A Comparative Study of Aortic Wall Stress Using Finite Element Analysis for Ruptured and Non-ruptured Abdominal Aortic Aneurysms*1

Venkatasubramaniam, Arcot; Fagan, Michael J.; Mehta, Tapan; Mylankal, Kurian J.; Ray, Biswajit; Kuhan, Ganesh; CHETTER, I; McCollum, P.T.

doi:10.1016/s1078-5884(04)00178-9

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…In 9 studies, AAA diameter was described as a marker for expansion8, 17, 19, 21, 40, 56, 57, 58, 59 and in 9 as a marker for rupture 34, 37, 60, 61, 62, 63, 64, 65, 66. Overall, the data are reliable because 2570 patients in total were included and 8 studies were appraised with low bias risk, 7 with medium risk, and only 3 with high risk.…”

Section: Resultsmentioning

confidence: 99%

“…In 5 studies, larger diameters were measured in ruptured (and symptomatic) AAA when compared with asymptomatic patients,34, 60, 61, 64, 65 and 1 study demonstrated aneurysm diameter as a prognostic marker for rupture (area under curve=0.67) 37. In 3 studies, of which 2 were with high bias risk, no difference was found in diameter between ruptured AAA patients versus patients preceding elective repair (total n=80) 62, 63, 66…”

Section: Resultsmentioning

confidence: 99%

“…Aortic peak wall stress (PWS) was investigated as a marker for AAA rupture in 9 studies 60, 62, 63, 64, 66, 72, 73, 74, 75. In 7 studies, significantly higher PWS (ranging 1.29–1.66‐fold higher) was found in ruptured (and symptomatic) AAA patients than in asymptomatic AAA patients (2 low risk, 4 medium risk, and 1 high risk of bias; total n=536).…”

Section: Resultsmentioning

confidence: 99%

“…Because aneurysms are not symmetrical dilations, pressure in the aneurysm sac is heterogeneously divided. Finite element analysis enables software programs to calculate the PWS on the aneurysm wall 63. In 7 of 9 studies, PWS retrospectively differentiated between ruptured and nonruptured AAA, but none investigated it as a prognostic value.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Groeneveld

Meekel

Rubinstein

et al. 2018

JAHA

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BackgroundThe natural course of abdominal aortic aneurysms (AAA) is growth and rupture if left untreated. Numerous markers have been investigated; however, none are broadly acknowledged. Our aim was to identify potential prognostic markers for AAA growth and rupture.Methods and ResultsPotential circulating, biomechanical, and genetic markers were studied. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library in February 2017, following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Study selection, data extraction, and methodological quality assessment were conducted by 2 independent researchers. Plausibility of markers was based on the amount of publications regarding the marker (more than 3), pooled sample size (more than 100), bias risk and statistical significance of the studies. Eighty‐two studies were included, which examined circulating (n=40), biomechanical (n=27), and genetic markers (n=7) and combinations of markers (n=8). Factors with an increased expansion risk included: AAA diameter (9 studies; n=1938; low bias risk), chlamydophila pneumonia (4 studies; n=311; medium bias risk), S‐elastin peptides (3 studies; n=205; medium bias risk), fluorodeoxyglucose uptake (3 studies; n=104; medium bias risk), and intraluminal thrombus size (5 studies; n=758; medium bias risk). Factors with an increased rupture risk rupture included: peak wall stress (9 studies; n=579; medium bias risk) and AAA diameter (8 studies; n=354; medium bias risk). No meta‐analysis was conducted because of clinical and methodological heterogeneity.ConclusionsWe identified 5 potential markers with a prognostic value for AAA growth and 2 for rupture. While interpreting these data, one must realize that conclusions are based on small sample sizes and clinical and methodological heterogeneity. Prospective and methodological consonant studies are strongly urged to further study these potential markers.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Groeneveld

Meekel

Rubinstein

et al. 2018

JAHA

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“…Besides the diameter and its change over time, many other clinical risk factors have been proposed including biomechanical risk indices [7][8][9][10][11][12][13][14][15][16], AAA shape [19,20], female sex [7,[21][22][23][24][25], family susceptibility [25][26][27], high mean arterial pressure (MAP) [3], smoking and fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) [28,29], a thick intraluminal thrombus (ILT) layer [18,30], and rapid increase in ILT volume [31].…”

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confidence: 99%

Biomechanical Rupture Risk Assessment - A consistent and objective decision-making tool for Abdominal Aortic Aneurysm patients

Gasser¹

2016

aorta

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Abdominal aortic aneurysm (AAA) rupture is a local event in the aneurysm wall that naturally demands tools to assess the risk for local wall rupture. Consequently, global parameters like the maximum diameter and its expansion over time can only give very rough risk indications; therefore, they frequently fail to predict individual risk for AAA rupture. In contrast, the Biomechanical Rupture Risk Assessment (BRRA) method investigates the wall's risk for local rupture by quantitatively integrating many known AAA rupture risk factors like female sex, large relative expansion, intraluminal thrombus-related wall weakening, and high blood pressure. The BRRA method is almost 20 years old and has progressed considerably in recent years, it can now potentially enrich the diameter indication for AAA repair. The present paper reviews the current state of the BRRA method by summarizing its key underlying concepts (i.e., geometry modeling, biomechanical simulation, and result interpretation). Specifically, the validity of the underlying model assumptions is critically disused in relation to the intended simulation objective (i.e., a clinical AAA rupture risk assessment). Next, reported clinical BRRA validation studies are summarized, and their clinical relevance is reviewed. The BRRA method is a generic, biomecha nics-based approach that provides several interfaces to incorporate information from different research disciplines. As an example, the final section of this review suggests integrating growth aspects to (potentially) further improve BRRA sensitivity and specificity. Despite the fact that no prospective validation studies are reported, a significant and still growing body of validation evidence suggests integrating the BRRA method into the clinical decision-making process (i.e., enriching diameterbased decision-making in AAA patient treatment). Problem DefinitionAbdominal aortic aneurysm (AAA) disease is a serious condition and causes many deaths, especially in males over 65 years. Progressive treatment (i.e., surgical or endovascular AAA repair) cannot be offered to all patients, and according to the best clinical practice, AAA repair is indicated if rupture risk exceeds the interventional risks. While center-specific treatment risks are reasonably predictable, assessing AAA rupture risk for individual patients remains the bottleneck in clinical decision making. However, an accurate rupture risk assessment is critical to reduce aneurysm-related mortality without substantially increasing the rate of AAA repair.According to the current clinical practice, AAA rupture risk is assessed by the aneurysm's largest

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Computational simulations of MR elastography in idealised abdominal aortic aneurysms

Hollis¹,

Conlisk²,

Thomas-Seale³

et al. 2016

Biomed. Phys. Eng. Express

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Introduction Patient specific modelling (PSM) of abdominal aortic aneurysm (AAA) aims to predict rupture risk by calculating the peak stress acting on the AAA wall using finite element analysis (FEA). It is hypothesised that magnetic resonance elastography (MRE), a non-invasive technique measuring material properties, can improve PSM by allowing integration of patient specific properties into the model. MRE measurements are, however, dependent on the geometry under investigation as well as the material properties. This preliminary study used FEA to investigate the ability of MRE to achieve reproducible measurements of the elastic properties of the thrombus in different sized idealised AAA geometries.Methods Idealised AAA geometries of diameter 50, 60 and 70 mm were created with material properties based on literature values prescribed. FEA was run with frequencies of 50, 100, and 120 Hz induced into the model. Synthetic noise was applied to the models and the ability of a 3-D Butterworth bandpass filter to remove it's influence was assessed.Results and Discussion In low prescribed shear moduli greatest accuracy was typically achieved at 50 Hz, contrasting with high prescribed shear moduli, where it was achieved at 120 Hz. Variation in measurements across the three AAAs was lowest at 120 Hz with a mean coefficient of variation across all prescribed shear moduli of 9% in contrast to 11 and 18% at 100 and 50 Hz respectively. Bandpass filtering was able to fully recover material property measurements at noise levels of 1 and 2%, but was unable to do so for high prescribed shear modulus values at levels above this.Conclusions Of the frequencies tested here, 120 Hz achieved the most reproducible measurements across the three AAA sizes, though accuracy of measurements at this frequency was compromised in low prescribed shear moduli.

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A Comparative Study of Aortic Wall Stress Using Finite Element Analysis for Ruptured and Non-ruptured Abdominal Aortic Aneurysms*1

Abstract: Peak wall stress can be calculated from routinely performed CT scans and may be a better predictor of risk of rupture than AAA diameter on an individual patient basis.

Cited by 8 publications

References 6 publications

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Systematic Review of Circulating, Biomechanical, and Genetic Markers for the Prediction of Abdominal Aortic Aneurysm Growth and Rupture

Biomechanical Rupture Risk Assessment - A consistent and objective decision-making tool for Abdominal Aortic Aneurysm patients

Computational simulations of MR elastography in idealised abdominal aortic aneurysms

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