Methodology for Estimation of Annual Risk of Rupture for Abdominal Aortic Aneurysm

Polzer, Stanislav; Kracík, Jan; Novotný, Tomáš; Kubíček, Luboš; Staffa, Robert; Raghavan, Madhavan L.

doi:10.1016/j.cmpb.2020.105916

Cited by 9 publications

(9 citation statements)

References 31 publications

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“…Additional approaches towards a more refined computation of the probabilistic rupture risk have included the variability of the blood pressure. 166 Recently, the information that an AAA is intact at the time of examination has also been incorporated within the formulation of the probabilistic rupture risk. It permits the exclusion of certain combinations of wall thickness and wall strength, which resulted in a significant reduction in the uncertainty of the rupture risk 166 Whilst probabilistic risk indices support a direct interpretation of the results, deterministic risk indices require further calibration to clinical data.…”

Section: Stochastic Modelsmentioning

confidence: 99%

“…166 Recently, the information that an AAA is intact at the time of examination has also been incorporated within the formulation of the probabilistic rupture risk. It permits the exclusion of certain combinations of wall thickness and wall strength, which resulted in a significant reduction in the uncertainty of the rupture risk 166 Whilst probabilistic risk indices support a direct interpretation of the results, deterministic risk indices require further calibration to clinical data. Which would then allow for the determination of the annual risk of rupture for a given risk index.…”

Section: Stochastic Modelsmentioning

confidence: 99%

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A quarter of a century biomechanical rupture risk assessment of abdominal aortic aneurysms. Achievements, clinical relevance, and ongoing developments

Gasser

Miller

Polzer

et al. 2022

Numer Methods Biomed Eng

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Abdominal aortic aneurysm (AAA) disease, the local enlargement of the infrarenal aorta, is a serious condition that causes many deaths, especially in men exceeding 65 years of age. Over the past quarter of a century, computational biomechanical models have been developed towards the assessment of AAA risk of rupture, technology that is now on the verge of being integrated within the clinical decision-making process. The modeling of AAA requires a holistic understanding of the clinical problem, in order to set appropriate modeling assumptions and to draw sound conclusions from the simulation results. In this article we summarize and critically discuss the proposed modeling approaches and report the outcome of clinical validation studies for a number of biomechanics-based rupture risk indices. Whilst most of the aspects concerning computational mechanics have already been settled, it is the exploration of the failure properties of the AAA wall and the acquisition of robust input data for simulations that has the greatest potential for the further improvement of this technology. K E Y W O R D Sabdominal aortic aneurysm, modeling, ruptuer risk assessment, vascular biomechanics | WHAT IS AAAWhilst an aneurysm, a permanent local enlargement of an artery by more than 50% of its diameter, may affect all arteries, the infrarenal aorta is most vulnerable to this disease and often leads to the development of an abdominal aortic aneurysm (AAA). The formation of AAAs is promoted by factors such as old age, male gender, smoking, and high mean arterial pressure (MAP). Furthermore, it is over-represented in persons with a family history of AAA and patients with coronary heart disease and Chronic Obstructive Pulmonary Disease. Aortic aneurysms can also present in patients with rare genetic diseases, such as Ehlers-Danlos syndrome type IV, Marfan syndrome, Loeys-Dietz syndrome, and fibromuscular dysplasia. Most AAAs remain small and therefore do not necessitate clinical intervention. However, an aneurysm may grow to a size that could result in aortic rupture, a life-threatening event. In urban areas only 50% of

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Section: Stochastic Modelsmentioning

confidence: 99%

Section: Stochastic Modelsmentioning

confidence: 99%

A quarter of a century biomechanical rupture risk assessment of abdominal aortic aneurysms. Achievements, clinical relevance, and ongoing developments

Gasser

Miller

Polzer

et al. 2022

Numer Methods Biomed Eng

Self Cite

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“…Finite element analysis (FEA) can be a useful tool in simulating the mechanics of aneurysms to estimate mechanical parameters that cannot easily be measured within patients. FEA has been used to investigate the mechanics of abdominal aortic aneurysm growth and rupture (20,21). Similar computational analyses of intracranial aneurysms have been generally limited to demonstration of the mechanics of aneurysm recurrence after endovascular treatments (22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging

et al. 2021

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Biomechanical computational simulation of intracranial aneurysms has become a promising method for predicting features of instability leading to aneurysm growth and rupture. Hemodynamic analysis of aneurysm behavior has helped investigate the complex relationship between features of aneurysm shape, morphology, flow patterns, and the proliferation or degradation of the aneurysm wall. Finite element analysis paired with high-resolution vessel wall imaging can provide more insight into how exactly aneurysm morphology relates to wall behavior, and whether wall enhancement can describe this phenomenon. In a retrospective analysis of 23 unruptured aneurysms, finite element analysis was conducted using an isotropic, homogenous third order polynomial material model. Aneurysm wall enhancement was quantified on 2D multiplanar views, with 14 aneurysms classified as enhancing (CRstalk≥0.6) and nine classified as non-enhancing. Enhancing aneurysms had a significantly higher 95th percentile wall tension (μ = 0.77 N/cm) compared to non-enhancing aneurysms (μ = 0.42 N/cm, p < 0.001). Wall enhancement remained a significant predictor of wall tension while accounting for the effects of aneurysm size (p = 0.046). In a qualitative comparison, low wall tension areas concentrated around aneurysm blebs. Aneurysms with irregular morphologies may show increased areas of low wall tension. The biological implications of finite element analysis in intracranial aneurysms are still unclear but may provide further insights into the complex process of bleb formation and aneurysm rupture.

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“…maximal in vivo stress) to the uncertainty of the material properties as estimated by one of the presented fitting method [37,38]. This will provide valuable insight in the role of the estimated material properties and their relation with uncertainties associated with other input parameters, such as in vivo geometry and loading conditions [39,40].…”

Section: Limitations Recommendations and Future Perspectivesmentioning

confidence: 99%

An improved parameter fitting approach of a planar biaxial test including the experimental prestretch

Linden

Fehervary²,

Maes³

et al. 2022

Journal of the Mechanical Behavior of Biomedical Materials

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Methodology for Estimation of Annual Risk of Rupture for Abdominal Aortic Aneurysm

Cited by 9 publications

References 31 publications

A quarter of a century biomechanical rupture risk assessment of abdominal aortic aneurysms. Achievements, clinical relevance, and ongoing developments

A quarter of a century biomechanical rupture risk assessment of abdominal aortic aneurysms. Achievements, clinical relevance, and ongoing developments

Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging

An improved parameter fitting approach of a planar biaxial test including the experimental prestretch

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