Hemodynamic performance within crossed stent grafts: computational and

experimental study on the effect of crossed position and angle

Summary: The crossed limb stent technique is used mainly in patients with
abdominal aortic aneurysm, unfavorable aneurysms or extended iliac arteries,
evaluating the hemodynamic performance using 2 series of grafts that are bifurcated
stent with transverse positions and transversal angles
Results: The helicity decreases when cutting the transversal angles. The average
tension of the wall was unchanged, whereas in the index of oscillating variation it
increased and the crossed position decreased in the iliac grafts.
Conclusions: Given this information, the optimal configuration of the crossed
extremities can contain a small transverse angle and a low cross position; however,
low cross positions may increase the risk of migration.

Background:
Bifurcated grafts are replaced by endovascular repairs for abdominal aortic
aneurysms. What sounds fantastic but this procedure can be very complex when
patients have very marked anatomical variations, for example, widespread iliac
arteries and necks of severe aneurysms.
Therefore, the cardiovascular surgeons have created a new technique "crossed
extremities", which consists in overcoming the anatomical obstacles with the
bifurcated stent in the position of a dancer. Several previous studies tell us that the
force of migration acts on the graft by the blood fluid.
Methods:
Two series of bifurcated stents were used, varying the transverse position and the
angulation for the study. The results of the sample were analyzed using the
commercial software SolidWorks.

Results:
The study was plated in 2 phases, an experimental part in vitro, for which a system
was generated that was similar to the aortic perfusion with a fluid that had the
characteristics of density and viscosity similar to blood.
The grafts with three-dimensional currents current lines within the iliac grafts have
higher velocities in relation to the trunk graft, it was found that as the crossed angle
increased gradually, the sizes of these two helical flows became similar.

Discussion:
In the present study, although geometrical models of idealized crossed extremities
with several angles and transversal positions were idealized to simplify, it is still
reasonable to draw trends of variation of hemodynamic parameters from the
simplified results.
The behavior of the migration could be affected several factors, such as the iliac
bifurcation angle, the size of the endograft, blood pressure, the compliance of the
stent wall, the curvature of the iliac branch and neck length among many others.

Conclusion:
In summary, the areas of high OSI strip and RRT on the external surface of the
iliac artery grafts could be vulnerable to the formation of thrombosis. A smaller
cross angle and a low cross position may be optimal configurations for the
implementation of the "crossed member" strategy; however, low cross positions
may increase the risk of migration.