From IRB21-0299
Thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) are used to respectively repair thoracic aortic and abdominal aortic diseases. The most important and well-known complication of TEVAR and EVAR is endoleak.
From Katz Specific Aims
The surgical approach to aortic disease is undergoing revolutionary change. Open aortic surgery, with large thoraco-abdominal incisions and week-long hospital stays, is giving way to minimally invasive endovascular surgery (EVAR/TEVAR). The critical challenge for the future success of endovascular aortic surgery is long term repair stability. Despite a wealth of available computed tomography angiography (CTA) imaging data, surgeons currently lack a systematic approach to pre-operatively evaluate the likelihood of a stable endovascular repair or monitor post-operative remodeling. Furthermore, the available endografts do not take into account variants in patient anatomy beyond diameter and length, making these devices the proverbial hammer square peg in round hole approach. To overcome these challenges, we propose to capitalize on the tremendous scientific progress in simulation and mathematics over the last two decades especially in geometric image analysis, modeling arterial biomechanics, and interfacial fragility and apply them to aortic endovascular surgery to bring this life saving technology fully into the 21st century.
Our long-term goal is an overall mechanistic understanding of the biomechanical interaction between an endograft and the aorta. The overall objective of this proposal is to provide a robust scientific framework within which to understand accepted clinical knowledge that seal zone anatomy dominates seal zone stability. By fully characterizing the anatomy in the form of aortic geometry and utilizing modern tools from computer vision and continuum mechanics, we will develop a mechanistic understanding of seal zone failure. The central hypothesis of this application is that seal zone elasto-adhesive stability is the determinant of endoleaks and controlled by the geometric incompatibility between the aortic wall and endograft.
We use computational methods such as finite element analysis and computational fluid dynamics to study the biomechanical properties and stability of the seal zone. We have shown that loss of seal is correlated with the appearance of high stress in the aortic neck.
