Biomechanical Rupture Risk Assessment of Abdominal Aortic Aneurysms: Model Complexity versus Predictability of Finite Element Simulations

Abstract

PWRR reinforces PWS as a biomechanical rupture risk index. The ILT has a major impact on AAA biomechanics and rupture risk, and hence, needs to be considered in meaningful FE simulations. The applied FE models, however, could not explain rupture in all analysed aneurysms.

Computational Growth and Remodeling of Abdominal Aortic Aneurysms Constrained by the Spine

“…The majority of the studies focused on stress analysis of the AAA wall in a specific time point during the progression of the disease [3,6,8,10,[37][38][39][40], suggesting that wall stress is a better estimator of rupture potential than the "maximum diameter criterion" on a patient-to-patient basis. Furthermore, a separate category of studies focused on the dynamic adaptive processes by which AAA wall grows and remodels [7,20,25].…”

“…For decades, physicians have conducted a great deal of biomedical engineering research striving to understand why some small AAAs rupture, yet some large AAAs do not [1,2]. Growing evidence provides provisions that have a powerful systematic integration of data-driven specific markers [3,4] and biomechanics [5][6][7] for a more reliable criterion to determine the rupture risk.…”

“…The finite element method (FEM) based approaches to calculate the AAA peak wall stress (PWS) [8][9][10], rupture potential index (RPI) [11], or peak wall rupture risk [3,6] are among such quantitative methods to determine rupture risk. Particularly, active research using FEM has been significantly advanced by incorporating fibrous material properties, patient-specific characteristics, and better damage models with the advantage of evaluating the AAA rupture risk [12][13][14][15][16].…”

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

“…The used systolic pressure is either obtained from the patient or assumed as a value from the range 110-130 mm Hg. Others used mean arterial pressure (MAP) as a loading force [53,54]. Both cases may lead to overestimation of wall stress, as the aneurysm is already under diastolic blood pressure.…”

Applying Findings of Computational Studies in Vascular Clinical Practice: Fact, Fiction, or Misunderstanding?

“…Therefore, a great step forward was the introduction of the aforementioned parameters in commercially available, validated, user-friendly software, i.e., the A4clinics software (VASCOPS GmbH), which allows a hospital-based clinical operator, after a short training session, to perform the RRI estimation procedure from standard computed tomographic angiography images in 10 to 20 minutes, with proven low intra-and interobserver variabilities. [6][7][8][9] Admittedly, none would deny an endovascular intervention to a patient with a large AAA and a low rupture risk index. However, this biomechanical insight may identify those small AAAs that share a high RRI and, hence, are more prone to rupture than the majority of small AAAs.…”