Mechanical properties of the aneurysmal aorta

MacSweeney, Shane T.; Young, Guy; Greenhalgh, Roger M.; Powell, J.T.

doi:10.1002/bjs.1800791211

Cited by 110 publications

(54 citation statements)

References 22 publications

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“…23 MacSweeney et al reported an increase in the pressure-strain elastic modulus in patients with AAA using M-mode ultrasonography. 24 Automated ultrasonographic measurements of the aortic wall and intraluminal thrombus performed in our laboratory demonstrated that the compliance of the AAA wall is decreased as compared with that of the luminal-thrombus interface. 25 The relatively constant area of ILT over the cardiac cycle reported in this study was the first to suggest the incompressibility of this tissue.…”

Section: In Vivo Mechanical Evaluationmentioning

confidence: 93%

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Vorp

Geest

2005

ATVB

232

172

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Abstract-Rupture of abdominal aortic aneurysm (AAA) represents a significant clinical event, having a mortality rate of 90% and being currently ranked as the 13th leading cause of death in the US. The ability to reliably evaluate the susceptibility of a particular AAA to rupture on a case-specific basis could vastly improve the clinical management of these patients. Because AAA rupture represents a mechanical failure of the degenerated aortic wall, biomechanical considerations are important to understand this process and to improve our predictions of its occurrence. Presented here is an overview of research to date related to the biomechanics of AAA rupture. This includes a summary of results related to ex vivo and in vivo mechanical testing, noninvasive AAA wall stress estimations, and potential mechanisms of AAA wall weakening. We conclude with a demonstration of a biomechanics-based approach to predicting AAA rupture on a patient-specific basis, which may ultimately prove to be superior to the widely and currently used maximum diameter criterion. Key Words: abdominal aortic aneurysm Ⅲ biomechanics Ⅲ rupture Ⅲ strength Ⅲ stress A bdominal aortic aneurysm (AAA) is a focal enlargement of the infrarenal aorta, which occurs over a time course of several years. This condition is present in Ϸ2% of the elderly population, with Ϸ150 000 new cases diagnosed each year, and the incidence is increasing. 1,2 If left untreated, AAA will gradually expand until rupture; it is an event that carries a mortality rate of 90% and that is ranked as the 13th most common cause of death in the US. 3 Current AAA repair procedures are expensive and carry significant morbidity and mortality risks.Open repair of AAA is a major surgical procedure that requires patients to be hospitalized typically for 1 week and to recuperate at home for several more weeks. The mean postoperative mortality for elective repair is Ϸ5% and for emergency operations 47% (range 27% to 69%). 4 The major drawback of open repair is the compromised quality of life after surgery because of postoperative pain, the prolonged recovery period, and the high costs associated with both the surgery and the recovery.An alternative approach that avoids the extensive tissue dissection associated with open repair is the minimally invasive endovascular repair procedure. The potential advantages of endovascular AAA repair include reductions in mortality, morbidity, blood loss, hospital stay, intensive careOriginal

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Section: In Vivo Mechanical Evaluationmentioning

confidence: 93%

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Vorp

Geest

2005

ATVB

232

172

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“…Segmental aortic dilation alters the hemodynamic flow pattern, increasing oscillatory and reducing (protective) laminar shear stress. Further, aneurysm formation is associated with markedly increased segmental stiffness (reduced circumferential strain) of the corresponding vessel wall (80). Interestingly, experimentally increased flow in the aorta during AAA formation increased laminar shear stress as well as cyclic strain and reduced AAA growth in a rodent model (94).…”

Section: Abdominal Aortic Aneurysmsmentioning

confidence: 99%

Hemodynamic Regulation of Reactive Oxygen Species: Implications for Vascular Diseases

Raaz

Toh

Maegdefessel

et al. 2014

Antioxidants & Redox Signaling

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Significance: Arterial blood vessels functionally and structurally adapt to altering hemodynamic forces in order to accommodate changing needs and to provide stress homeostasis. This ability is achieved at the cellular level by converting mechanical stimulation into biochemical signals (i.e., mechanotransduction). Physiological mechanical stress helps maintain vascular structure and function, whereas pathologic or aberrant stress may impair cellular mechano-signaling, and initiate or augment cellular processes that drive disease. Recent Advances: Reactive oxygen species (ROS) may represent an intriguing class of mechanically regulated second messengers. Chronically enhanced ROS generation may be induced by adverse mechanical stresses, and is associated with a multitude of vascular diseases. Although a causal relationship has clearly been demonstrated in large numbers of animal studies, an effective ROS-modulating therapy still remains to be established by clinical studies. Critical Issues and Future Directions: This review article focuses on the role of various mechanical forces (in the form of laminar shear stress, oscillatory shear stress, or cyclic stretch) as modulators of ROS-driven signaling, and their subsequent effects on vascular biology and homeostasis, as well as on specific diseases such as arteriosclerosis, hypertension, and abdominal aortic aneurysms. Specifically, it highlights the significance of the various NADPH oxidase (NOX) isoforms as critical ROS generators in the vasculature. Directed targeting of defined components in the complex network of ROS (mechano-)signaling may represent a key for successful translation of experimental findings into clinical practice. Antioxid. Redox Signal. 20,[914][915][916][917][918][919][920][921][922][923][924][925][926][927][928]

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“…Often, it is alteration of the quantity and/or architecture of these fibres that leads to the mechanical, and hence functional, changes associated with aortic disease [9,14,34 -42]. For example, structural alterations in the walls of large arteries with progressing age causes a decrease in the total arterial compliance [9,10,[43][44][45][46], which in turn leads to both a decreased distal blood flow and an increase in aortic pulse pressure [30]. This increased pulse pressure has been shown to be the strongest predictor of cardiovascular mortality, because it increases the mechanical load on the left ventricle [47].…”

Section: Introductionmentioning

confidence: 99%

Elastin and collagen fibre microstructure of the human aorta in ageing and disease: a review

Tsamis

Krawiec

Vorp

2013

J. R. Soc. Interface.

408

300

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Aortic disease is a significant cause of death in developed countries. The most common forms of aortic disease are aneurysm, dissection, atherosclerotic occlusion and ageing-induced stiffening. The microstructure of the aortic tissue has been studied with great interest, because alteration of the quantity and/or architecture of the connective fibres (elastin and collagen) within the aortic wall, which directly imparts elasticity and strength, can lead to the mechanical and functional changes associated with these conditions. This review article summarizes the state of the art with respect to characterization of connective fibre microstructure in the wall of the human aorta in ageing and disease, with emphasis on the ascending thoracic aorta and abdominal aorta where the most common forms of aortic disease tend to occur.

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Mechanical properties of the aneurysmal aorta

Cited by 110 publications

References 22 publications

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Hemodynamic Regulation of Reactive Oxygen Species: Implications for Vascular Diseases

Elastin and collagen fibre microstructure of the human aorta in ageing and disease: a review

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