Biomechanical Indices for Rupture Risk Estimation in Abdominal Aortic Aneurysms

Leemans, Eva L.; Willems, Tineke P.; Laan, Maarten J. van der; Slump, Cornelis H.; Zeebregts, Clark J.

doi:10.1177/1526602816680088

Cited by 33 publications

(22 citation statements)

References 41 publications

(121 reference statements)

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“…28 Large AAA diameter, rapid expansion, smoking, hypertension, female sex, saccular morphology, and elevated PWS are risk factors for AAA rupture. 27,29,30 Here, it is important to be aware that hypertension is a risk factor for AAA rupture, 29,30 but it is not a significant risk factor for AAA expansion. [21][22][23]28 Therefore, it is understandable that antihypertensive therapy cannot prevent AAA expansion in humans.…”

Section: Mechanisms Of Aaa Occurrence and Expansionmentioning

confidence: 99%

Comprehensive Cardiac Rehabilitation as a Therapeutic Strategy for Abdominal Aortic Aneurysm

2019

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stenosis. 11 Among them, inflammatory cells and cytokines play an important role in AAA occurrence and expansion. 12-14 Consistently, inhibition of tumor necrosis factor (TNF)-α, the complement system and peroxisome proliferator-activated receptor γ successfully prevented AAA formation and expansion in mouse AAA models. 15 In contrast, anti-transforming growth factor-β (anti-TGF-β) antibody injection induced AAA rupture in an angiotensin II-stimulated AAA model, 16 indicating that upregulated TGF-β plays a protective role against AAA progression and rupture. 16,17 Taken together, at least in animal models, the mechanism underlying AAA expansion is not similar to that underlying the occurrence of AAA. Risk Factors for AAA Occurrence, Expansion, and Rupture in Humans Consistent with the aforedescribed experimental findings, the risk profiles of occurrence, expansion, and rupture of AAA are different from one another in humans. Except for AAA caused by infection, trauma, or Marfan syndrome, AAA occurrence is more prevalent in aged patients, male subjects, smokers, and those who have chronic obstructive pulmonary disease, hypertension, and low high-density lipoprotein cholesterol. 18 Many cohort studies identified smoking as the strongest risk factor for AAA formation. 19 A cohort study in Sweden suggested that

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Section: Mechanisms Of Aaa Occurrence and Expansionmentioning

confidence: 99%

Comprehensive Cardiac Rehabilitation as a Therapeutic Strategy for Abdominal Aortic Aneurysm

2019

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“…Mechanical stimuli are thought to be key contributors to the initiation of aneurysms and dissections, not just their progression (Manopoulos et al 2018). Estimation of the mechanical stresses/strains within the vessel wall via biomechanical simulations thus represents a promising approach for risk stratification (Farotto et al 2018;Leemans et al 2016) and patientspecific interventional management (Bonfanti et al 2017;Chen et al 2016;Perrin et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Co-localization of microstructural damage and excessive mechanical strain at aortic branches in angiotensin-II-infused mice

Aslanidou

Ferraro

Lovrić

et al. 2019

Biomech Model Mechanobiol

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“…The clinical applicability and additional value of these biomechanical indices compared to the maximum diameter are still unknown, particularly, due to the lack of standardization. [ 17 ] However, over recent years dedicated software for the biomechanical analysis of AAA became available. This software might help to implement the biomechanical analysis in daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Additional value of biomechanical indices based on CTa for rupture risk assessment of abdominal aortic aneurysms

et al. 2018

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ObjectiveBiomechanics for rupture risk prediction in abdominal aortic aneurysms (AAA) are gaining popularity. However, their clinical applicability is still doubtful as there is lack of standardization. This study evaluates the added value of biomechanical indices in rupture risk assessment.MethodsThis study included 175 asymptomatic, 11 sAAA and 45 ruptured aneurysms. 3D-geometries were reconstructed using computer tomography angiographies. Subsequently, finite element models were made to calculate peak wall stress (PWS), peak wall rupture index (PWRI) and the rupture risk equivalent diameter (RRED). The indices were determined with a dedicated software to facilitate standardization.ResultsSAAAs showed a trend towards higher PWS, PWRI and RRED compared to asymptomatic AAAs, but PWS (22.0±5.8 vs. 33.4±15.8 N/cm2), PWRI (0.52±0.2 vs. 1.01±0.64), and RRED (65±60 vs. 98±51 mm) were significantly (p = 0.001) higher in ruptured. However, after diameter-matching no significant differences were seen. The ROC-curves for the maximum diameter and all biomechanical indices were similar but it slightly increased when diameter and biomechanical indices were combined.ConclusionsThis study showed no added value for biomechanical indices in AAA rupture risk assessment. Additionally, the difficulty of such an assessment increases. However, as symptomatic aneurysms show a trend towards higher biomechanical indices with similar diameters the indices may provide information about aneurysm growth and development.

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Biomechanical Indices for Rupture Risk Estimation in Abdominal Aortic Aneurysms

Cited by 33 publications

References 41 publications

Comprehensive Cardiac Rehabilitation as a Therapeutic Strategy for Abdominal Aortic Aneurysm

Comprehensive Cardiac Rehabilitation as a Therapeutic Strategy for Abdominal Aortic Aneurysm

Co-localization of microstructural damage and excessive mechanical strain at aortic branches in angiotensin-II-infused mice

Additional value of biomechanical indices based on CTa for rupture risk assessment of abdominal aortic aneurysms

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