PAD treatment planning based on CTA was mostly consistent with DUS-based treatment plans, although CTA was still felt to be needed to increase confidence. This observation suggests that to promote greater use of less invasive DUS imaging, not only improvement of DUS quality but also improvement of clinician confidence is required.

the symptomatic/ruptured AAAs compared with the asymptomatic intact AAAs (SMD, 0.95; 95% confidence interval, 0.71-1.18; P < .001). The findings remained significant after adjustment for mean systolic blood pressure, standardized at 120 mmHg (SMD, 0.68; 95% confidence interval, 0.39-0.96; P < .001). There was minimal heterogeneity between studies (I 2 ¼ 0%).Comment: There are commercially available semi-automated FEA programs. However there is variability between the different software packages. Before peak wall stress calculations using FEA can be incorporated into the decision making for repair of abdominal aortic aneurysm, all software models must be tested for interobserver variability and correlation between models. AAA rupture is not necessarily at the site of maximum diameter and peak wall stress measurements are often higher at points proximal or distal to maximum diameter. In addition, inflammation and other biochemical changes in the AAA wall can interact with peak wall stress to either promote or protect from rupture. Nevertheless, inquiries along this line are important in our knowledge of AAA disease and eventually determining which which patients are at particular risk for rupture. There will likely be a day where aneurysm diameter combined with peak wall stress measurements and other biomarker activities can be used in combination to predict the fate of an abdominal aortic aneurysm.

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