Towards patient specific biomechanical indices for abdominal aortic aneurysm rupture risk

Leemans, E.L. (2015) Towards patient specific biomechanical indices for abdominal aortic aneurysm rupture risk.

Abstract:Rupture of an abdominal aortic aneurysm (AAA) is well known for its high mortality rate. Prevention of growth and rupture is the primary treatment goal. Options consist of surveillance, pharmacologic administration, life style management, and surgery. The latter, more invasive open or endovascular repair is considered with high estimated rupture risk. Currently only the maximum AAA diameter is validated as clinically relevant rupture risk predictor. In general, small and slowly expanding aneurysms are less likely to rupture. However, this estimated rupture risk is based on large trials and therefore not patient-specific, resulting in unnecessary treatment or death. Therefore new patient-specific diagnostic indices must be found. These indices should be able to predict when an aneurysm ruptures and when to treat this specific patient. To develop such indices several patient specific measures based on biomechanical criteria are introduced. Biomechanical criteria describe the basic principles of material failure: an aneurysm ruptures when mural stresses exceed wall strength. This study first aimed to evaluate the feasibility of biomechanical modelling to predict AAA rupture and, second, to clarify the additional clinical role of biomechanical indices based on diagnostic imaging in the rupture risk assessment of AAA patients compared to the maximum diameter. This study showed that biomechanical analysis supports a patient specific, individualized AAA rupture risk assessment. However, no clear improvements in risk assessment compared to the maximum AAA diameter are seen. Nevertheless, combination of the maximum AAA diameter and biomechanical indices will likely give a full overview of the patient’s specific risk, especially in small to medium sized aneurysms. In conclusion, although challenges remain, biomechanical analysis is promising in the assessment of AAA rupture risk as it incorporates the major factors, such as geometries, tissue properties and patient specific risks.
Item Type:Essay (Master)
UMCG, Groningen, Netherlands
UMCG, Groningen, Netherlands
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
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