Patient-Specific Finite-Element Simulation of the Insertion of Guidewire During an EVAR Procedure: Guidewire Position Prediction Validation on 28 Cases.

OBJECTIVE: Validation of a numerical method to compute arterial deformations under the insertion of an "extra-siff" guidewire during Endovascular Repair of Abdominal Aortic Aneurysm.
METHODS: We propose the validation of a previously developed simulation method. The model is calibrated using anatomical hypothesis and intraoperative observations. Simulation results are blindly evaluated against 3-D imaging data acquired during the surgical procedure on 28 patients, based on the predicted position of the intraoperative guidewire.
RESULTS: Simulation was successfully conducted on the 28 patients. The mean position error given by the Modified Hausdorff Distance for the 28 cases was 3.8 ± 1.9 mm, which demonstrates very good results for most of the cases.
CONCLUSION: The work reported here shows that numerical simulation can predict some rather large variations in the vascular geometry due to tools insertion, for a wide variety of aorto-iliac morphologies. This is a new step toward clinically applicable mechanical simulation. SIGNIFICANCE: Validation on 3-D intraoperative data on a large number of cases-robustness on adverse anatomies.