Biomechanical Imaging Markers as Predictors of Abdominal Aortic Aneurysm Growth or Rupture: A Systematic Review

Indrakusuma, Reza; Jalalzadeh, Hamid; Planken, R. Nils; Marquering, Henk A.; Legemate, Dink A.; Koelemay, M.J.W.; Balm, Ron

doi:10.1016/j.ejvs.2016.07.003

Cited by 42 publications

(26 citation statements)

References 37 publications

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“…To predict and prevent early aneurysm rupture and to improve the selection for AAA repair, additional risk factors besides diameter and growth rate must be considered, for example biomechanical properties, 24 intra-luminal thrombus biomarkers, 25e27 or volume. 10,11 In a prospective 3D-CT study of 57 patients with 14 months of follow-up, Parr et al demonstrated that almost half of the patients with volume growth did not display a concomitant diameter increase, supporting the present findings acquired non-invasively with 3D-US.…”

Section: Discussionmentioning

confidence: 99%

Follow-up on Small Abdominal Aortic Aneurysms Using Three Dimensional Ultrasound: Volume Versus Diameter

Ghulam

Bredahl

Lönn

et al. 2017

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 99%

Follow-up on Small Abdominal Aortic Aneurysms Using Three Dimensional Ultrasound: Volume Versus Diameter

Ghulam

Bredahl

Lönn

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…In one study, PWS had increased sensitivity (94% vs. 81%), accuracy (85% vs. 73%) and specificity (81% vs. 70%) as a predictor of rupture-risk relative to maximum diameter [ 27 ]. A further systematic review highlighted a number of methodological weaknesses of prior studies [ 28 ]. There is therefore remaining uncertainty about the value of measuring PWS to predict AAA rupture [ 28 ].…”

Section: Biomechanics Forces and Aaa Rupturementioning

confidence: 99%

“…A further systematic review highlighted a number of methodological weaknesses of prior studies [ 28 ]. There is therefore remaining uncertainty about the value of measuring PWS to predict AAA rupture [ 28 ].…”

Section: Biomechanics Forces and Aaa Rupturementioning

confidence: 99%

Risk Factors and Mouse Models of Abdominal Aortic Aneurysm Rupture

Krishna

Morton

et al. 2020

IJMS

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Abdominal aortic aneurysm (AAA) rupture is an important cause of death in older adults. In clinical practice, the most established predictor of AAA rupture is maximum AAA diameter. Aortic diameter is commonly used to assess AAA severity in mouse models studies. AAA rupture occurs when the stress (force per unit area) on the aneurysm wall exceeds wall strength. Previous research suggests that aortic wall structure and strength, biomechanical forces on the aorta and cellular and proteolytic composition of the AAA wall influence the risk of AAA rupture. Mouse models offer an opportunity to study the association of these factors with AAA rupture in a way not currently possible in patients. Such studies could provide data to support the use of novel surrogate markers of AAA rupture in patients. In this review, the currently available mouse models of AAA and their relevance to the study of AAA rupture are discussed. The review highlights the limitations of mouse models and suggests novel approaches that could be incorporated in future experimental AAA studies to generate clinically relevant results.

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“…This paradox of stated and used diameters is rarely reflected upon in standard care [13,14]. Even if aneurysm diameter growth is reported to be more accurately predicted by aneurysm volume than diameter [15], and biomechanical analysis of AAAs has been shown to outperform diameter measurements in both growth and rupture risk prediction [16,17], diameter is still the gold standard for surveillance and threshold for elective repair [13].…”

Section: Introductionmentioning

confidence: 99%

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

et al. 2019

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Objective In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. Methods All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009–2013 with a CT-verified rupture (n = 192) were included, and morphological measurements were performed. Patients with small rAAAs, maximal diameter (Dmax) ≤ 60 mm were selected (n = 27), and matched 2:1 by Dmax, sex and age to intact AAA (iAAAs). For these patients, morphology including volume and finite element analysis-derived biomechanics were assessed. Results The mean Dmax for all rAAAs was 80.8 mm (SD = 18.9 mm), women had smaller Dmax at rupture (73.4 ± 18.4 mm vs 83.1 ± 18.5 mm, p = 0.003), and smaller neck and iliac diameters compared to men. Aortic size index (ASI) was similar between men and women (4.1 ± 3.1 cm/m 2 vs 3.8 ± 1.0 cm/m 2 ). Fourteen percent of all patients ruptured at Dmax ≤ 60 mm, and a higher proportion of women compared to men ruptured at Dmax ≤ 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax ≤ 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3–15.3 vs 12.8, IQR = 11.4–14.0) and peak wall rupture index (PWRI, 0.35 ± 0.08 vs 0.43 ± 0.11, p = 0.016) were higher for small rAAAs compared to matched iAAAs. Aortic size index, peak wall stress and aneurysm volume did not differ. Conclusion More than one tenth of ruptures occur at smaller diameters, women continuously suffer an even higher risk of presenting with smaller diameters, and this must be considered in surveillance programs. The increased supra-renal aortic size index and PWRI are potential markers for rupture risk, and patients under surveillance with these markers may benefit from increased attention, and potentially from timely repair.

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Biomechanical Imaging Markers as Predictors of Abdominal Aortic Aneurysm Growth or Rupture: A Systematic Review

Cited by 42 publications

References 37 publications

Follow-up on Small Abdominal Aortic Aneurysms Using Three Dimensional Ultrasound: Volume Versus Diameter

Follow-up on Small Abdominal Aortic Aneurysms Using Three Dimensional Ultrasound: Volume Versus Diameter

Risk Factors and Mouse Models of Abdominal Aortic Aneurysm Rupture

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

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