Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U 1059 Sainbiose, Centre CIS, F - 42023 Saint-Etienne, France; Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France.
Department of Vascular Surgery, Henri Mondor Hospital, University of Paris XII, Créteil, France.
Eur J Vasc Endovasc Surg. 2020 Feb;59(2):237-246. doi: 10.1016/j.ejvs.2019.10.009. Epub 2019 Dec 19.
The aim was to validate a computational patient specific model of Zenith® fenestrated device deployment in abdominal aortic aneurysms to predict fenestration positions.
This was a retrospective analysis of the accuracy of numerical simulation for fenestrated stent graft sizing. Finite element computational simulation was performed in 51 consecutive patients that underwent successful endovascular repair with Zenith® fenestrated stent grafts in two vascular surgery units with a high volume of aortic procedures. Longitudinal and rotational clock positions of fenestrations were measured on the simulated models. These measurements were compared with those obtained by (i) an independent observer on the post-operative computed tomography (CT) scan and (ii) by the stent graft manufacturer planning team on the pre-operative CT scan. (iii) Pre- and post-operative positions were also compared. Longitudinal distance and clock face discrepancies >3 mm and 15°, respectively, were considered significant. Reproducibility was assessed using Bland-Altman and linear regression analysis.
A total of 195 target arteries were analysed. Both Bland-Altman and linear regression showed good reproducibility between the three measurement techniques performed. The median absolute difference between the simulation and post-operative CT scan was 1.0 ± 1.1 mm for longitudinal distance measurements and 6.9 ± 6.1° for clock positions. The median absolute difference between the planning centre and post-operative CT scan was 0.8 ± 0.8 mm for longitudinal distance measurements and 5.1 ± 5.0° for clock positions. Finally, the median absolute difference between the simulation and the planning centre was 0.96 ± 0.97 mm for longitudinal distance measurements and 4.8 ± 3.6° for clock positions.
The numerical model of deployed fenestrated stent grafts is accurate for planning position of fenestrations. It has been validated in 51 patients, for whom fenestration locations were similar to the sizing performed by physicians and the planning centre.
验证用于预测开窗位置的腹部主动脉瘤 Zenith®开窗型移植物植入的计算患者特定模型。
这是一项对用于 fenestrated 支架移植物尺寸测量的数值模拟准确性的回顾性分析。在两家血管外科中心的 51 例连续患者中进行了有限元计算模拟，这些患者均成功接受了 Zenith® fenestrated 支架移植物的血管内修复，且这两家外科中心都有大量的主动脉手术。对模拟模型上的 fenestration 的纵向和旋转时钟位置进行了测量。这些测量值与（i）术后 CT 扫描上的独立观察者，以及（ii）术前 CT 扫描上的支架移植物制造商规划团队所获得的值进行了比较。（iii）还比较了术前和术后的位置。分别将纵向距离和钟面差异>3mm 和 15°视为显著。使用 Bland-Altman 和线性回归分析评估了重复性。
共分析了 195 个靶动脉。Bland-Altman 和线性回归分析均表明，三种测量技术之间具有良好的可重复性。模拟与术后 CT 扫描之间的纵向距离测量值的中位数绝对差为 1.0±1.1mm，时钟位置的中位数绝对差为 6.9±6.1°。规划中心与术后 CT 扫描之间的纵向距离测量值的中位数绝对差为 0.8±0.8mm，时钟位置的中位数绝对差为 5.1±5.0°。最后，模拟与规划中心之间的纵向距离测量值的中位数绝对差为 0.96±0.97mm，时钟位置的中位数绝对差为 4.8±3.6°。
已部署的 fenestrated 支架移植物的数值模型在 fenestration 位置规划方面是准确的。已在 51 例患者中进行了验证，fenestration 位置与医生和规划中心的尺寸测量相似。
