significant parameter that has yet to be fully evaluated.2 New technologies develop and evolve so as to both optimize their capabilities and expand the applications to which they may be applied. Such it was with x-rays, and such it is with CFD. New technologies are most often overvalued when first described; then, as they become disseminated, they sink below their true value, finally reaching a state of realistic value only when they have been widely tested and optimized. Potential applications of CFD have not been fully explored, optimization of computational techniques for assessing blood flow in and around IAs is ongoing, and the definition of the most meaningful output parameters are not at a stage where there can be any broad consensus. Thus, in our opinion, it is not realistic to make a value judgment regarding the ultimate value of CFDs, either as a means for investigating basic hemodynamic phenomena or as a tool that may be useful in a clinical environment.
Next Step and Closing RemarksTo us, it seems implausible to expect that, in isolation, CFD studies may reveal singular keys to important questions about a biologic process such as the initiation, growth, and rupture of IAs. It does, however, seem quite plausible that the results from CFD studies on large populations could provide great help in categorizing aneurysms according any number of hemodynamic parameters. Perhaps, then, these categories, when correlated with other factors known to be important in vascular health-such as collagen mutations, smoking, family history, and so on-and then if further combined with information specific to individual patients-such as age, sex, and perianeurysmal environment-could give insights that might prove useful in predicting the risk of aneurysm rupture. We fully realize that correlations do not represent causation; however, in our experiences, as well as in those of others, they sometimes offer very significant hints. 3,4 As the ability to perform CFD in clinical environments on large numbers of patients increases, as more insight is gained into the regulation of arterial health (homeostasis) and remodeling, as more understanding is gained about the mechanics of the vascular wall, as the ability to image not only the vascular lumen but also the arterial wall increases, this additional information may send computational scientists back to broaden and refine their mathematic models, thereby leading to methods that would allow investigation and integration of other important and potentially clinically relevant parameters, such as collagen turnover, cross-linking, and so on (eg, fluid-structure-growth modeling).Believing in the great potential for the integration of observations and measurements made by clinicians with simulations, calculations, and models made by scientists, we feel that this is a time to be optimistic and proactive in collaborations that unite and optimize our ability to define just what value CFD adds to the ability to mitigate the death and misery currently associated with IAs.