Eva L Leemans1,2,3,4, Tineke P Willems5, Maarten J van der Laan1, Cornelis H Slump4, Clark J Zeebregts1. 1. 1 Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, the Netherlands. 2. 2 Department of Biomechanical Engineering and Physics, Academic Medical Centre, Amsterdam, the Netherlands. 3. 3 Department of Radiology, Academic Medical Centre, Amsterdam, the Netherlands. 4. 4 MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands. 5. 5 Department of Radiology, University Medical Center Groningen, University of Groningen, the Netherlands.
Abstract
PURPOSE: To review the use of biomechanical indices for the estimation of abdominal aortic aneurysm (AAA) rupture risk, emphasizing their potential use in a clinical setting. METHODS: A search of the PubMed, Embase, Scopus, and Compendex databases was made up to June 2015 to identify articles involving biomechanical analysis of AAA rupture risk. Outcome variables [aneurysm diameter, peak wall stress (PWS), peak wall shear stress (PWSS), wall strain, peak wall rupture index (PWRI), and wall stiffness] were compared for asymptomatic intact AAAs vs symptomatic or ruptured AAAs. For quantitative analysis of the pooled data, a random effects model was used to calculate the standard mean differences (SMDs) with the 95% confidence interval (CI) for the biomechanical indices. RESULTS: The initial database searches yielded 1894 independent articles of which 19 were included in the analysis. The PWS was significantly higher in the symptomatic/ruptured group, with a SMD of 1.11 (95% CI 0.93 to 1.26, p<0.001). Likewise, the PWRI was significantly higher in the ruptured or symptomatic group, with a SMD of 1.15 (95% CI 0.30 to 2.01, p=0.008). After adjustment for the aneurysm diameter, the PWS remained higher in the ruptured or symptomatic group, with a SMD of 0.85 (95% CI 0.46 to 1.23, p<0.001). Less is known of the wall shear stress and wall strain indices, as too few studies were available for analysis. CONCLUSION: Biomechanical indices are a promising tool in the assessment of AAA rupture risk as they incorporate several factors, including geometry, tissue properties, and patient-specific risk factors. However, clinical implementation of biomechanical AAA assessment remains a challenge owing to a lack of standardization.
PURPOSE: To review the use of biomechanical indices for the estimation of abdominal aortic aneurysm (AAA) rupture risk, emphasizing their potential use in a clinical setting. METHODS: A search of the PubMed, Embase, Scopus, and Compendex databases was made up to June 2015 to identify articles involving biomechanical analysis of AAA rupture risk. Outcome variables [aneurysm diameter, peak wall stress (PWS), peak wall shear stress (PWSS), wall strain, peak wall rupture index (PWRI), and wall stiffness] were compared for asymptomatic intact AAAs vs symptomatic or ruptured AAAs. For quantitative analysis of the pooled data, a random effects model was used to calculate the standard mean differences (SMDs) with the 95% confidence interval (CI) for the biomechanical indices. RESULTS: The initial database searches yielded 1894 independent articles of which 19 were included in the analysis. The PWS was significantly higher in the symptomatic/ruptured group, with a SMD of 1.11 (95% CI 0.93 to 1.26, p<0.001). Likewise, the PWRI was significantly higher in the ruptured or symptomatic group, with a SMD of 1.15 (95% CI 0.30 to 2.01, p=0.008). After adjustment for the aneurysm diameter, the PWS remained higher in the ruptured or symptomatic group, with a SMD of 0.85 (95% CI 0.46 to 1.23, p<0.001). Less is known of the wall shear stress and wall strain indices, as too few studies were available for analysis. CONCLUSION: Biomechanical indices are a promising tool in the assessment of AAA rupture risk as they incorporate several factors, including geometry, tissue properties, and patient-specific risk factors. However, clinical implementation of biomechanical AAA assessment remains a challenge owing to a lack of standardization.
Authors: Sebastian Fernandez-Alonso; Esther Martinez-Aguilar; Susana Ravassa; Josune Orbe; Jose A Paramo; Leopoldo Fernandez-Alonso; Carmen Roncal Journal: Life (Basel) Date: 2022-05-31
Authors: Eva L Leemans; Tineke P Willems; Cornelis H Slump; Maarten J van der Laan; Clark J Zeebregts Journal: PLoS One Date: 2018-08-22 Impact factor: 3.240
Authors: Pantelis Sarafidis; Sven Martens; Athanasios Saratzis; Daniella Kadian-Dodov; Patrick T Murray; Catherine M Shanahan; Allen D Hamdan; Daniel T Engelman; Ulf Teichgräber; Charles A Herzog; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Holger Reinecke; Kirsten Johansen Journal: Cardiovasc Res Date: 2022-09-20 Impact factor: 13.081