for experimental data to better understand and quantify damage initiation and propagation on MTUs. The present study presents original experimental data on muscle tissue extracted from the hamstring muscle group of rabbits under relevant mechanical solicitations up to rupture, revealing elementary micro-mechanisms and providing quantified values of elastic properties as well as initiation stress and energy release rate. More specifically, tensile, peeling and shear lap tests were performed to explore cohesion of muscle tissue along the fibre direction or across fibres (mode I) and in shear (mode II), as well as at the muscle/tendon interface. We show that muscle tissue is weaker in shear than tension (p-value < 0.01) and that the Biceps Femoris had the lowest energy release rate as calculated from mode I peeling tests (G = 0.23 ± 0.16 N/mm) compared to the Semi-Membranous (G = 0.53 ± 0.08 N/mm) and the Semi-Tendinous (0.45 ± 0.20 N/mm), and that this energy is the lowest at the musculotendinous junction. Our study suggests a preferred damage initiation mechanism based on fibre decohesion in mode I or II and provides quantitative data to model these phenomena. Results also suggest that the Biceps Femoris and more precisely its musculotendinous junction could be the weakest point of the hamstring group. These findings could be used as a basis to develop mechanical models (e.g. finite element) to better understand and predict the onset of hamstring lesions and help in preventing such events.

Review of Current Advances in the Mechanical Description and Quantification of Aortic Dissection Mechanisms.

Aortic dissection is a life-threatening event associated with a very poor outcome. A number of complex phenomena are involved in the initiation and propagation of the disease. Advances in the comprehension of the mechanisms leading to dissection have been made these last decades, thanks to improvements in imaging and experimental techniques. However, the micro-mechanics involved in triggering such rupture events remains poorly described and understood. It constitutes the primary focus of the present review. Towards the goal of detailing the dissection phenomenon, different experimental and modeling methods were used to investigate aortic dissection, and to understand the underlying phenomena involved. In the last ten years, research has tended to focus on the influence of microstructure on initiation and propagation of the dissection, leading to a number of multiscale models being developed. This review brings together all these materials in an attempt to identify main advances and remaining questions.

Implementing a micromechanical model into a finite element code to simulate the mechanical and microstructural response of arteries.

A computational strategy based on the finite element method for simulating the mechanical response of arterial tissues is herein proposed. The adopted constitutive formulation accounts for rotations of the adventitial collagen fibers and introduces parameters which are directly measurable or well established. Moreover, the refined constitutive model is readily utilized in finite element analyses, enabling the simulation of mechanical tests to reveal the influence of microstructural and histological features on macroscopic material behavior. Employing constitutive parameters supported by histological examinations, the results herein validate the model's ability to predict the micro- and macroscopic mechanical behavior, closely matching previously observed experimental findings. Finally, the capabilities of the adopted constitutive description are shown investigating the influence of some collagen disorders on the macroscopic mechanical response of the arterial tissues.

Does the Knowledge of the Local Thickness of Human Ascending Thoracic Aneurysm Walls Improve Their Mechanical Analysis?

Ascending thoracic aortic aneurysm (ATAA) ruptures are life threatening phenomena which occur in local weaker regions of the diseased aortic wall. As ATAAs are evolving pathologies, their growth represents a significant local remodeling and degradation of the microstructural architecture and thus their mechanical properties. To address the need for deeper study of ATAAs and their failure, it is required to analyze the mechanical behavior at the sub-millimeter scale by making use of accurate geometrical and kinematical measurements during their deformation. For this purpose, we propose a novel methodology that combined an accurate tool for thickness distribution measurement of the arterial wall, digital image correlation to assess local strain fields and bulge inflation to characterize the physiological and failure response of flat unruptured human ATAA specimens. The analysis of the heterogeneity of the local thickness and local physiological stress and strain was carried out for each investigated subject. At the subject level, our results state the presence of a non-consistent relationship between the local wall thickness and the local physiological strain field and high heterogeneity of the variables. At the inter-subject level, thicknesses were studied in relation to physiological strain and stress and load at rupture. The rupture pressure was correlated with neither the average thickness nor the lowest thickness of the specimens. Our results confirm that intrinsic material strength (hence structure) differs a lot from a subject to another and even within the same subject.

A computational model for understanding the micro-mechanics of collagen fiber network in the tunica adventitia.

Abdominal aortic aneurysm is a prevalent cardiovascular disease with high mortality rates. The mechanical response of the arterial wall relies on the organizational and structural behavior of its microstructural components, and thus, a detailed understanding of the microscopic mechanical response of the arterial wall layers at loads ranging up to rupture is necessary to improve diagnostic techniques and possibly treatments. Following the common notion that adventitia is the ultimate barrier at loads close to rupture, in the present study, a finite element model of adventitial collagen network was developed to study the mechanical state at the fiber level under uniaxial loading. Image stacks of the rabbit carotid adventitial tissue at rest and under uniaxial tension obtained using multi-photon microscopy were used in this study, as well as the force-displacement curves obtained from previously published experiments. Morphological parameters like fiber orientation distribution, waviness, and volume fraction were extracted for one sample from the confocal image stacks. An inverse random sampling approach combined with a random walk algorithm was employed to reconstruct the collagen network for numerical simulation. The model was then verified using experimental stress-stretch curves. The model shows the remarkable capacity of collagen fibers to uncrimp and reorient in the loading direction. These results further show that at high stretches, collagen network behaves in a highly non-affine manner, which was quantified for each sample. A comprehensive parameter study to understand the relationship between structural parameters and their influence on mechanical behavior is presented. Through this study, the model was used to conclude important structure-function relationships that control the mechanical response. Our results also show that at loads close to rupture, the probability of failure occurring at the fiber level is up to 2%. Uncertainties in usually employed rupture risk indicators and the stochastic nature of the event of rupture combined with limited knowledge on the microscopic determinants motivate the development of such an analysis. Moreover, this study will advance the study of coupling microscopic mechanisms to rupture of the artery as a whole.

Patient-specific simulation of guidewire deformation during transcatheter aortic valve implantation.

Transcatheter aortic valve implantation is a recent mini-invasive procedure to implant an aortic valve prosthesis. Prosthesis positioning in transcatheter aortic valve implantation appears as an important aspect for the success of the intervention. Accordingly, we developed a patient-specific finite element framework to predict the insertion of the stiff guidewire, used to position the aortic valve. We simulated the guidewire insertion for 2 patients based on their pre-operative CT scans. The model was designed to primarily predict the position and the angle of the guidewires in the aortic valve, and the results were successfully compared with intraoperative images. The present paper describes extensively the numerical model, which was solved by using the ANSYS software with an implicit resolution scheme, as well as the stabilization techniques which were used to overcome numerical instabilities. We performed sensitivity analysis on the properties of the guidewire (curvature angle, curvature radius, and stiffness) and the conditions of insertion (insertion force and orientation). We also explored the influence of the model parameters. The accuracy of the model was quantitatively evaluated as the distance and the angle difference between the simulated guidewires and the intraoperative ones. A good agreement was obtained between the model predictions and intraoperative views available for 2 patient cases. In conclusion, we showed that the shape of the guidewire in the aortic valve was mainly determined by the geometry of the patient's aorta and by the conditions of insertion (insertion force and orientation).

Numerical Model Reduction for the Prediction of Interface Pressure Applied by Compression Bandages on the Lower Leg.

OBJECTIVE: To develop a new method for the prediction of interface pressure applied by medical compression bandages. METHODS: A finite element simulation of bandage application was designed, based on patient-specific leg geometries. For personalized interface pressure prediction, a model reduction approach was proposed, which included the parametrization of the leg geometry. Pressure values computed with this reduced model were then confronted to experimental pressure values. RESULTS: The most influencing parameters were found to be the bandage tension, the skin-to-bandage friction coefficient and the leg morphology. Thanks to the model reduction approach, it was possible to compute interface pressure as a linear combination of these parameters. The pressures computed with this reduced model were in agreement with experimental pressure values measured on 66 patients' legs. CONCLUSION: This methodology helps to predict patient-specific interface pressure applied by compression bandages within a few minutes whereas it would take a few days for the numerical simulation. The results of this method show less bias than Laplace's Law, which is for now the only other method for interface pressure computation.

Tensile rupture of medial arterial tissue studied by X-ray micro-tomography on stained samples.

Detailed characterization of damage and rupture mechanics of arteries is one the current challenges in vascular biomechanics, which requires developing suitable experimental approaches. This paper introduces an approach using in situ tensile tests in an X-ray micro-tomography setup to observe mechanisms of damage initiation and progression in medial layers of porcine aortic samples. The technique requires the use of sodium polytungstate as a contrast agent, of which the conditions for use are detailed in this paper. Immersion of the samples during 24h in a 15g/L concentrated solution provided the best compromise for viewing musculo-elastic units in this tissue. The process of damage initiation, delamination and rupture of medial tissue under tensile loading was observed and can be described as an elementary process repeating several times until complete failure. This elementary process initiates with a sudden mode I fracture of a group of musculo-elastic units, followed by an elastic recoil of these units, causing mode II separation of these, hence a delamination plane. The presented experimental approach constitutes a basis for observation of other constituents, or for investigations on other tissues and damage mechanisms.

Superimposition of elastic and nonelastic compression bandages.

OBJECTIVE: The objective of this study was to investigate the pressure applied by superimposed bandages and to compare it with the pressure applied by single-component bandages. METHODS: Six different bandages, composed of one elastic bandage, one nonelastic bandage, or both, were applied in a spiral pattern on both legs of 25 patients at risk of venous thrombosis as a consequence of central or peripheral motor deficiency. Pressure was measured at four measurement points on the leg (B1 and C on the medial and lateral sides of the leg) and in three positions: supine, sitting, and standing. RESULTS: The two single bandages applied similar pressure in the supine position. Their superimposition showed different pressure levels (P < .05) but similar static stiffness index, depending on the order in which the bandage components were applied on the leg. The highest interface pressure was measured at point B1 on the medial side of the leg. This point also showed the highest pressure increase from supine to standing position. The pressure applied by the superimposition of two bandages was computed as a linear combination of the pressure applied by each single component (with a constant term set to 0). However, this linear combination did not properly fit the experimental pressure measurements. CONCLUSIONS: The order of bandage application showed a significant impact on interface pressure. However, the poor correlation between the pressure applied by each bandage component and the pressure resulting from their superimposition underlined the poor understanding of interface pressure generated by the superimposition of compression bandages and should lead to further investigations.

Biaxial loading of arterial tissues with 3D in situ observations of adventitia fibrous microstructure: A method coupling multi-photon confocal microscopy and bulge inflation test.

Disorders in the wall microstructure underlie all forms of vascular disease, such as the aortic aneurysm, the rupture of which is necessarily triggered at the microscopic level. In this context, we developed an original experimental approach, coupling a bulge inflation test to multiphoton confocal microscopy, for visualizing the 3D micro-structure of porcine, human non-aneurysmal and aneurysmal aortic adventitial collagen under increasing pressurization. The experiment complexity on such tissues led to deeply address the acquisition major hurdles. The important innovative features of the methodology are presented, especially regarding region-of-interest tracking, definition of a stabilization period prior to imaging and correction of z-motion, z being the objective's axis. Such corrections ensured consistent 3D qualitative and quantitative analyses without z-motion. Qualitative analyses of the stable 3D images showed dense undulated collagen fiber bundles in the unloaded state which tended to progressive straightening and separation into a network of thinner bundles at high pressures. Quantitative analyses were made using a combination of weighted 2D structure tensors and fitting of 4 independent Gaussian functions to measure parameters related to straightening and orientation of the fibers. They denoted 3 principal fibers directions, approximately 45°, 135° and 90° with respect to the circumferential axis in the circumferential-axial plane without any evident reorientation of the fibers under pressurization. Results also showed that fibers at zero-pressure state were straighter and less dispersed in orientation for human samples - especially aneurysms - than for pigs. Progressive straightening and decrease in dispersion were quantified during the inflation. These findings provide further insight into the micro-architectural changes within the arterial wall.

Atherosclerotic plaque delamination: Experiments and 2D finite element model to simulate plaque peeling in two strains of transgenic mice.

Finite element analyses using cohesive zone models (CZM) can be used to predict the fracture of atherosclerotic plaques but this requires setting appropriate values of the model parameters. In this study, material parameters of a CZM were identified for the first time on two groups of mice (ApoE-/- and ApoE-/- Col8-/-) using the measured force-displacement curves acquired during delamination tests. To this end, a 2D finite-element model of each plaque was solved using an explicit integration scheme. Each constituent of the plaque was modeled with a neo-Hookean strain energy density function and a CZM was used for the interface. The model parameters were calibrated by minimizing the quadratic deviation between the experimental force displacement curves and the model predictions. The elastic parameter of the plaque and the CZM interfacial parameter were successfully identified for a cohort of 11 mice. The results revealed that only the elastic parameter was significantly different between the two groups, ApoE-/- Col8-/- plaques being less stiff than ApoE-/- plaques. Finally, this study demonstrated that a simple 2D finite element model with cohesive elements can reproduce fairly well the plaque peeling global response. Future work will focus on understanding the main biological determinants of regional and inter-individual variations of the material parameters used in the model.

Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts.

The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to help practitioners plan their intervention.

Numerical Approach for the Assessment of Pressure Generated by Elastic Compression Bandage.

Compression of the lower leg by bandages is a common treatment for the advanced stages of some venous or lymphatic pathologies. The outcomes of this treatment directly result from the pressure generated onto the limb. Various bandage configurations are proposed by manufacturers: the study of these configurations requires the development of reliable methods to predict pressure distribution applied by compression bandages. Currently, clinicians and manufacturers have no dedicated tools to predict bandage pressure generation. A numerical simulation approach is presented in this work, which includes patient-specific leg geometry and bandage. This model provides the complete pressure distribution over the leg. The results were compared to experimental pressure measurements and pressure values computed with Laplace's law. Using an appropriate surrogate model, this study demonstrated that such simulation is appropriate to account for phenomena which are neglected in Laplace's law, like geometry changes due to bandage application.

Experimental Investigation of Pressure Applied on the Lower Leg by Elastic Compression Bandage.

Compression therapy with stockings or bandages is the most common treatment for venous or lymphatic disorders. The objective of this study was to investigate the influence of bandage mechanical properties, application technique and subject morphology on the interface pressure, which is the key of this treatment. Bandage stretch and interface pressure measurements (between the bandage and the leg) were performed on 30 healthy subjects (15 men and 15 women) at two different heights on the lower leg and in two positions (supine and standing). Two bandages were applied with two application techniques by a single operator. The statistical analysis of the results revealed: no significant difference in pressure between men and women, except for the pressure variation between supine and standing positions; a very strong correlation between pressure and bandage mechanical properties (p < 0.00001) and between pressure and bandage overlapping (p < 0.00001); a significant pressure increase from supine to standing positions (p < 0.0001). Also, it showed that pressure tended to decrease when leg circumference increased. Overall, pressure applied by elastic compression bandages varies with subject morphology, bandage mechanical properties and application technique. A better knowledge of the impact of these parameters on the applied pressure may lead to a more effective treatment.

Patient-specific numerical simulation of stent-graft deployment: Validation on three clinical cases.

Endovascular repair of abdominal aortic aneurysms faces some adverse outcomes, such as kinks or endoleaks related to incomplete stent apposition, which are difficult to predict and which restrain its use although it is less invasive than open surgery. Finite element simulations could help to predict and anticipate possible complications biomechanically induced, thus enhancing practitioners' stent-graft sizing and surgery planning, and giving indications on patient eligibility to endovascular repair. The purpose of this work is therefore to develop a new numerical methodology to predict stent-graft final deployed shapes after surgery. The simulation process was applied on three clinical cases, using preoperative scans to generate patient-specific vessel models. The marketed devices deployed during the surgery, consisting of a main body and one or more iliac limbs or extensions, were modeled and their deployment inside the corresponding patient aneurysm was simulated. The numerical results were compared to the actual deployed geometry of the stent-grafts after surgery that was extracted from postoperative scans. We observed relevant matching between simulated and actual deployed stent-graft geometries, especially for proximal and distal stents outside the aneurysm sac which are particularly important for practitioners. Stent locations along the vessel centerlines in the three simulations were always within a few millimeters to actual stents locations. This good agreement between numerical results and clinical cases makes finite element simulation very promising for preoperative planning of endovascular repair.

Material model calibration from planar tension tests on porcine linea alba.

The purpose of this study was to determine biomechanical properties of linea alba subjected to transverse planar tension and to compare its behavior at different locations of the abdominal wall. Samples of linea alba from five different porcine abdominal walls were tested in planar tension. During these tests, strain maps were measured for the first time ever using the stereo-digital image correlation (S-DIC) technique. The strain maps were used to derive the properties of different hyperelastic material models. It was shown that the Ogden model and the Holzapfel-Gasser-Ogden model are appropriate to reproduce the response in planar tension. The linea alba located above the umbilicus was significantly more compliant than below the umbilicus. This difference which is reported for the first time here is consistent with the tissue microstructure and it is discussed within the perspective of clinically-relevant numerical simulations.

Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool.

The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications.