Finite Element Analysis in Asymptomatic, Symptomatic, and Ruptured Abdominal Aortic Aneurysms: In Search of New Rupture Risk Predictors

Erhart, Philipp; Hyhlik‐Dürr, A.; Geisbüsch, Philipp; Kotelis, Drosos; Müller–Eschner, Matthias; Gasser, Thomas C.; Tengg-Kobligk, Hendrik von; Böckler, Dittmar

doi:10.1016/j.ejvs.2014.11.010

Cited by 95 publications

(96 citation statements)

References 27 publications

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“…In 2 studies as a marker for expansion33, 71 and in 1 as a marker for rupture,60 all studies had medium risk of bias. Speelman et al measured significantly higher expansion rates in patients with a large ILT volume (≥32% of the total aneurysm sac) versus a small ILT volume (total n=30).…”

Section: Resultsmentioning

confidence: 99%

“…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 6 studies, with a total of 552 patients, significant outcomes were demonstrated for AAA diameter as a marker for rupture. 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%

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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: Resultsmentioning

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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“…Consequently, biomechanical indices like peak wall stress (PWS; see [12] and references therein) and the peak wall rupture index (PWRI; [13][14][15][16]) have been regularly shown to be higher in ruptured/ symptomatic AAAs than in intact/non-symptomatic AAAs. In recent years, the continuous development of biomechanical AAA rupture risk assessment includes improved modelling assumptions (by considering the zero-pressure configuration [17][18][19][20]), the homogeneous stress hypothesis [21], wall calcifications [22,23], wall anisotropy [17,24], poro-elastic tissue descriptions [25,26], fluid-structure interaction [27][28][29]) and highly automatized three-dimensional model generation [30].…”

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confidence: 99%

Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index

Polzer

Gasser

2015

J. R. Soc. Interface.

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A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n ¼ 7) and intact (n ¼ 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly ( p ¼ 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach.

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Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms

Singh

Moxon

Iyer

et al. 2020

British Journal of Surgery

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Background Previous studies have suggested that finite element analysis (FEA) can estimate the rupture risk of an abdominal aortic aneurysm (AAA); however, the value of biomechanical estimates over measurement of AAA diameter alone remains unclear. This study aimed to compare peak wall stress (PWS) and peak wall rupture index (PWRI) in participants with ruptured and asymptomatic intact AAAs. Methods The reproducibility of semiautomated methods for estimating aortic PWS and PWRI from CT images was assessed. PWS and PWRI were estimated in people with ruptured AAAs and those with asymptomatic intact AAAs matched by orthogonal diameter on a 1 : 2 basis. Spearman's correlation coefficient was used to assess the association between PWS or PWRI and AAA diameter. Independent associations between PWS or PWRI and AAA rupture were identified by means of logistic regression analyses. Results Twenty individuals were included in the analysis of reproducibility. The main analysis included 50 patients with an intact AAA and 25 with a ruptured AAA. Median orthogonal diameter was similar in ruptured and intact AAAs (82·3 (i.q.r. 73·5–92·0) versus 81·0 (73·2–92·4) mm respectively; P = 0·906). Median PWS values were 286·8 (220·2–329·6) and 245·8 (215·2–302·3) kPa respectively (P = 0·192). There was no significant difference in PWRI between the two groups (P = 0·982). PWS and PWRI correlated positively with orthogonal diameter (both P < 0·001). Participants with high PWS, but not PWRI, were more likely to have a ruptured AAA after adjusting for potential confounders (odds ratio 5·84, 95 per cent c.i. 1·22 to 27·95; P = 0·027). This association was not maintained in all sensitivity analyses. Conclusion High aortic PWS had an inconsistent association with greater odds of aneurysm rupture in patients with a large AAA.

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Finite Element Analysis in Asymptomatic, Symptomatic, and Ruptured Abdominal Aortic Aneurysms: In Search of New Rupture Risk Predictors

Abstract: From different FEA derived parameters, PWRI distinguishes most precisely between asymptomatic and symptomatic AAAs. If elevated, this value may represent a negative prognostic factor for asymptomatic AAAs.

Cited by 95 publications

References 27 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 of abdominal aortic aneurysms based on a novel probabilistic rupture risk index

Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms

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