Is There a Role for Biomechanical Engineering in Helping to Elucidate the Risk Profile of the Thoracic Aorta?

Martufi, Giampaolo; Forneris, Arianna; Appoo, Jehangir J.; Martino, Elena S. Di

doi:10.1016/j.athoracsur.2015.07.028

Cited by 56 publications

(49 citation statements)

References 64 publications

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“…ECAP, which was generally considered as the thrombosis potential, could be a sign of rupture in AAAs without ILTs. (b) Thin‐layered ILTs provide stress shielding for the dilated AAA wall in the recirculation flow region with high ECAPs . However, the impact loading of the dominant flow on the wall leads to increased cyclic stretching, hastening wall fatigue, and rupture .…”

Section: Discussionmentioning

confidence: 99%

“…ECAP is an indicator of “thrombotic susceptibility,” which characterizes the possibility of thrombus formation . Definitions of the WSS‐based indicators are described as follows:

T A W S S = \frac{1}{T} {false\int}_{0}^{T} |WSS| d t

W S S G = \sqrt{{()(, \frac{\partial T A W S S}{\partial x})}^{2} + {()(, \frac{\partial T A W S S}{\partial y})}^{2} + {()(, \frac{\partial T A W S S}{\partial z})}^{2}}

O S I = 0.5 [1 - (\frac{|{false\int}_{0}^{T} W S S d t|}{\int_{0}^{T} (||, italicWSS) d t})]

E C A P = \frac{OSI}{TAWSS}

…”

Section: Methodsmentioning

confidence: 99%

“…It is important to determine whether a particular AAA might rupture as the complexity and intensity of AAA treatments could result in significant cost and resource utilization. As a result, numerous researchers have tried to use computational methods to estimate the rupture potential of AAAs . However, no truly reliable method to evaluate the rupture risk of patient‐specific AAAs currently exists …”

Section: Introductionmentioning

confidence: 99%

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Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

et al. 2019

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Purpose Intraluminal thrombus (ILTs) are found in most abdominal aortic aneurysms (AAAs) of clinically relevant size; however, the role of ILTs in AAA ruptures remains unclear. This study investigated the role of the presence and thickness of ILTs in AAA ruptures by analyzing the hemodynamic environment in ruptured AAAs (RAAAs). Methods Three‐dimensional reconstructions from computed tomography scans were performed, and 13 RAAA cases were categorized into a no‐ILT group, a thin‐layered ILT group (thickness < 3 mm), and a thick‐layered ILT group. The hemodynamic features of the RAAAs were assessed using computational fluid dynamics simulation. Results The thin‐ and thick‐layered ILT groups showed significant differences in aneurysm diameters (P < 0.05). The three types of AAAs ruptured at different flow regions, with different hemodynamic features: (a) the no‐ILT AAAs ruptured at regions of flow recirculation where velocity and wall shear stresses (WSSs) were close to zero; (b) the thin‐layered ILT AAAs ruptured at sites at which the dominant flow impinged the wall; and (c) the thick‐layered ILT AAAs ruptured at the border of the dominant flow channel and recirculation zone where the flow velocity and pressure changed dramatically. Conclusions Hemodynamic characteristics influence the rupture mechanisms of particular AAAs differently on the basis of the presence and thickness of ILTs. Recirculation flows and low WSSs may have negative effects by inducing local rupture or positive effects by promoting the formation of thin‐layered ILTs. However, eccentrically located thick‐layered ILTs may increase the rupture risk of small AAAs because of their location in the sac lumen, which results in chaotic flow patterns and rapid increases in flow resistance.

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Section: Discussionmentioning

confidence: 99%

“…ECAP is an indicator of “thrombotic susceptibility,” which characterizes the possibility of thrombus formation . Definitions of the WSS‐based indicators are described as follows:

T A W S S = \frac{1}{T} {false\int}_{0}^{T} |WSS| d t

W S S G = \sqrt{{()(, \frac{\partial T A W S S}{\partial x})}^{2} + {()(, \frac{\partial T A W S S}{\partial y})}^{2} + {()(, \frac{\partial T A W S S}{\partial z})}^{2}}

O S I = 0.5 [1 - (\frac{|{false\int}_{0}^{T} W S S d t|}{\int_{0}^{T} (||, italicWSS) d t})]

E C A P = \frac{OSI}{TAWSS}

…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

et al. 2019

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“…Finite-element analyses can be used to estimate the local distribution of the stress applied by the blood pressure onto the aortic wall [7][8][9]. An open question is to estimate the patientspecific strength, which can vary from a few tenths of MPa to a few units of MPa from one individual to another [10,11].…”

Section: Introductionmentioning

confidence: 99%

Biaxial rupture properties of ascending thoracic aortic aneurysms

et al. 2016

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Despite their medical importance, rupture properties of ascending thoracic aortic aneurysms (ATAA) subjected to biaxial tension were inexistent in the literature. In order to address this lack, our group developed a novel methodology based on bulge inflation and full-field optical measurements. Here we report rupture properties obtained with this methodology on 31 patients. It is shown for the first time that rupture occurs when the stretch applied to ATAAs reaches the maximum extensibility of the tissue and that this maximum extensibility correlates strongly with the elastic properties. The outcome is a better detection of at-risk individuals for elective surgical repair.

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“…Over the last decade, researchers pursued more sophisticated, biomechanically motivated indicators for rupture risk assessment, showing that Peak Wall Stress (PWS) correlates better with clinically observed outcomes than the aforementioned geometric criteria (Fillingeret al, 2002;Martufi et al, 2016). Increased accuracy of stress estimations require biofidelic continuum mechanics-based descriptions of aortic tissue (Pierce et al, 2015b;Gasser et al, 2006).…”

Section: Abdominal Aortic Aneurysmsmentioning

confidence: 99%

Rupture risk in abdominal aortic aneurysms: A realistic assessment of the explicit GPU approach

Štrbac

Pierce

Rodríguez-Vila

et al. 2017

Journal of Biomechanics

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Accurate estimation of peak wall stress (PWS) is the crux of biomechanically motivated rupture risk assessment for abdominal aortic aneurysms aimed to improve clinical outcomes. Such assessments often use the finite element (FE) method to obtain PWS, albeit at a high computational cost, motivating simplifications in material or element formulations. These simplifications, while useful, come at a cost of reliability and accuracy. We achieve research-standard accuracy and maintain clinically applicable speeds by using novel computational technologies. We present a solution using our custom finite element code based on graphics processing unit (GPU) technology that is able to account for added complexities involved with more physiologically relevant solutions, e.g. strong anisotropy and heterogeneity. We present solutions up to 17x faster relative to an established finite element code using state-of-the-art nonlinear, anisotropic and nearly-incompressible material descriptions. We show a realistic assessment of the explicit GPU FE approach by using complex problem geometry, biofidelic material law, doubleprecision floating point computation and full element integration. Due to the increased solution speed without loss of accuracy, shown on five clinical cases of abdominal aortic aneurysms, the method shows promise for clinical use in determining rupture risk of abdominal aortic aneurysms.

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Is There a Role for Biomechanical Engineering in Helping to Elucidate the Risk Profile of the Thoracic Aorta?

Cited by 56 publications

References 64 publications

Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

Biaxial rupture properties of ascending thoracic aortic aneurysms

Rupture risk in abdominal aortic aneurysms: A realistic assessment of the explicit GPU approach

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