Morphological and stent design risk factors to prevent migration phenomena for a thoracic aneurysm: a numerical analysis.

The primary mechanically related problems of endovascular aneurysm repair are migration and type Ia endoleaks. They occur when there is no effective seal between the proximal end of the stent-graft and the vessel. In this work, we have developed several deployment simulations of parameterized stents using the finite element method (FEM) to investigate the contact stiffness of a nitinol stent in a realistic Thoracic Aortic Aneurysm (TAA). Therefore, we evaluated the following factors associated with these complications: (1) Proximal Attachment Site Length (PASL), (2) stent oversizing value (O%), (3) different friction conditions of the stent/aorta contact, and (4) proximal neck angulation α. The simulation results show that PASL>18 mm is a crucial factor to prevent migration at a neck angle of 60°, and the smoothest contact condition with low friction coefficient (µ=0.05). The increase in O% ranging from 10% to 20% improved the fixation strength. However, O%≥25% at 60° caused eccentric deformation and stent collapse. Higher coefficient of friction µ>0.01 considerably increased the migration risk when PASL=18 mm. No migration was found in an idealized aorta model with a neck angle of 0°, PASL=18 mm and µ=0.05. Our results suggest carefully considering the stent length and oversizing value in this neck morphology to strengthen the contact and prevent migration.

Finite element dependence of stress evaluation for human trabecular bone.

Numerical simulation using finite element models (FEM) has become more and more suitable to estimate the mechanical properties of trabecular bone. The size and kind of elements involved in the models, however, may influence the results. The purpose of this study is to analyze the influence of hexahedral elements formulation on the evaluation of mechanical stress applied to trabeculae bone during a compression test simulation. Trabecular bone cores were extracted from 18 L2 vertebrae (12 women and 6 men, mean age: 76 ± 11, BV/TV=7.5 ± 1.9%). Samples were micro-CT scanned at 20 µm isotropic voxel size. Micro-CT images have been sub-sampled (20, 40 and 80 µm) to create 5.6 mm cubic FEM. For each sample, a compression test FEM has been created, using either 8-nodes linear hexahedral elements with full or reduced integration or 20-nodes quadratic hexahedral elements fully integrated, resulting in nine models per samples. Bone mechanical properties have been assumed isotropic, homogenous and to follow a linear elastic behavior law (Young modulus: 8 GPa, Poisson ratio: 0.3). Despite micro-architecture modifications (loss of connectivity, trabeculae thickening) due to voxel size increase, apparent mechanical properties calculated with low resolution models are significantly correlated with high resolution results, no matter the element formulation. However, stress distributions are more sensitive to both resolution and element formulation modifications. With linear elements, increasing voxel size leads to an alteration of stress concentration areas due to stiffening errors. On the opposite, the use of reduced integration induces severe smoothing and underestimation of stress fields resulting in stress raisers loss. Notwithstanding their high computational cost, quadratic elements are most appropriate for stress prediction in low resolution trabecular bone FEM. These observations are dependent on trabecular bone micro-architecture, and are more significant for low density sample displaying low trabecular thickness. In conclusion, we found that element formulation is almost important as element size when evaluating trabecular bone mechanical behavior at trabeculae scale. Therefore, element type should be chosen carefully when evaluating trabecular bone behavior using FEM.