Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm

• Published in: European journal of vascular and endovascular surgery Vol. 60; no. 3; pp. 365 - 373
• Main Authors: Doyle, Barry J., Bappoo, Nikhilesh, Syed, Maaz B.J., Forsythe, Rachael O., Powell, Janet T., Conlisk, Noel, Hoskins, Peter R., McBride, Olivia M.B., Shah, Anoop S.V., Norman, Paul E., Newby, David E.
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.09.2020
• Subjects: Abdominal aortic aneurysm; Aged; Aged, 80 and over; Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - physiopathology; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - complications; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - diagnostic imaging; Aortic Rupture - etiology; Aortic Rupture - physiopathology; Aortic Rupture - surgery; Aortography; Biomechanical Phenomena; Computational biomechanics; Computed Tomography Angiography; Disease Progression; Female; Hemodynamics; Humans; Imaging; Magnetic Resonance Angiography; Male; Models, Cardiovascular; Patient-Specific Modeling; Peripheral vascular disease; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Stress, Mechanical; Time Factors; Vascular Surgical Procedures; Peripheral vascular disease; Computational biomechanics; Imaging; Abdominal aortic aneurysm
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2020.02.023

To test whether aneurysm biomechanical ratio (ABR; a dimensionless ratio of wall stress and wall strength) can predict aneurysm related events. In a prospective multicentre clinical study of 295 patients with an abdominal aortic aneurysm (AAA; diameter ≥ 40 mm), three dimensional reconstruction and computational biomechanical analyses were used to compute ABR at baseline. Participants were followed for at least two years and the primary end point was the composite of aneurysm rupture or repair. The majority were male (87%), current or former smokers (86%), most (72%) had hypertension (mean ± standard deviation [SD] systolic blood pressure 140 ± 22 mmHg), and mean ± SD baseline diameter was 49.0 ± 6.9 mm. Mean ± SD ABR was 0.49 ± 0.27. Participants were followed up for a mean ± SD of 848 ± 379 days and rupture (n = 13) or repair (n = 102) occurred in 115 (39%) cases. The number of repairs increased across tertiles of ABR: low (n = 24), medium (n = 34), and high ABR (n = 44) (p = .010). Rupture or repair occurred more frequently in those with higher ABR (log rank p = .009) and ABR was independently predictive of this outcome after adjusting for diameter and other clinical risk factors, including sex and smoking (hazard ratio 1.41; 95% confidence interval 1.09–1.83 [p = .010]). It has been shown that biomechanical ABR is a strong independent predictor of AAA rupture or repair in a model incorporating known risk factors, including diameter. Determining ABR at baseline could help guide the management of patients with AAA. [Display omitted]