Abstract
Computational biomechanics via finite element analysis (FEA) has long promised a means of assessing patient-specific abdominal aortic aneurysm (AAA) rupture risk with greater efficacy than current clinically used size-based criteria. The pursuit stems from the notion that AAA rupture occurs when wall stress exceeds wall strength. Quantification of peak (maximum) wall stress (PWS) has been at the cornerstone of this research, with numerous studies having demonstrated that PWS better differentiates ruptured AAAs from non-ruptured AAAs. In contrast to wall stress models, which have become progressively more sophisticated, there has been relatively little progress in estimating patient-specific wall strength. This is because wall strength cannot be inferred non-invasively, and measurements from excised patient tissues show a large spectrum of wall strength values. In this review, we highlight studies that investigated the relationship between biomechanics and AAA rupture risk. We conclude that combining wall stress and wall strength approximations should provide better estimations of AAA rupture risk. However, before personalized biomechanical AAA risk assessment can become a reality, better methods for estimating patient-specific wall properties or surrogate markers of aortic wall degradation are needed. Artificial intelligence methods can be key in stratifying patients, leading to personalized AAA risk assessment.
Highlights
Abdominal aortic aneurysm (AAA) is a potentially life-threatening condition, characterized as a pathological expansion of the abdominal aorta, wherein the maximal transverse diameter exceeds 30 mm [1,2,3]
The first two relatively large patient studies to investigate the relationship between biomechanics and AAA rupture were conducted by Fillinger et al [54,55], and soon, other studies followed [56,57,58]
peak wall stress (PWS) correlates with AAA rupture; patient-specific systolic blood pressure (SBP) needed
Summary
Abdominal aortic aneurysm (AAA) is a potentially life-threatening condition, characterized as a pathological expansion of the abdominal aorta, wherein the maximal transverse diameter exceeds 30 mm [1,2,3]. Clinical studies have long ago determined that the risk of repair is exceeded by the risk of rupture when either: (1) AAA maximal transverse diameter is greater than 55 mm for men or 50 mm for women; or (2) annual AAA growth rate is greater than 10 mm/year [18,19,20,21]. Hemodynamic forces within the lumen, blood pressure, generate stress on the AAA wall, which, in tandem with aortic wall strength, may result in rupture. Other hemodynamic forces such as wall shear stress (WSS) have been shown to add little to rupture risk prediction [47]. The geometry of the lumen plays an important role in the generation of wall stress, and on AAA rupture
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