Erik Groot Jebbink1, Varghese Mathai2, Johannes T Boersen3, Chao Sun2, Cornelis H Slump4, Peter C J M Goverde5, Michel Versluis2, Michel M P J Reijnen6. 1. Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Physics of Fluids Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. Electronic address: erik.grootjebbink@gmail.com. 2. Physics of Fluids Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands; MESA+ Institute for Nanotechnology, University of Twente, Enschede, The Netherlands. 3. Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands; Physics of Fluids Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. 4. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. 5. Department of Vascular Surgery, Vascular Clinic ZNA, Antwerp, Belgium. 6. Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Abstract
BACKGROUND: Endovascular treatment of aortoiliac occlusive disease entails the use of multiple stents to reconstruct the aortic bifurcation. Different configurations have been applied and geometric variations exist, as quantified in previous work. Other studies concluded that specific stent geometry seems to affect patency. These variations may affect local flow patterns, resulting in different wall shear stress (WSS) and oscillating shear index (OSI). The aim of this study was to compare the effect of different stent configurations on flow perturbations (recirculation and fluid stasis), WSS, and OSI in an in vitro setup. METHODS: Three different stent configurations were deployed in transparent silicone models: bare-metal kissing (BMK) stents, covered kissing (CK) stents, and the covered endovascular reconstruction of the aortic bifurcation (CERAB) configuration. Transparent covered stents were created with polyurethane to enable visualization. Models were placed in a circulation setup under physiologic flow conditions. Time-resolved laser particle image velocimetry techniques were used to quantify the flow, and WSS and OSI were calculated. RESULTS: The BMK configuration did not show flow disturbances at the inflow section, and WSS values were similar to the control. An area of persistent low flow was observed throughout the cardiac cycle in the area between the anatomic bifurcation and neobifurcation. The CK model showed recirculation zones near the inflow area of the stents with a resulting low average WSS value and high OSI. The proximal inflow of the CERAB configuration did not show flow disturbances, and WSS values were comparable to control. Near the inflow of the limbs, a minor zone of recirculation was observed without changes in WSS values. Flow, WSS, and OSI on the lateral wall of the proximal iliac artery were undisturbed in all models. CONCLUSIONS: The studied aortoiliac stent configurations have distinct locations where flow disturbances occur, and these are related to the radial mismatch. The CERAB configuration is the most unimpaired physiologic reconstruction, whereas BMK and CK stents have their typical zones of flow recirculation.
BACKGROUND: Endovascular treatment of aortoiliac occlusive disease entails the use of multiple stents to reconstruct the aortic bifurcation. Different configurations have been applied and geometric variations exist, as quantified in previous work. Other studies concluded that specific stent geometry seems to affect patency. These variations may affect local flow patterns, resulting in different wall shear stress (WSS) and oscillating shear index (OSI). The aim of this study was to compare the effect of different stent configurations on flow perturbations (recirculation and fluid stasis), WSS, and OSI in an in vitro setup. METHODS: Three different stent configurations were deployed in transparent silicone models: bare-metal kissing (BMK) stents, covered kissing (CK) stents, and the covered endovascular reconstruction of the aortic bifurcation (CERAB) configuration. Transparent covered stents were created with polyurethane to enable visualization. Models were placed in a circulation setup under physiologic flow conditions. Time-resolved laser particle image velocimetry techniques were used to quantify the flow, and WSS and OSI were calculated. RESULTS: The BMK configuration did not show flow disturbances at the inflow section, and WSS values were similar to the control. An area of persistent low flow was observed throughout the cardiac cycle in the area between the anatomic bifurcation and neobifurcation. The CK model showed recirculation zones near the inflow area of the stents with a resulting low average WSS value and high OSI. The proximal inflow of the CERAB configuration did not show flow disturbances, and WSS values were comparable to control. Near the inflow of the limbs, a minor zone of recirculation was observed without changes in WSS values. Flow, WSS, and OSI on the lateral wall of the proximal iliac artery were undisturbed in all models. CONCLUSIONS: The studied aortoiliac stent configurations have distinct locations where flow disturbances occur, and these are related to the radial mismatch. The CERAB configuration is the most unimpaired physiologic reconstruction, whereas BMK and CK stents have their typical zones of flow recirculation.
Authors: Erik Groot Jebbink; Thijs G Ter Mors; Cornelis H Slump; Robert H Geelkerken; Suzanne Holewijn; Michel Mpj Reijnen Journal: Vascular Date: 2017-05-22 Impact factor: 1.285
Authors: Erik Groot Jebbink; Stefan Engelhard; Guillaume Lajoinie; Jean-Paul P M de Vries; Michel Versluis; Michel M P J Reijnen Journal: J Endovasc Ther Date: 2017-09-21 Impact factor: 3.487
Authors: Albert Chong; Zhonghua Sun; Lennart van de Velde; Shirley Jansen; Michel Versluis; Michel M P J Reijnen; Erik Groot Jebbink Journal: Artif Organs Date: 2020-03-25 Impact factor: 3.094