A biomechanics-based rupture potential index for abdominal aortic aneurysm risk assessment: Demonstrative application

Jonathan P. Vande Geest, Elena S. Di Martino, Ajay Bohra, Michel S. Makaroun, David A. Vorp

Research output: Chapter in Book/Report/Conference proceedingConference contribution

131 Scopus citations

Abstract

Abdominal aortic aneurysms (AAAs) can typically remain stable until the strength of the aorticwall is unable to withstand the forces acting on it as a result of the luminal blood pressure, resulting in AAA rupture. The clinical treatment of AAA patients presents a dilemma for the surgeon: surgery should only be recommended when the risk of rupture of the AAA outweighs the risks associated with the interventional procedure. Since AAA rupture occurs when the stress acting on the wall exceeds its strength, the assessment of AAA rupture should include estimates of both wall stress and wall strength distributions. The present work details a method for noninvasively assessing the rupture potential of AAAs using patient-specific estimations the rupture potential index (RPI) of the AAA, calculated as the ratio of locally acting wall stress to strength. The RPI was calculated for thirteen AAAs, which were broken up into ruptured (n = 8 and nonruptured (n = 5) groups. Differences in peak wall stress, minimum strength and maximum RPI were compared across groups. There were no statistical differences in the maximum transverse diameters (6.8 ± 0.3 cm vs. 6.1 ± 0.5 cm, p = 0.26) or peak wall stress (46.0 ± 4.3 vs. 49.9 ± 4.0 N/cm2, p = 0.62) between groups. There was a significant decrease in minimum wall strength for ruptured AAA (81.2 ± 3.9 and 108.3 ± 10.2 N/cm2, p = 0.045). While the differences in RPI values (ruptured = 0.48 ± 0.05 vs. nonruptured = 0.36 ± 0.03, respectively; p = 0.10) did not reach statistical significance, the p-value for the peak RPI comparison was lower than that for both the maximum diameter (p = 0.26) and peak wall stress (p = 0.62) comparisons. This result suggests that the peak RPI may be better able to identify those AAAs at high risk of rupture than maximum diameter or peak wall stress alone. The clinical relevance of this method for rupture assessment has yet to be validated, however, its success could aid clinicians in decision making and AAA patient management.

Original languageEnglish (US)
Title of host publicationThe Abdominal Aortic Aneurysm
Subtitle of host publicationGenetics, Pathophysiology, and Molecular Biology
PublisherBlackwell Publishing Inc.
Pages11-21
Number of pages11
ISBN (Print)1573316571, 9781573316576
DOIs
StatePublished - Nov 2006

Publication series

NameAnnals of the New York Academy of Sciences
Volume1085
ISSN (Print)0077-8923
ISSN (Electronic)1749-6632

Keywords

  • Abdominal aortic aneurysm
  • Rupture
  • Strength
  • Stress

ASJC Scopus subject areas

  • Neuroscience(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • History and Philosophy of Science

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    Vande Geest, J. P., Di Martino, E. S., Bohra, A., Makaroun, M. S., & Vorp, D. A. (2006). A biomechanics-based rupture potential index for abdominal aortic aneurysm risk assessment: Demonstrative application. In The Abdominal Aortic Aneurysm: Genetics, Pathophysiology, and Molecular Biology (pp. 11-21). (Annals of the New York Academy of Sciences; Vol. 1085). Blackwell Publishing Inc.. https://doi.org/10.1196/annals.1383.046