Progression of abdominal aortic aneurysm towards rupture: refining clinical risk assessment using a fully coupled fluid-structure interaction method.
Progression of abdominal aortic aneurysm towards rupture: refining clinical risk assessment using a fully coupled fluid-structure interaction method.
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DOI：
10.1007/s10439-014-1224-0
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发表时间：
2015-01
影响因子：
3.8
通讯作者：
Bluestein, Danny
中科院分区：
文献类型：
--
作者：
Xenos, Michalis;Labropoulos, Nicos;Rambhia, Suraj;Alemu, Yared;Einav, Shmuel;Tassiopoulos, Apostolos;Sakalihasan, Natzi;Bluestein, Danny
关键词：
腹主动脉瘤（AAA）破裂与高死亡率相关。破裂风险是多因素的，涉及AAA几何构型、血管迂曲度和腔内病理学的存在。在基于患者的计算机断层扫描（CT）重建几何结构中进行流体结构相互作用（FSI）模拟，以监测从正常腹主动脉瘤到非破裂和包含破裂AAA（rAAA）的动脉瘤疾病进展，并评估AAA破裂风险。研究了三组，每组8名受试者：8名正常受试者和16名病理受试者（8名非破裂AAA和8名破裂AAA）。分割的AAA解剖结构包括血腔、腔内血栓（ILT）、血管壁和嵌入的钙化。血管壁用各向异性材料模型描述，该模型与AAA组织标本的实验测量相匹配。采用用于估计局部壁强度分布的统计模型来生成破裂潜力指数（RPI）的图，该破裂潜力指数表示局部应力与局部强度分布之间的比率。FSI模拟遵循从正常到病理情况的壁应力增加的明显趋势。在不存在ILT的区域观察到最大应力，表明ILT具有潜在的保护作用。三组之间的收缩期峰值应力（PSS）和平均动脉压（MAP）下的峰值应力之间存在统计学显著差异。对于破裂的动脉瘤，重建了完整动脉瘤的几何形状，FSI模拟的结果清楚地描绘了先验已知破裂位置处的最大壁应力。RPI图显示了几个不同的高RPI区域，与实际破裂位置一致。FSI方法表明，可以通过数值模拟描述动脉瘤性疾病，如研究组（正常腹主动脉瘤、AAA和破裂AAA）中主动脉壁应力增加的明显趋势所示。最终，结果表明，FSI壁应力映射和RPI可用作通过预测实际破裂位置来预测AAA潜在破裂的工具，通过提供用于决定是否进行手术干预或使患者免于不必要的风险手术的预测诊断工具来补充当前的临床实践。
Rupture of abdominal aortic aneurysm (AAA) is associated with high mortality rates. Risk of rupture is multi-factorial involving AAA geometric configuration, vessel tortuosity, and the presence of intraluminal pathology. Fluid structure interaction (FSI) simulations were conducted in Patient based computed tomography (CT) scans reconstructed geometries in order to monitor aneurysmal disease progression from normal aortas to non-ruptured and contained ruptured AAA (rAAA), and the AAA risk of rupture was assessed. Three groups of 8 subjects each were studied: 8 normal and 16 pathological (8 non-ruptured and 8 ruptured AAA). The AAA anatomical structures segmented included the blood lumen, intraluminal thrombus (ILT), vessel wall, and embedded calcifications. The vessel wall was described with anisotropic material model that was matched to experimental measurements of AAA tissue specimens. A statistical model for estimating the local wall strength distribution was employed to generate a map of a rupture potential index (RPI), representing the ratio between the local stress and local strength distribution. The FSI simulations followed a clear trend of increasing wall stresses from normal to pathological cases. The maximal stresses were observed in the areas where the ILT was not present, indicating a potential protective effect of the ILT. Statistically significant differences was observed between the peak systolic stress (PSS) and the peak stress at the mean arterial pressure (MAP) between the three groups. For the ruptured aneurysms, where the geometry of intact aneurysm was reconstructed, results of the FSI simulations clearly depicted maximum wall stress at the a-priori known location of rupture. The RPI mapping indicated several distinct regions of high RPI coinciding with the actual location of rupture. The FSI methodology demonstrates that the aneurysmal disease can be described by numerical simulations, as indicated by a clear trend of increasing aortic wall stresses in the studied groups, (normal aortas, AAAs and ruptured AAAs). Ultimately, the results demonstrate that FSI wall stress mapping and RPI can be used as a tool for predicting the potential rupture of an AAA by predicting the actual rupture location, complementing current clinical practice by offering a predictive diagnostic tool for deciding whether to intervene surgically or spare the patient from an unnecessary risky operation.
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DOI：
10.1016/s1078-5884(98)80031-2
发表时间：
1998-04-01
影响因子：
5.7
作者：
Di Martino, E;Mantero, S;Fumero, R
通讯作者：
Fumero, R
影响因子：
4.3
作者：
Fillinger, MF;Marra, SP;Kennedy, FE
通讯作者：
Kennedy, FE
影响因子：
2
作者：
Holzapfel, GA;Gasser, TC;Ogden, RW
通讯作者：
Ogden, RW
影响因子：
2.4
作者：
Humphrey, J. D.;Holzapfel, G. A.
通讯作者：
Holzapfel, G. A.
影响因子：
2.4
作者：
de Putter, S.;Wolters, B. J. B. M.;van de Vosse, F. N.
通讯作者：
van de Vosse, F. N.