October 2004

Case St udy
Case St udy www.nafems.org
Page 29
O
ne of t he more i nt ri gui ng
challenges in modern medicine is
the repair of abdominal aortic
aneur ysms, usi ng st ent -graf t s. An
aneur ysm of the aorta is an excessive
dilation, possibly leading to rupture, of
the arter y deep inside the human body,
whi ch can be readi l y det ect ed wi t h
i magi ng syst ems such as comput ed
tomography, a.k.a. cat scans.
Most aneur ysms can be repai red,
employing minimally invasive surger y, if
caught before they burst. Surgeons now
routinely use stent-graf ts (SGs) that are
guided into place from the groin af ter a
small incision, and then propped open in
the aorta. Stent-graf ts are tubular wire
mesh stents inter woven with a synthetic
graf t material. However, some of them
move out of place, for reasons that
were not well understood until recently.
Stent-graf t migration may again expose
the weakened aortic wall to relatively
high blood pressure, potentially leading to
sudden aneur ysm rupture and death.
Developing that understanding and finding
suitable solutions is our current work at the
Bi omechani cal Engi neeri ng Research
Group (BERG) of North Carolina State
University in Raleigh. We are using a
pai ri ng of comput at i onal f l ui d
dynami cs (CFD) i nt eract i vel y
coupl ed wi t h comput at i onal
st r uct ure anal ysi s: f l ui d
structure interaction (FSI).
Usi ng coupl ed CFX and
ANSYS Structural models, we
are learning what goes on
inside the aorta before and
af ter a stent-graf t is surgically
i nsert ed or i f t he st ent -graf t
migrates or dislodges.
Most studies of arter y problems assume
that arter y walls are stiff with regard to the
pressure changes t hat come wi t h each
heart beat , and t hat art eri al wal l
thicknesses are constant both axially
and circumferentially. Neither is
usually true, especially for older
pat ient s wit h hypert ension, a
group that suffers most from
aneur ysms.
The st ent mi grat i on probl em i n
abdominal aortic aneur ysm (AAA) repairs is critical to the
patient s sur vival. When the stented graf t slides out of
pl ace axi al l y, t he weakened or
diseased arter y wall is re-exposed to
the high blood pressure of pulsating
blood flow. That greatly increases the
possibility of AAA-rupture, which is usually
fatal. Easily overlooked, aortic aneur ysms are the
13th leading cause of death in the U.S.
Five case hist ories were used t o comput e t he
incipient migration forces of a stented graf t under
different placement conditions. In the process, we
modeled different arter y neck configurations,
variable arterial wall thicknesses, transient
hemodynami cs and mul t i -st r uct ure
interactions.
The actual stented AAA model
consisted of a lumen or bulge
i n t he art er y wal l , an
endovascular graf t shell, a
cavity of stagnant blood
and the AAA wall.
Using iterative fluid structure interaction was an
intense computational problem involving the
exchange of coupled variations in wall flex and
geometr y, requiring several new flow and
structure results at each time step. The
st r uct ural probl em cent ered around
nonlinear, large deformation, contact and
dynamic analyses.
H emodynami cs
H emodynami cs
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esear
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ch at N or t h
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Car
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ol i na St at e
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Uni ver si t y
Uni ver si t y
By Dr. Clement Kleinstreuer, Professor and Director of the
Computational Fluid-Particle Dynamics Laborator y and
Zhonghua Li, Doctoral Student,
Biomechanical Engineering Research Group,
North Carolina State University
Figure 1: Representation of a cross-section of an
aortic arter y aneur ysm (bulge on lef t) between the
renal arter y (to the kidneys, top) and the iliac
bifurcation (to the legs). Image courtesy of
Bi omechani cal Engi neeri ng Research Group,
North Carolina State University, Raleigh, N.C.
www.nafems.org
October 2004 Page 30
Case St udy
Case St udy
Coupled fluid structure simulations verified that a stent-
graf t can significantly reduce the risk of an aneur ysm
rupture even when high blood pressure is the fundamental
cause. Clearly, these tools for blood-flow-stent-arter y
interactions are valid, predictive and power ful for optimal
surgical recommendations, improved stent designs, and
proper stent placement.
Cont act
Dr. Clement Kleinst reuer,
Professor and Director, Biomechanical Engineering Research Group
North Carolina State University
E ck@eos.ncsu.edu
W www.mae.ncsu.edu/research/ck_CFPDlab/index.html
The CFX post-processor in conjunction with our programs
gives us a great deal of insight into the physical processes.
It helps us to spot critical areas where platelets or low-
density lipoproteins [ LDLs] may clump together and
ultimately, it helps us with design optimization of stent-
graf ts and secure stent-graf t placements.
The coupled results were validated with experimental date
sets and with clinical obser vations.
Surgeons and scient ist s know t hat f orces t riggering
st ent ed graf t mi grat i on i ncl ude bl ood moment um
changes, blood pressure and arter y wall shear stress,
inappropriate configurations of the healthy aortic neck
section, tissue problems in the aortic neck segment, and
biomechanical degradation of the prosthetic material.
To set the model stent-graf t into motion, an increasing
pul l f orce was appl i ed wi t h a macro subrout i ne.
Coulomb s Law was used for each contact element s
f ri ct i on coef f i ci ent s, but t he si mul at i ons reveal ed a
nonlinear correlation in large displacements between the
migration force needed to move the stent and the friction
coefficients.
The simulation also revealed that the risk of displacement
rises sharply in patients with high blood pressure.
Figure 3: Schematic representation of an aortic arter y aneur ysm including
i mpl ant ed st ent -graf t wi t h rel evant anal yt i cal dat a. Image court esy of
Biomechanical Engineering Research Group, North Carolina State University,
Raleigh, N.C.
Figure 2: Representation of
an aortic arter y aneur ysm
(bulge on lef t) between the
renal arter y (to the kidneys,
top) and the iliac bifurcation
(to the legs).
Image courtesy of Biomechanical
Engineering Research Group,
North Carolina State University,
Raleigh, N.C.
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