Association Between Aneurysm Shoulder Stress and Abdominal Aortic Aneurysm Expansion

Li, Zhiyong; Sadat, Umar; U-King-Im, Jean Marie; Tang, Tjun Yip; Bowden, David J.; Hayes, Paul D.; Gillard, Jonathan H.

doi:10.1161/circulationaha.110.939819

Cited by 85 publications

(55 citation statements)

References 41 publications

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“…In vivo, of course, perivascular and other effects could also affect the development of tortuosity relative to that of an idealized model as studied herein. Interestingly, stresses in the shoulder region have also shown potential for estimating rupture risk [52]. Just as in the case of G&R of arteries in response to altered hemodynamic loading (cf.…”

Section: Discussionmentioning

confidence: 99%

Parametric study of effects of collagen turnover on the natural history of abdominal aortic aneurysms

2013

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Abdominal aortic aneurysms (AAAs) are characterized by significant changes in the architecture of the aortic wall, notably, loss of functional elastin and smooth muscle. Because collagen is the principal remaining load-bearing constituent of the aneurysmal wall, its turnover must play a fundamental role in the natural history of the lesion. Nevertheless, detailed investigations of the effects of different aspects of collagen turnover on AAA development are lacking. A finite-element membrane model of the growth and remodelling of idealized AAAs was thus used to investigate parametrically four of the primary aspects of collagen turnover: rates of production, half-life, deposition stretch (prestretch) and material stiffness. The predicted rates of aneurysmal expansion and spatio-temporal changes in wall thickness, biaxial stresses and maximum collagen fibre stretch at the apex of the lesion depended strongly on all four factors, as did the predicted clinical endpoints (i.e. arrest, progressive expansion or rupture). Collagen turnover also affected the axial expansion, largely due to mechanical changes within the shoulder region of the lesion. We submit, therefore, that assessment of rupture risk could be improved by future experiments that delineate and quantify different aspects of patient-specific collagen turnover and that such understanding could lead to new targeted therapeutics.

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Section: Discussionmentioning

confidence: 99%

Parametric study of effects of collagen turnover on the natural history of abdominal aortic aneurysms

2013

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“…Li et al [108] specifically suggested that elevated shoulder stress associates with rapidly expanding AAAs. Our own growth and remodeling simulations [109] also suggest that the shoulder represents a region where elastin may fail mechanically as an aneurysm enlarges, thus leading to steep gradients in stress.…”

Section: Implications Of Spatial Distribution-the Shoulder and Neck Rmentioning

confidence: 99%

Biochemomechanics of Intraluminal Thrombus in Abdominal Aortic Aneurysms

Wilson

Virag

Achille

et al. 2013

Journal of Biomechanical Engineering

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Most computational models of abdominal aortic aneurysms address either the hemodynamics within the lesion or the mechanics of the wall. More recently, however, some models have appropriately begun to account for the evolving mechanics of the wall in response to the changing hemodynamic loads. Collectively, this large body of work has provided tremendous insight into this life-threatening condition and has provided important guidance for current research. Nevertheless, there has yet to be a comprehensive model that addresses the mechanobiology, biochemistry, and biomechanics of thrombus-laden abdominal aortic aneurysms. That is, there is a pressing need to include effects of the hemodynamics on both the development of the nearly ubiquitous intraluminal thrombus and the evolving mechanics of the wall, which depends in part on biochemical effects of the adjacent thrombus. Indeed, there is increasing evidence that intraluminal thrombus in abdominal aortic aneurysms is biologically active and should not be treated as homogeneous inert material. In this review paper, we bring together diverse findings from the literature to encourage next generation models that account for the biochemomechanics of growth and remodeling in patient-specific, thrombus-laden abdominal aortic aneurysms.

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“…Computational fluid dynamics evaluated with coronary intravascular ultrasound (IVUS) in experimental atherosclerosis or carotid magnetic resonance imaging in patients provided further evidence of the role of reduced shear stress not only in plaque formation but also in its progression (12,13). Conversely, high wall stress at the shoulder of abdominal aneurysms in humans was found to predict more rapid expansion (14).…”

Section: Mechanisms Of Diseasementioning

confidence: 91%