Sufficient apposition of the endograft with the aortic wall (>10 mm) is essential to prevent type I endoleak. We have developed and validated patented software to calculate the shortest length of circumferential apposition of the endograft with the aortic wall on standard postoperative CT scans. The next step is to predict the apposition from the preoperative CT scan using virtual stenting.
In the Netherlands >1000 people succumb to a rupture due to an aneurysm of the aorta (AAA) yearly, which is a life-threatening condition. To prevent this, 2700 undergo treatment for an aneurysm of the aorta. In many cases, this treatment is done via endovascular aorta repair (EVAR). When needed, this repair is elongated into the thorax (TEVAR) or fenestrations are added to bridge the visceral arteries (FEVAR).
One of the most important factors to take into account during planning of this procedure is that the implanted endograft will have sufficient apposition with the wall of the aorta and iliac arteries. Insufficient apposition is associated with an increased risk of leakage of blood into the aneurysm (type I endoleak). This will expose the patient again to a high risk of rupture of the aneurysm. Despite accurate planning of the operation, it can be difficult to accurately predict what part of the seal zone will actually be covered by the endograft. Also, challenging anatomy of the aorta, progression of disease and migration of the endograft can cause a type I endoleak over time.
During yearly follow-up after the operation, computed tomography angiography (CTA) and duplex ultrasound are commonly used to check for complications. The CTA scan contains a lot of information about the position and apposition of the endograft, but this is not yet measured during regular follow-up. In previous research we have found that a later type I endoleak can be predicted by closely evaluating the apposition with special developed software. This allows us to detect and consequentially treat deteriorating apposition before large complications arise.
The next big step in this research is to predict the anticipated apposition in patient-specific anatomy before the actual operation. Therefore, we have created a 3D model of the aorta of patients that have previously been operated. With this model, we are developing a simulation tool to accurately tailor the operation to individual patients’ anatomy: virtual stenting.
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