A non-invasive methodology for ATAA rupture risk estimation

Trabelsi, Olfa; Gutierrez, M.; Farzaneh, Solmaz; Duprey, Ambroise; Avril, Stéphane

doi:10.1016/j.jbiomech.2017.11.012

Cited by 17 publications

(13 citation statements)

References 27 publications

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“…Our study showed also that it is relevant to define aTAA rupture using a maximum stretch criterion although the maximum stress criterion is commonly used for the rupture of other types of aneurysms [21]. Whereas the peak wall stress was shown to estimate patient risk with a higher accuracy, sensitivity, and specificity for patients with abdominal aortic aneurysms (AAAs) [22], Trabelsi et al [23] supported the significance of stretch-based rupture criteria in aTAAs. Moreover, their results showed that a failure criterion based on the in vitro ultimate stretch was significantly correlated with the aortic extensional stiffness derived from in vivo distensibility [24].…”

Section: About the Correlation Of Wss And Tawss With Aortic Wall Biomsupporting

confidence: 53%

“…The second limitation concerns our rupture risk criterion which was established in vitro and not in vivo. To address this limitation, we are developing a new method enabling the non-invasive characterization of local biomechanical properties of the aorta based on medical imaging analysis [7,23,24]. Moreover, our numerical model used to calculate the hemodynamic descriptors (WSS and TAWSS) relies on a number of assumptions.…”

Section: Limitations/future Workmentioning

confidence: 99%

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Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties

Condemi

Campisi

Viallon

et al. 2020

IEEE Trans. Biomed. Eng.

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Ascending thoracic aortic aneurysm (aTAA) is a major cause of human deaths. Despite important recent progress to better understand its pathogenesis and development, the role played by deranged hemodynamics on aTAA risk of rupture is still partially unknown. Our aim was to develop and apply a novel methodology to assess the correlation between aTAA rupture risk and hemodynamic biomarkers combining for the first time in vivo, in vitro and in silico analyses. Methods: Computational fluid dynamic (CFD) analyses were performed and validated on 10 patients using patient-specific data derived from CT scan and 4D MRI. Systolic wall shear stress (WSS), time-averaged wall shear stress (TAWSS), flow eccentricity (Floweccentricity) and helicity intensity (h2) were assessed. A bulge inflation test was carried out in vitro on the 10 aTAA samples resected during surgical repair. The biomechanical and rupture properties of these samples were derived: the burst pressure, the physiological tangent elastic modulus (), the Cauchy stress at rupture (), the rupture stretch () and the rupture stretch criterion (ϒ). Statistical analysis was performed to determine correlation between all variables. Results: Statistically highly significant (p<0.01) positive correlation between and the TAWSS (r=0.867 and p=0.001) was found.

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Section: About the Correlation Of Wss And Tawss With Aortic Wall Biomsupporting

confidence: 53%

Section: Limitations/future Workmentioning

confidence: 99%

Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties

Condemi

Campisi

Viallon

et al. 2020

IEEE Trans. Biomed. Eng.

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“…the effects of the known changes of axial prestretch and microstructural composition of the aortic wall in dependency of the distance from the heart on its cyclic elastic properties can be captured . Aortic distensibility has been suggested as a predictor for aortic aneurysm rupture risk and has been shown to correlate with an in vitro stretch based failure criterion in ascending thoracic aortic aneurysms . Based on highly resolved full field strain imaging, we introduce a definition of the local distensibility of a segment of the aortic wall.…”

Section: Introductionmentioning

confidence: 99%

Towards non‐invasive in vivo characterization of the pathophysiological state and mechanical wall strength of the individual human AAA wall based on 4D ultrasound measurements

et al. 2018

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Abdominal aortic aneurysms (AAA) are a degenerative disease of the aorta with high associated mortality. Currently, there is a lack of in vivo information, which allows to characterise the individual aneurysmal wall with regard to wall strength or rupture risk. We have used 4D ultrasound strain imaging to compute the spatially resolved distribution of the in-plane strain tensor and of the local distensibility in three patient groups (young, < 40 y. o.; elderly, > 60 y. o.; AAA). Mean and local maximum deformation and distensibility as well as indices for the local variations of the strain and the distensibility distribution were determined. Mean distensibility is significantly decreasing from young (3.83 [2.83, 5.87] 10 −3 mmHg −1 ) to elderly (0.67 [0.39, 0.87] 10 −3 mmHg −1 ) and AAA (0.27 [0.20, 0.54] 10 −3 mmHg −1 ). Both indices characterising the heterogeneous elastic behaviour are significantly increasing from young through elderly to AAA. Linear dependency of some of the distensibility distribution indices on age and aortic diameter was observed in the young and elderly group.In contrast, none of the indices depended on age or maximum diameter in the AAA group. We hypothesize that the heterogeneous distensibility distribution is indicative of microstructural changes in the aortic and aneurysmal wall and might contribute to a more complete and informative pathophysiological characterisation of the AAA wall, either with respect to wall strength or rupture risk. To confirm this hypothesis, further studies will be necessary in which the correlation between the proposed indices and individual wall strength and rupture risk is tested. K E Y W O R D Sabdominal aortic aneurysm, in vivo, local distensibility, spatial heterogeneity INTRODUCTIONAn abdominal aortic aneurysm (AAA) is a degenerative disease of the aorta, which is characterised by a permanent local dilatation of the aorta. AAA occur with a rate between 1.3% and 8.9% in men over 60 y.o. and 2.2% in women. [1,2] The main risk of this mostly asymptomatic disease is the rupture of the aneurysmal wall [3] with associated mortality rates of 53.1% in the US, 65.9% in the UK, [4] and 48% in men and 39% in women in Germany. [5] Currently, the clinical indications for surgical or endovascular treatment are a maximum AAA diameter larger than 5 cm in women and 5.5 cm in men or a growth rate of

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“…The variation of cross sectional area between diastole and systole was used to derive the arterial distensibility and to deduce the extensional stiffness property based on in-vivo distensibility, denoted E in−vivo . Results are reported in Table 1 and were derived from a previous analysis 35 . 17 .…”

Section: Data Acquisitionmentioning

confidence: 99%

“…A major conclusion of the current study is that it is important to identify local stiffness properties and not a global stiffness property based on distensibility analysis for instance 35 , as rupture is a local phenomenon. Over the past decades the biomechanical properties of the aorta have been widely investigated 14,15,31,35,39 , but the material properties were usually is common to ATAA whatever their aetiologies 29 . When elastin networks are disrupted, a larger fraction of collagen fibers need to be produced to resist to the wall stress 36 .…”

Section: Regional Variations Of Stiffness Across Ataamentioning

confidence: 99%

Identifying Local Arterial Stiffness to Assess the Risk of Rupture of Ascending Thoracic Aortic Aneurysms

et al. 2019

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It was recently submitted that the rupture risk of an ascending thoracic aortic aneurysm (ATAA) is strongly correlated with the aortic stiffness. To validate this assumption, we propose a non-invasive inverse method to identify the patient-specific local extensional stiffness of aortic walls based on gated CT scans. Using these images, the local strain distribution is reconstructed throughout the cardiac cycle. Subsequently, obtained strains are related to tensions, through local equilibrium equations, to estimate the local extensional stiffness at every position. We apply the approach on 11 patients who underwent a gated CT scan before surgical ATAA repair and whose ATAA tissue was tested after the surgical procedure to estimate the rupture risk criterion. We find a very good correlation between the rupture risk criterion and the local extensional stiffness. Finally it is shown that patients can be separated in two groups: a group of stiff and brittle ATAA with a rupture risk criterion above 0.9, and a group of relatively compliant ATAA with a rupture risk below 0.9. Although these results need to be repeated on larger cohorts to impact the clinical practice, they support the paradigm that local aortic stiffness is an important determinant of ATAA rupture risk.

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A non-invasive methodology for ATAA rupture risk estimation

Cited by 17 publications

References 27 publications

Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties

Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties

Towards non‐invasive in vivo characterization of the pathophysiological state and mechanical wall strength of the individual human AAA wall based on 4D ultrasound measurements

Identifying Local Arterial Stiffness to Assess the Risk of Rupture of Ascending Thoracic Aortic Aneurysms

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