Patient-Specific Finite-Element Simulation of the Insertion of Guidewire During an EVAR Procedure: Guidewire Position Prediction Validation on 28 Cases

Objective: Validation of a numerical method to compute arterial deformations under the insertion of an extra-siff guidewire during Endovascular Repair of Abdominal Aortic Aneurysm. Methods: We propose the validation of a previously developed simulation method. The model is calibrated using anatomical hypothesis and intra-operative observations. Simulation results are blindly evaluated against 3-D imaging data acquired during the surgical procedure on 28 patients, based on the predicted position of the intraoperative guidewire. Results: Simulation was successfully conducted on the 28 patients. The mean position error given by the Modified Hausdorff Distance for the 28 cases was 3.8 +/- 1.9 mm, which demonstrates very good results for most of the cases. Conclusion: The work reported here shows that numerical simulation can predict some rather large variations in the vascular geometry due to tools insertion, for a wide variety of aorto-iliac morphologies. This is a new step toward clinically applicable mechanical simulation. Significance: Validation on 3-D intraoperative data on a large number of cases-robustness on adverse anatomies.