Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model

Focusing on a representative abdominal aortic aneurysm (AAA) with a bifurcating stent-graft (SG), a fluid–structure interaction (FSI) solver with user-supplied programs has been employed to solve for blood flow, AAA/SG deformation, sac pressure and wall stresses, as well as the downward forces acting on the SG. Simulation results indicate that implanting a SG can significantly reduce sac pressure, mechanical stress, pulsatile wall motion, and maximum diameter change in AAAs; hence, it may restore normal blood flow and prevent AAA rupture effectively. The transient SG drag force is similar in trend as the cardiac pressure. Its magnitude depends on multi-factors including blood flow conditions, as well as SG and aneurysm geometries. Specifically, AAA neck angle, iliac bifurcation angle, neck aorta-to-iliac diameter ratio, SG size, and blood waveform play important roles in generating a fluid flow force potentially leading to SG migration. It was found that the drag force can exceed 5 N for an AAA with a large neck or iliac angle, wide aortic neck and narrow iliac arteries, large SG size, and/or abnormal blood waveform. Thus, the fixation of self-expandable or balloon-expandable SG contact may be inadequate to withstand the forces of blood flowing through the implant and hence means of extra fixation should be considered. A comprehensive FSI analysis of the coupled SG–AAA dynamics provides physical insight for evaluating the luminal hemodynamics, and maximum AAA-stresses as well as biomechanical factors leading potentially to SG migration.