Journal of Biomechanics 46 (2013) 1335–1342

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Journal of Biomechanics
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www.JBiomech.com

Fluid structure interaction simulation in three-layered aortic

aneurysm model under pulsatile flow: Comparison of wrapping
and stenting
Feng Gao a,n, Hiroshi Ueda a, Gang Lib, Hiroshi Okada a
a
Department of Mechanical Engineering, Faculty of Engineering and Technology, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan
b
Cardiac Centre of Hebei General Hospital, 348 Heping Xilu, Shijiazhuang, Hebei 050051, China

a r t i c l e i n f o abstract

Article history: One treatment method for aortic aneurysm is the invasive insertion of a stent into the aneurysm.
Accepted 5 February 2013 Another method is wrapping the aneurysm using newly developed expanded polytetrafluoroethylene
(PTFE) material. A virtual stented aneurysm model and a wrapped aneurysm model were created to
Keywords: study the flow and wall dynamics by means of fluid-structure interaction analyses. The flow velocity
Biomechanics and pressure distribution as well as the deformation and wall stress were investigated. Stenting
Aneurysm significantly changed the blood flow pattern and the vortexes in the aneurysm. Wrapping increased the
Stent thickness of the aneurysm wall and increased the strength of the vessel wall. The maximum von Mises
Numerical analysis stress in the stented model was found to be 220,494 Pa and 228,218 Pa at the time of peak flow and
peak pressure, respectively. This was reduced by 37.8% and 36.7% to 137,200 and 144,354 Pa,
respectively, in the wrapped model. Our results provide information that may improve the under-
standing of the biomechanics of stenting and wrapping.
& 2013 Elsevier Ltd. All rights reserved.

1. Introduction failure strength, a criterion for repair based upon quantification of

Endovascular aneurysm repair is a minimally invasive techni-
que that involves inserting a stent into the aneurysm site via the
femoral and iliac arteries. Clinically, it has been shown that
aneurysms can continue to expand after endovascular aneurysm
repair without the presence of endoleaks (Kougias et al., 2008).
The wrapping of intracranial aneurysms has been performed
since 1933, when Dott used hammered muscle to form a
secure scaffolding for the clotting and fibrosis around the aneur-
ysm (Dott, 1993). Advances in micro-neurosurgery, clip tech-
nology, and endovascular treatment have resulted in wrapping
currently being a nearly obsolete technique. However, neurosur-
geons encounter aneurysms that defy clipping, and wrapping is
the only possible treatment option. The data in the literature is
contradictory as to whether wrapping provides any protection
against rupture (Cossu et al., 1993; Fujiwara et al., 1990; Todd
et al., 1989).
Deciding among the various aneurysm repair techniques is
difficult due to the lack of a reliable predictor of rupture risk.
Since aneurysm rupture is a phenomenon that occurs when the
mechanical stress acting on the dilating inner wall exceeds its
n
Corresponding author. Tel.: þ81 4 71241501x3926.
E-mail address: wind.fgao@gmail.com (Feng Gao).
aneurysm stress and strength could facilitate a better method to
determine at-risk aneurysms. Unfortunately, there is no current
method of obtaining in vivo measurements of tissue stresses.
Numerical aneurysm modeling is useful for determining stresses.
Finite element analysis allows the stresses on the aneurysm wall to
be determined (Fillinger et al., 2002; Doyle et al., 2008). Fluid
structure interaction analysis of aneurysms, though still an emer-
ging field of study, has seen an increasing number of publications in
recent years. However, minimal research has been published on the
effect of stents and wrapping on aneurysm wall stress.
In most studies, the arterial wall was considered to consist of
homogeneous material and to be one layer throughout the
arterial wall (Vorp et al., 1998; Raghavan et al., 2000; Gianna
koulas et al. 2005; Papaharilaou et al., 2007). Although this has
been considered for simplicity, it is not consistent with the
microstructure. Despite the significant contributions of previous
research, a better arterial model would consider the arterial wall
to consist of layers: intima, media, and adventitia. In the present
work, a three-layered wall model is developed.
The objective of this work was to investigate the effects of
stenting and wrapping on aortic aneurysm with the use of fluid
structure interaction analysis. A stented aneurysm model and a
wrapped aneurysm model were utilized in the study, which aims
to provide a non-invasive methodology for quantifying aneurysm
wall mechanics.

0021-9290/$ - see front matter & 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jbiomech.2013.02.002
1336 F. Gao et al. / Journal of Biomechanics 46 (2013) 1335–1342
2. Methods
2.1. Geometry
A stented aneurysm model and a wrapped aneurysm model were generated with
COMSOL commercial software (version 4.0a, COMSOL, Inc., Burlington, MA, USA).
Fig. 1 shows the two dimensional (2D) axisymmetric geometric models of stented
and wrapped three-layered aneurysms and three different locations in the aneurysm
model. The 2D axisymmetric model represents a slice of the actual three dimensional
(3D) model. If revolved around the axis, the 2D axisymmetric model would become
the original 3D structure. As shown in Fig. 1(c), for the 2D axisymmetric model, the
helical coil stent was reasonably modeled as axisymmetric circular wires. The inlet
and outlet radius was set to 12 mm and the maximum aneurysm radius was set to
30 mm. The thickness of the entire wall was chosen to be 2 mm and the thicknesses
of the intima, media, and adventitia in aneurysm models were ti ¼ 0.2 mm,
tm ¼ 1.2 mm, and ta ¼0.6 mm, respectively (Gao et al., 2006). The vessel walls were
modeled to be two dimensional axisymmetric solid.
In the stented aneurysm model, the stent covered the aneurysm segment. The
diameter of the stent wire varies with the individual stent type: 0.14 mm for the
TM
Expander stent (Zhao et al., 2012), 0.4 mm for the Cook ZENITH stent (Sun and
Fig. 1. (a) Two dimensional axisymmetric stented aneurysm model with three-layered wall. (b) Two dimensional axisymmetric wrapped aneurysm model with three-
layered wall. (c) The helical coil stent was modeled as an axisymmetric wire model.
Chaichana, 2009), and 0.5 mm for the Ti–Ni alloy stent (Nakamura et al., 1992).
The flow velocity was reduced by 20–30% when the diameter of the stent wire
increased from 0.4 mm to 1.0 and 2.0 mm in Sun and Chaichana’s study (2009).
The diameter of abdominal aorta in Sun and Chaichana’s study is smaller than the
aorta in our study. Taking into consideration the increase in the hemodynamic
effect of stent, the wire diameter must increase. Furthermore, blood materials may
accumulate on the stent surface over a period of time. Given this, we chose a
1.0 mm stent wire diameter. The stent has a total length l ¼90 mm, and n¼ 10
braids. The center of stent was chosen to lie on the center of the aneurysm.
To perform a stent delivery procedure, a vascular surgeon makes a small incision
in the groin and inserts a catheter. The catheter is threaded through the artery
until it reaches the site of the aneurysm, whereupon a balloon is inflated and then
deflated and removed. When the aortal wall is contracted, the stent is utilized to
support the aortal wall. When the aortal wall is expanded, the stent does not pull
the wall back. In our model, the stent is assumed to be rigid and fixed. The stent
wire diameter is much smaller than the vessel diameter (Lieber et al., 2002). In the
wrapped model, the surface of the outer wall of the aneurysm was covered by a
100-mm-thick expanded polytetrafluoroethylene (ePTFE) sheet (Ujiie et al., 2007).
The ePTFE was a newly improved material developed by the ion beam irradiation
technique. It was biologically inert and able to firmly adhere to the aortic wall. The
sheet is fixed on the wall in the numerical simulation.
 F. Gao et al. / Journal of Biomechanics 46 (2013) 1335–1342
2.2. Governing equations and boundary conditions
The flow is assumed to be laminar Newtonian, viscous and incompressible.
The Navier–Stokes equations in Arbitrary Lagrangian–Eulerian (ALE) formulation
are used as the governing equations:
h i
T points. The solution was done as 2D axisymmetric. In this work we make use of
rf @u
@t r ðpÞI þ mðr u þ ðr uÞÞ þ rf ððuum ÞrÞu ¼ F
ð1Þ
ru ¼ 0
where rf is the fluid’s density, u is the velocity field of the flow, p is the fluid
pressure, I is the identity tensor, F is the volume force affecting the fluid, um is the
mesh velocity due to the movement of the coordinate system, and r is the
differential operator with respect to the Eulerian coordinate. It is assumed that no
gravitation or other volume forces affect the fluid, so F ¼0. Blood is modeled to
have a density rf ¼ 1050 kg/m3 and a dynamic viscosity m ¼ 0.0035 Pa s. The
structure deformations are solved using an elastic formulation. The governing
equation for the solid can be described by the following equation:
@2 ds
rr þ F s ¼ rs ð2Þ
@t 2
where rs is the solid density, r is the Cauchy stress tensor, Fs is the body force per
unit volume, and ds is the displacement of the solid. The wall experiences a load
from the fluid, given by
F T ¼ nðpI þ Zðru þ ðruÞT ÞÞ ð3Þ
where n is the normal vector to the boundary. This load represents a sum of
pressure and viscous forces. The aneurysm wall is assumed to be an isotropic,
linear, nearly incompressible, and elastic solid with a density rs ¼2000 kg/m3, a
Poisson’s ratio n ¼0.45, and mean Young’s modulus E¼ 4.0 MPa. Young’s modulus
values of the intima, media, and adventitia are 1.6, 4.8, and 3.2 MPa, respectively
(Gao et al., 2006).
A uniform flow was assigned at the inlet and a pressure boundary was assigned
at the outlet (Fig. 2). For the composite structure, the boundary conditions include
fixed displacements at the inlet and the outlet, and free displacement of the wall. The
stent is assumed to be rigid and fixed and the ePTFE sheet is adhered firmly to the
surface of the aneurysm wall. A Young’s modulus of 54.58 MPa and a density of
583.25 kg/m3 used in the analysis for medical-grade ePTFE were obtained by means
of tensile tests (Catanese et al., 1999).
Fig. 2. (a) Flow waveform and pressure waveform adapted from Mills et al. (1970). (b) Mesh models for the stented aneurysm and the wrapped aneurysm.
1337
2.3. Coupled fluid–solid interaction simulation
COMSOL software (v4.0a, COMSOL Inc., USA) was utilized for the numerical
simulation of fluid structure interaction (FSI) between the wall and the lumen. The
finite element method was used to solve the governing equations, which discretizes
the computational domain into finite elements that are interconnected by nodal
triangular, three-node elements to discretize the fluid and solid domains. The
meshing was automatically performed by COMSOL software. The underlying finite
element discretization method in COMSOL Multiphysics is the Galerkin method in
which a weak equation form corresponding to a given strong equation is obtained
by multiplying with the basis function and integrating over the computational
domain (COMSOL Multiphysics User’s Guide, 2010). A mesh independence test was
performed for each model. The coarse meshes are 17,550 for the stented model and
16,899 for the wrapped model. The fine meshes are 23,104 for the stented model
and 29,737 for the wrapped model. The maximum difference in velocity, pressure,
and wall stress between the coarse and fine meshes was within 5%. Only results from
fine meshes are presented.
The stented aneurysm model contained 23,104 elements and 11,737 nodes. The
wrapped aneurysm model contained 29,737 elements and 15,458 nodes. The average
mesh quality is 0.944 for the stented model and 0.934 for the wrapped model. The
minimum mesh quality is 0.540 for the stented model and 0.406 for the wrapped
model. The boundary mesh was set to 10 elements and an element ratio of 10 in the
inlet and outlet edges. Fig. 2(b) illustrates the fluid and solid meshes for the stented
aneurysm model and the wrapped aneurysm model. In order to start the pulsatile
cycle calculations, a steady state solution at the maximum flow was first obtained.
This steady state solution was then used as the initial condition for pulsatile
simulation. The calculations were performed using 3334 steps per cycle which
corresponds to a step time of 0.0003 s. The relative tolerance for all degrees of
freedom was set to 0.001. Wall stress and displacement reached convergence on the
second pulsatile cycle and the fluid domain required three cycles to reach conver-
gence. In this study, three pulsatile cycles were computed to obtain a periodic
solution and the fourth was used as the final solution.
3. Results
Computations were performed for the stented aneurysm
model and the wrapped aneurysm model under a pulsatile flow
1338 F. Gao et al. / Journal of Biomechanics 46 (2013) 1335–1342
Fig. 3. Comparison of flow velocity in the stented aneurysm model and the wrapped aneurysm model: (a) peak flow and (b) peak pressure.
Fig. 4. Temporal flow volume rate for inlet and outlet in the stented aneurysm
model and the wrapped aneurysm model. The conservation of mass over one cycle
is shown.
condition. Fig. 3 shows the flow velocity in the stented aneurysm
model and the wrapped aneurysm model at the time of peak flow
and peak pressure. In the stented model, the flow was stunted and
the velocity was higher at the entrance of the aneurysm segment.
During peak systolic pressure, the flow of blood began to decelerate,
which can lead to vortex formation.
Fig. 4 shows the flow volume rate for the inlet and outlet in the
stented aneurysm model and the wrapped aneurysm model. It is
expressed by
ZZ
Q¼ v dA ð4Þ
A
where v is the flow velocity and A is the cross-sectional area of the
vessel. Over one cycle, the flow volume passing through the outlet
in the stented aneurysm model and the wrapped aneurysm model
is 2.6  10–5 m3, which is the same as the flow volume passing
through the inlet. This shows that conservation of mass in the
fluid flow is satisfied. During the systolic phase, the outflow rate is
lower than the inlet flow rate because of wall deformation.
Fig. 5 shows the pressure distribution in the stented aneurysm
model and the wrapped aneurysm model at the time of peak flow
and peak pressure. At the time of peak flow, the pressure in the
proximal neck is higher in the wrapped model than in the stented
model, while at the time of peak pressure, the pressure in the
proximal neck and the inflated region is much higher in the
wrapped model than in the stented model.
The temporal deformation and stress distribution were
measured at three locations in the stented model and the wrapped
model (Fig. 6). In each location, the deformation was lower in the
wrapped model. At the inflection point and at maximum diameter,
the stress was lower in the wrapped model. At the proximal neck
point, the stress is lower in the stented model, but the magnitude is
much lower than the inflection point and the maximum diameter
point. Fig. 7 shows the total deformation distribution in the stented
model and the wrapped model at the time of peak pressure. A 3D
plot was generated by revolution of the 2D data set to visualize the
 F. Gao et al. / Journal of Biomechanics 46 (2013) 1335–1342
Fig. 5. Comparison of pressure distribution in the stented aneurysm model and the wrapped aneurysm model: (a) peak flow and (b) peak pressure.
solution in 3D from the 2D axial symmetric solution in Fig. 7
(revolution angle: 3601) and Fig. 8 (revolution angle: 3001).
Significant gradients occur at the inflection points of the aneur-
ysm curvature. The total deformation is lower in the wrapped
model than the stented model. The von Mises stress distribution
in the stented model and the wrapped model at the time of peak
pressure is shown in Fig. 8. As stress is a tensor quantity with nine
components, the von Mises stress is a stress index that is
especially suited for failure analysis (Raghavan et al., 2000). The
von Mises stress or equivalent tensile stress (a scalar measure of
the stress tensor that is proportional to the strain energy density
at each point (Papaharilaou et al., 2007)) can be computed from
the stress tensor, which is used to predict yielding of materials
under any loading condition (Xu et al., 2011). Both peak stresses
occur in the media layer at the inflection region. The stresses
at the midsection were higher than those at the proximal
neck and the distal neck. The wall stresses on the proximal neck
and the distal neck were very similar between the stented model
and the wrapped model. However, the stresses were much
higher in the stented model than in the wrapped model. Fig. 9
shows the von Mises stress distribution across wall thickness at
inflection points in the stented aneurysm model and the
wrapped aneurysm model at the time of peak flow and peak
pressure. The maximum von Mises stress in the stented model
was found to be 220,494 Pa and 228,218 Pa at the time of peak
flow and peak pressure, respectively. This was reduced by 37.8%
and 36.7% to 137,200 Pa and 144,354 Pa, respectively, in the
wrapped model.
1339
4. Discussion
The wrapping technique is a surgical technique used under
certain circumstances in the case of ascending aortal dilatation.
Most previous work has investigated numerous parameters in a
stented model based on computed tomography (CT) scans (Li and
Kleinstreuer, 2005; Fu et al. 2010). It was observed that peak wall
stress is reduced 20-fold in a stented aneurysm (Li and
Kleinstreuer, 2005; Fu et al. 2010). In a patient-specific stented
finite element analysis (FEA) model, a 90% decrease in aneurysm
wall stress was reported (Di Martino et al., 2004). Our results
compare the effects of stenting and wrapping on the flow as well
as the wall stress. The peak von Mises wall stress on the
aneurysm was reduced by 37% in the wrapped model compared
with the stented model. Wrapping of intracranial aneurysm has
been performed since 1933 when Dott used hammered muscle to
form a secure scaffolding for the clotting and fibrosis around the
aneurysm (Dott, 1993). This wrapping method has been widely
used to obtain hemostasis and reinforcement of the anastomotic
site (Kouchoukos et al., 2003). Recent advances in endovascular
treatment can sometimes be helpful, but currently remain inade-
quate for these difficult aneurysms. Reinforcing the aneurysmal
sac with some form of wrapping or coating is sometimes the only
possible treatment option. Several types of material have been
used for wrapping. Autogenous material such as muscle, fascia, or
dura mater have been shown to adhere slowly to the aneurysmal
wall, giving inadequate early protection, and are absorbed in the
long term, giving poor long-term results (Cossu et al., 1993; Ebina
1340
Fig. 6. Temporal deformation distribution (a) and stress distribution (b) at three
locations (A: proximal neck, B: inflection, and C: maximum diameter) on the
stented aneurysm model and the wrapped aneurysm model.
Fig. 7. Total deformation distribution in the stented model and the wrapped model at the time of peak pressure.
F. Gao et al. / Journal of Biomechanics 46 (2013) 1335–1342
et al., 1984; Fujiwara et al., 1990; Mount and Antunes, 1975;
Robinson, 1971; Sachs, 1972; Taylor and Choudhury, 1977).
Cotton derivatives, such as gauze and muslin, showed better
experimental adherence (Ebina et al., 1984; Sachs, 1972) and
good results in some (Taylor and Choudhury, 1977; Todd et al.,
1989) but a high incidence of rebleeding in other clinical studies
(Cossu et al., 1993; Mount and Antunes, 1975). They were also
associated with optochiasmatic arachnoiditis and granuloma
formation (Haisa et al., 1990; Marcus et al., 1986; Onoue et al.,
1992). Ujiie et al. (2007) developed a newly improved ePTFE using
the ion beam irradiation technique that is biologically inert and
able to firmly adhere to surrounding tissue and had good clinical
results. The wrapping increases the thickness of the aneurysm
wall as well as the strength of the vessel wall (Ebina et al., 1984;
Sachs, 1972). Our results showed that wrapping decreased the
peak wall stress in the aneurysm and provided protection against
rupture compared to stent treatment. Our results also revealed
that the media layer was subjected to higher loads than other
layers and that the stresses were much higher in the media layer.
The wrapping method decreased the load of the media layer and
the wall stress was lower in the wrapped model than in the
stented model. The multi-layered wall model accounts for the
relatively detailed effects of stenting and wrapping on the stress
distribution inside the wall tissues and provides better accuracy
when compared with a homogeneous one-layer model in biome-
chanical simulation.
The fluid structure interaction of a stented aneurysm and a
wrapped aneurysm was simulated. The velocity, pressure, defor-
mation and wall stress were examined. We compared the results
of the stented aneurysm model with those of the wrapped
aneurysm model. Stenting protects the weakened aneurysm wall
from blood flow and high pressure. Despite higher pressure, the
peak stress in the media layer in the wrapped aneurysm was 37%
 F. Gao et al. / Journal of Biomechanics 46 (2013) 1335–1342
Fig. 8. von Mises stress distribution in the stented model and the wrapped model at the time of peak pressure.
Fig. 9. von Mises stress distribution across wall thickness at inflection points in
the stented aneurysm model and the wrapped aneurysm model at the time of
peak flow and peak pressure.
smaller than in the stented aneurysm. Our results provide
information that may improve the understanding of the biome-
chanics of stenting and wrapping.
Conflict of interest
We declare that we have no conflict of interest.
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