Computational tools for thoracic endovascular aortic repair planning

Endovascular treatment in the thoracic aorta has mostly replaced open surgery in subjects with given anatomical requirements, showing excellent postoperative results. The selection of the right stent-graft is based on aortic morphology and operator skills, with the goal of guaranteeing good apposition and long-term stability. However, complications such as endoleak and migration can occur after thoracic endovascular aortic repair, mostly caused by a weakened mechanical interaction between the wall, the blood and the device. The goal of this review is to explore the current effort of the biomechanics community to predict in-hospital and long-term outcomes by means of computational simulations. Benchtop tests, finite element analysis and computational fluid dynamics will be explored together with several examples in order to show the current state-of-the-art for surgical planning and complications prediction. Our analysis shows the potentiality of numerical tools not only to foresee problems which cannot be diagnosed by current tools, but also that the proof-of-concept stage has been passed and that the technology is ready for the bedside.