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Aortic Lumen Area Is Increased in Ruptured Abdominal Aortic Aneurysms and Correlates to Biomechanical Rupture Risk
Karolinska Inst, Dept Mol Med & Surg, L8 03 Karolinska Sjukhuset Solna, S-17164 Stockholm, Sweden..
Karolinska Inst, Dept Mol Med & Surg, L8 03 Karolinska Sjukhuset Solna, S-17164 Stockholm, Sweden..
Karolinska Inst, Dept Mol Med & Surg, L8 03 Karolinska Sjukhuset Solna, S-17164 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Vasc Surg, Stockholm, Sweden..
KTH, School of Engineering Sciences (SCI), Solid Mechanics (Dept.).
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2018 (English)In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, Vol. 25, no 6, p. 750-756Article in journal (Refereed) Published
Abstract [en]

Purpose: To investigate how 2-dimensional geometric parameters differ between ruptured and asymptomatic abdominal aortic aneurysms (AAAs) and provide a biomechanical explanation for the findings. Methods: The computed tomography angiography (CTA) scans of 30 patients (mean age 77 +/- 10 years; 23 men) with ruptured AAAs and 60 patients (mean age 76 +/- 8 years; 46 men) with asymptomatic AAAs were used to measure maximum sac diameter along the center lumen line, the cross-sectional lumen area, the total vessel area, the intraluminal thrombus (ILT) area, and corresponding volumes. The CTA data were segmented to create 3-dimensional patient-specific models for finite element analysis to compute peak wall stress (PWS) and the peak wall rupture index (PWRI). To reduce confounding from the maximum diameter, 2 diameter-matched groups were selected from the initial patient cohorts: 28 ruptured AAAs and another with 15 intact AAAs (diameters 74 +/- 12 vs 73 +/- 11, p=0.67). A multivariate model including the maximum diameter, the lumen area, and the ILT area of the 60 intact aneurysms was employed to predict biomechanical rupture risk parameters. Results: In the diameter-matched subgroup comparison, ruptured AAAs had a significantly larger cross-sectional lumen area (1954 +/- 1254 vs 1120 +/- 623 mm(2), p=0.023) and lower ILT area ratio (55 +/- 24 vs 68 +/- 24, p=0.037). The ILT area (2836 +/- 1462 vs 2385 +/- 1364 mm(2), p=0.282) and the total vessel area (3956 +/- 1170 vs 4338 +/- 1388 mm(2), p=0.384) did not differ statistically between ruptured and intact aneurysms. The PWRI was increased in ruptured AAAs (0.80 vs 0.48, p<0.001), but the PWS was similar (249 vs 284 kPa, p=0.194). In multivariate regression analysis, lumen area was significantly positively associated with both PWS (p<0.001) and PWRI (p<0.01). The ILT area was also significantly positively associated with PWS (p<0.001) but only weakly with PWRI (p<0.01). The lumen area conferred a higher risk increase in both PWS and PWRI when compared with the ILT area. Conclusion: The lumen area is increased in ruptured AAAs compared to diameter-matched asymptomatic AAAs. Furthermore, this finding may in part be explained by a relationship with biomechanical rupture risk parameters, in which lumen area, irrespective of maximum diameter, increases PWS and PWRI. These observations thus suggest a possible method to improve prediction of rupture risk in AAAs by measuring the lumen area without the use of computational modeling.

Place, publisher, year, edition, pages
Sage Publications, 2018. Vol. 25, no 6, p. 750-756
Keywords [en]
abdominal aortic aneurysm, aneurysm diameter, biomechanics, computed tomography angiography, finite element analysis, intraluminal thrombus, lumen area, rupture risk, ruptured aneurysm
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:kth:diva-240762DOI: 10.1177/1526602818808292ISI: 000452481100015PubMedID: 30354931Scopus ID: 2-s2.0-85056391682OAI: oai:DiVA.org:kth-240762DiVA, id: diva2:1275621
Funder
Swedish Heart Lung Foundation, 20160266 20150529 20140722 20140811 20130657Swedish Research Council, 2016-0176 2015-04476 2016-0176 2015-04476
Note

QC 20190107

Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved

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