Geometric analysis of ruptured and nonruptured abdominal aortic aneurysms

Kimura, Masao; Hoshina, Katsuyuki; Miyahara, Kensuke; Nitta, Jun; Kobayashi, Masaharu; Yamamoto, Sota; Ohshima, Marie

doi:10.1016/j.jvs.2018.04.035

Cited by 11 publications

(10 citation statements)

References 24 publications

(28 reference statements)

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“…This study complements the studies carried out by Jusko et al [ 22 ], Fillinger et al [ 60 ], Di Martino et al [ 61 ], and Kimura et al [ 62 ], who demonstrated that the geometric analysis of the AAA provides valuable information, with a predictive role superior to that of the maximum diameter in the case of the risk of AAA rupture.…”

Section: Discussionsupporting

confidence: 84%

Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture

Arbănași

Mureșan

Coșarcă³

et al. 2022

IJERPH

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Background: Abdominal aortic aneurysm (AAA) is a complex vascular disease characterized by progressive and irreversible local dilatation of the aortic wall. Currently, the indication for repair is linked to the transverse diameter of the abdominal aorta, using computed tomography angiography imagery, which is one of the most used markers for aneurysmal growth. This study aims to verify the predictive role of imaging markers and underlying risk factors in AAA rupture. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included 220 patients over 18 years of age with a diagnosis of AAA, confirmed by computed tomography angiography (CTA), admitted to Vascular Surgery Clinic of Mures County Emergency Hospital in Targu Mures, Romania, between January 2018 and September 2022. Results: Patients with a ruptured AAA had higher incidences of AH (p = 0.006), IHD (p = 0.001), AF (p < 0.0001), and MI (p < 0.0001), and higher incidences of all risk factors (tobacco (p = 0.001), obesity (p = 0.02), and dyslipidemia (p < 0.0001)). Multivariate analysis showed that a high baseline value of all imaging ratios markers was a strong independent predictor of AAA rupture (for all p < 0.0001). Moreover, a higher baseline value of DAmax (OR:3.91; p = 0.001), SAmax (OR:7.21; p < 0.001), and SLumenmax (OR:34.61; p < 0.001), as well as lower baseline values of DArenal (OR:7.09; p < 0.001), DACT (OR:12.71; p < 0.001), DAfemoral (OR:2.56; p = 0.005), SArenal (OR:4.56; p < 0.001), SACT (OR:3.81; p < 0.001), and SThrombusmax (OR:5.27; p < 0.001) were independent predictors of AAA rupture. In addition, AH (OR:3.33; p = 0.02), MI (OR:3.06; p = 0.002), and PAD (OR:2.71; p = 0.004) were all independent predictors of AAA rupture. In contrast, higher baseline values of SAmax/Lumenmax (OR:0.13; p < 0.001) and ezetimibe (OR:0.45; p = 0.03) were protective factors against AAA rupture. Conclusions: According to our findings, a higher baseline value of all imaging markers ratios at CTA strongly predicts AAA rupture and AH, MI, and PAD highly predicted the risk of rupture in AAA patients. Furthermore, the diameter of the abdominal aorta at different levels has better accuracy and a higher predictive role of rupture than the maximal diameter of AAA.

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Section: Discussionsupporting

confidence: 84%

Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture

Arbănași

Mureșan

Coșarcă³

et al. 2022

IJERPH

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“…The differences in AAA morphology, the length and characteristics of the aortic section it covers, as well as the histological structure of the vascular wall make it reasonable to look for individual factors that would allow the patient to be provided with surgical treatment. There may be factors other than the maximum size of the aneurysm, which, according to the variables mentioned above, could in some cases lower the diameter importance [ 7 , 10 , 25 ]. In the current guidelines, the only manifestations of taking into account the individual characteristics of a certain patient are lowering the AAA size range due to the female gender and qualifying patients for surgical treatment with AAA, which increases its maximum size relatively quickly [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…The starting point of this study is the assumption that even a single CT scan can provide more data indicating an increased risk of AAA rupture in a certain patient than the maximal aneurysm size alone. A study by Kimura et al took into account, for example, the fillet radius and the aspect ratio, the parameters whose values, obtained through a single CT scan, distinguished RAAA from AAA [ 25 ]. In our study, emphasis was placed on taking into account the size of the unchanged aorta and iliac arteries and comparing them to the size of aneurysm sac.…”

Section: Discussionmentioning

confidence: 99%

“…The same CT scan, after a more detailed analysis, may provide additional valuable data that can be used to estimate the risk of AAA rupture. Kimura et al were comparing CT scans of patients with AAA and RAAA, and they found that the ruptured aneurysms are characterized by a smaller rounding radius (departure angle) and a smaller aspect ratio (longitudinal diameter divided by transverse) [ 25 ]. Such observations lead us to a deepening of the analysis of data that can be obtained from a CT scan, because finding the characteristic features of RAAA other than the maximum diameter could increase the number of patients qualifying for treatment.…”

Section: Introductionmentioning

confidence: 99%

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The Ratio of the Size of the Abdominal Aortic Aneurysm to That of the Unchanged Aorta as a Risk Factor for Its Rupture

et al. 2022

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Background: A ruptured abdominal aortic aneurysm is a severe condition associated with high mortality. Currently, the most important criterion used to estimate the risk of its rupture is the size of the aneurysm, but due to patients’ anatomical variability, many aneurysms have a high risk of rupture with a small aneurysm size. We asked ourselves whether individual differences in anatomy could be taken into account when assessing the risk of rupture. Methods: Based on the CT scan image, aneurysm and normal aorta diameters were collected from 186 individuals and compared in patients with ruptured and unruptured aneurysms. To take into account anatomical differences between patients, diameter ratios were calculated by dividing the aneurysm diameter by the diameter of the normal aorta at various heights, and then further comparisons were made. Results: It was found that the calculated ratios differ between patients with ruptured and unruptured aneurysms. This observation is also present in patients with small aneurysms, with its maximal size below the level that indicates the need for surgical treatment. For small aneurysms, the ratios help us to estimate the risk of rupture better than the maximum sac size (AUC: 0.783 vs. 0.650). Conclusions: The calculated ratios appear to be a valuable feature to indicate which of the small aneurysms have a high risk of rupture. The obtained results suggest the need for further confirmation of their usefulness in subsequent groups of patients.

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“…have been confirmed as key factors affecting AAA physiology and pathology [ 9 , 10 ]. Meanwhile, various studies have shown that the gender difference in the risk of AAA rupture might be caused not only by physiological factors (such as LDL and sex hormone) [ 11 – 13 ] but also by anatomical factors [ 14 ] (such as the body size and the diameter of the aorta [ 15 ]). Therefore, the present study hypothesized that the differences in anatomical structure between female and male would influence the hemodynamics in the AAA which might induce different biological consequences.…”

Section: Introductionmentioning

confidence: 99%

Gender differences of morphological and hemodynamic characteristics of abdominal aortic aneurysm

et al. 2020

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Background: Gender difference in cardiovascular diseases (CVDs) is an important topic in the field of cardiovascular medicine. In this study, we focused on the mortality difference of abdominal aortic aneurysms (AAA), which is higher for female than that of male. The aim of this study was to verify whether morphological and hemodynamic factors play their roles in this phenomenon. Methods: Patient-specific AAA models of 11 females and 23 males with similar age and body mass index (BMI) have been reconstructed based on clinical computed tomography (CT) data. Firstly, the morphological parameters (diameters, curvature, intraluminal thrombus volume, etc.) of AAA models and lumbar vertebrae models were collected and analyzed. Then, based on statistical results of morphological parameters, uniformed male and female AAA models were reconstructed, and hemodynamic simulations were conducted respectively. In post-processing, the hemodynamic performances induced by gender-different morphological geometries were analyzed and compared. Results: The comparison of morphological parameters revealed that the average curvature of lumbar vertebrae and AAA centerline of female AAA models were obviously higher than that of the male. The amount of intraluminal thrombus in female AAA models was relatively lower than that of the male. According to the hemodynamic simulation, the uniform female AAA model has higher peak pressure, lower oscillatory shear stress index (OSI), and lower relative residence time (RRT) than that of the male model, all of which put female AAA to a relatively higher risk hemodynamic situation. Conclusions: The morphological and hemodynamic features of AAA have very obvious gender differences that would induce higher risk of rupture for female AAA biomechanically. These findings would help to explore the mechanism of gender differences in AAA and draw attention to gender-specific consideration for AAA treatment. More morphological and hemodynamic indictors are suggested to be involved in the future guidelines.

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Geometric analysis of ruptured and nonruptured abdominal aortic aneurysms

Abstract: The geometric analysis performed in this study revealed that ruptured AAAs had a smaller fillet radius and smaller aspect ratio than nonruptured AAAs did.

Cited by 11 publications

References 24 publications

Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture

Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture

The Ratio of the Size of the Abdominal Aortic Aneurysm to That of the Unchanged Aorta as a Risk Factor for Its Rupture

Gender differences of morphological and hemodynamic characteristics of abdominal aortic aneurysm

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