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Total endovascular repair of the aortic arch represents a promising optionfor patients ineligible to open surgery. Custom-made design of stent-grafts(SG), such as the Terumo Aortic RelayBranch device (DB), requires complexpreoperative measures. Accurate SG deployment is required to avoidintraoperative or postoperative complications, which is extremely challengingin the aortic arch. In that context, our aim is to develop a computational toolable to predict SG deployment in such highly complex situations. Apatient-specific case is performed with complete deployment of the DB and itsbridging stents in an aneurysmal aortic arch. Deviations of our simulationpredictions from actual stent positions are estimated based on post-operativescan and a sensitivity analysis is performed to assess the effects of materialparameters. Results show a very good agreement between simulations andpost-operative scan, with especially a torsion effect, which is successfullyreproduced by our simulation. Relative diameter, transverse and longitudinaldeviations are of 3.2$\pm$4.0%, 2.6$\pm$2.9mm and 5.2$\pm$3.5mm respectively.Our numerical simulations show their ability to successfully predict the DBdeployment in complex anatomy. The results emphasize the potential ofcomputational simulations to assist practitioners in planning and performingcomplex and secure interventions.

Predictive Numerical Simulations of Double Branch Stent-Graft Deployment in an Aortic Arch Aneurysm