Estimation of Abdominal Aortic Aneurysm Rupture Risk with Biomechanical Imaging Markers |
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Authors: | Hamid Jalalzadeh Eva L Leemans Reza Indrakusuma R Nils Planken Mark JW Koelemay Clark J Zeebregts Henk A Marquering Maarten J van der Laan Ron Balm |
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Institution: | 1. Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;2. Department of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;3. Department of Radiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;4. Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands |
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Abstract: | PurposeTo evaluate whether the biomechanical marker known as rupture risk equivalent diameter (RRED) was superior to the actual abdominal aortic aneurysm (AAA) diameter in estimating future rupture risk in patients who had undergone pre-rupture computed tomography (CT) angiography.Materials and MethodsA retrospective study was conducted in 13 patients with ruptured AAAs who had undergone CT angiography before and after rupture between 2001 and 2015. The median time between the 2 scans was 731 days. Biomechanical and geometrical markers such as maximal AAA diameter, peak wall stress (PWS), and RRED were calculated with AAA-dedicated software. The main analyses determined whether RRED was higher than the actual diameter and the threshold diameter for elective surgery (55 mm for men, 50 mm for women) in AAAs before and after rupture. Differences between diameter and biomechanical markers before and after rupture were tested with appropriate statistical tests.ResultsRRED before and after rupture was smaller than the actual diameter in 7 of 13 cases. Post-rupture RRED was estimated to be smaller than the threshold diameter for elective repair in 4 cases, again suggesting a low rupture risk. The median PWS before and after rupture was 181.7 kPa (interquartile range IQR], 152.1–244.2 kPa) and 274.1 kPa (IQR, 172.2–377.2 kPa), respectively.ConclusionsRRED was smaller than the actual diameter in more than half of pre-rupture AAAs, suggesting a lower rupture risk than estimated with the actual diameter. The results suggest that the currently available biomechanical imaging markers might not be ready for use in clinical practice. |
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Keywords: | AAA abdominal aortic aneurysm FEA finite element analysis ILT intraluminal thrombus IQR interquartile range PWRR peak wall rupture risk PWS peak wall stress RAAA ruptured abdominal aortic aneurysm RRED rupture risk equivalent diameter |
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