Mathematics and Supercomputers to understand the cause of Type II Endoleaks.

A Computational model to understand the Physiology, Etiology and Biological Behavior of Type II Endoleaks (CoφEndoleak).

Type II endoleaks are a persistent problem after endovascular aneurysm repair (EVAR) with a prevalence of 15-25%. They are characterised by the reversal of blood into the aneurysmal sac from side branches and growth of the aneurysm thereof. The occurrence of type II endoleaks is thus related to unfavorable sac dynamics, that in turn is associated with reinterventions and long-term survival. Even after over 25 years of experience, type II endoleaks remain the Achilles heel of the technique. Prediction models of type II endoleaks occurrence/behavior are a clinical unmet need with regard to identifying patients at risk for development of a persistent type II endoleak, to predicting the association with unfavorable sac dynamics and to identify the optimal treatment algorithm. The reasons for the occurrence of type II endoleaks in some patients is an open question fundamentally.

This project will leverage fully resolved direct numerical simulation of flow on large supercomputers, combined with a model for thrombosis to study the risk of type II endoleaks, based on patient data. They will conduct detailed simulations on supercomputers using the APES simulation framework ( to quantify intrinsic flow dynamics, and arrive at a fundamental understanding about endoleaks. This will lead to improvement in clinical practice in the management of patients, reduction in follow-up costs, reduced burden on the health costs in Netherlands.

Research questions:

  1. Why do type II endoleaks happen in some patients while not in others after the EVAR procedure?
  2. Can we predict their persistence in time?
  3. Can we predict the sac remodeling with computational methods?
  4. In case of a reintervention, can the primary target vessel(s) be identified to optimize the treatment success rate?

More information can be found here

Abdominal Aortic Aneurysms (AAA) are treated using stent grafts. In some patients, Type II endoleaks occur that are characterized by the reversal of blood flow into the aneurysm. After 25 years of clinical practice the cause of these endoleaks has remained an enigma. Using computational modeling and simulations, this project will answer this open question that is faced by the human society.
Technology Readiness Level (TRL)
1 - 4
Time period
49 months