Biomechanical indices are more sensitive than diameter in predicting rupture of asymptomatic abdominal aortic aneurysms

Geometric and biomechanical modeling aided by machine learning improves the prediction of growth and rupture of small abdominal aortic aneurysms

“…These results are in line with previous literature. Specifically, both PWS and PWRI (or equivalents) have been proposed as superior predictors of rupture compared with diameter 27 – 31 , 33 , 35 , 40 , 49 – 52 , whereas two studies did not observe a significant difference 32 , 53 . The size of the lumen as a marker of rupture risk has also recently been described by our group and others 54 – 56 .…”

“…While yielding the only significant AUCs, the precision of PWRI, PWS and lumen diameter to predict rupture or symptoms in the present data was not excellent, with AUCs of 0.65 to 0.67. Importantly, the event occurred long after the initial CTA images, with an interval of between 1.7 and 9.7 years, and increased precision of PWRI to predict rupture in the near-term rather than long-term has recently been observed 33 .…”

“…Examples of suggested alternative predictors include characteristics of the intraluminal thrombus (ILT) 5 , 19 – 22 , tracer imaging of AAA vessel wall metabolism, calcification processes and inflammation 23 – 25 as well as circulating markers of extracellular matrix degradation, inflammation, coagulation and microRNAs 26 . Further, finite element analysis (FEA) has in several retrospective case-control studies been reported to predict rupture 27 – 33 but also to predict growth or future surgery 34 , 35 . As of yet, none of these alternative markers have been included into clinical management algorithms.…”

Biomechanical rupture risk assessment of abdominal aortic aneurysms using clinical data: A patient-specific, probabilistic framework and comparative case-control study

“…Our work builds upon previous efforts by our group and collaborators regarding the biomechanical modeling and characterization of AAA in-vivo behavior [10][11][12][13][14][15][16], as well as several previous studies indicating that biomechanical indices are more accurate predictors for AAA rupture risk than the clinically established maximum diameter criterion [17][18][19][20][21][22][23][24]. In contrast to the approaches in [17-20, 22, 24], however, we advocate a probabilistic treatment to account for uncertain vessel wall properties.…”

Commentary: Do not “futz” with Laplace

“…The current size-based guidelines, using 5.0-to 5.5-cm aortic diameter as an elective surgery criterion, were derived from extensive large patient population studies. 10 Furthermore, prior engineering studies, taking into account patient-specific tissue elastic properties and tissue failure strength, 11 and patient-specific 3-dimensional geometries and loading/boundary condition, [12][13][14][15] also support the conclusion that patients with aneurysm and an aortic diameter greater than 5 cm have a high rupture risk (Figure 1).…”