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Improved assessment and treatment of abdominal aortic aneurysms: the use of 3D reconstructions as a surgical guidance tool in endovascular repair

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Abstract

Background

Endovascular repair is fast becoming the treatment of choice for abdominal aortic aneurysms in anatomically suitable patients. 3D reconstructions not only aid conventional 2D measurements but also allow further analyses of the vessel anatomy.

Methods

Computed tomography scan data for four male patients awaiting endovascular repair were obtained. 3D reconstructions were performed to determine measurements. Wall stress was determined on one particular case using finite element analysis.

Results

3D reconstruction allows measurements to be obtained that can be difficult to determine using 2D images. This method complements traditional 2D approaches. Reconstructions also provided imaging of potential anatomical problems. Wall stress results showed key regions that may be possible rupture sites.

Conclusion

3D reconstructions greatly aid surgical planning. As stent-graft devices evolve, anatomical difficulties previously considered contraindications to endovascular repair can now be overcome with careful planning. 3D reconstruction is a useful adjunct to assessment and planning of endovascular repair.

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References

  1. Sakalihasan N, Limet R, Defawe OD (2005) Abdominal aortic aneurysm. Lancet 365:1577–1589. doi:10.1016/S0140-6736(05)66459-8

    Article  PubMed  CAS  Google Scholar 

  2. Bengtsson H, Nilsson P, Bergqvist D (1998) Natural history of abdominal aortic aneurysm detected by screening. Br J Surg 80:718–720. doi:10.1002/bjs.1800800613

    Article  Google Scholar 

  3. Vorp DA (2007) Biomechanics of abdominal aortic aneurysm. J Biomech 40:1887–1902. doi:10.1016/j.jbiomech.2006.09.003

    Article  PubMed  Google Scholar 

  4. Ouriel K, Green RM, Donayre C et al (1992) An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture. J Vasc Surg 15:12–20. doi:10.1067/mva.1992.32982

    Article  PubMed  CAS  Google Scholar 

  5. Kleinstreuer C, Li Z (2006) Analysis and computer program for rupture-risk prediction of abdominal aortic aneurysms. Biomed Eng Online 5:19. doi:10.1186/1475-925X-5-19

    Article  PubMed  Google Scholar 

  6. McGregor JC, Pollock JG, Anton HC (1975) The value of ultrasonography in the diagnosis of abdominal aortic aneurysm. Scott Med J 20:133–137

    PubMed  CAS  Google Scholar 

  7. Grimshaw GM, Thompson JM (1997) Changes in diameter of the abdominal aorta with age: an epidemiological study. J Clin Ultrasound 25:7–13. doi:10.1002/(SICI)1097-0096(199701)25:1<7::AID-JCU2>3.0.CO;2-M

    Article  PubMed  CAS  Google Scholar 

  8. Johnston KW, Rutherford RB, Tilson MD et al (1991) Suggested standards for reporting on arterial aneurysms. Subcommittee on reporting standards for arterial aneurysms, Ad hoc committee on reporting standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 13:452–458. doi:10.1067/mva.1991.26737

    Article  PubMed  CAS  Google Scholar 

  9. Sayers RD (2002) Aortic aneurysms, inflammatory pathways and nitric oxide. Ann R Coll Surg Engl 84(4):239–246. doi:10.1308/003588402320439667

    Article  PubMed  CAS  Google Scholar 

  10. Raghavan ML, Vorp DA (2000) Toward a biomechanical tool to evaluate rupture potential of abdominal aortic aneurysm: identification of a finite strain constitutive model and evaluation of its applicability. J Vasc Surg 33:475–482

    CAS  Google Scholar 

  11. Fillinger MF, Marra SP, Raghavan ML et al (2003) Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg 37:724–732. doi:10.1067/mva.2003.213

    Article  PubMed  Google Scholar 

  12. Fillinger MF, Raghavan ML, Marra SP et al (2002) In vivo analysis of mechanical wall stress and abdominal aortic aneurysm rupture risk. J Vasc Surg 36:589–597. doi:10.1067/mva.2002.125478

    Article  PubMed  Google Scholar 

  13. Morris LG (2004) Numerical and experimental investigation of mechanical factors in the treatment of abdominal aortic aneurysms. PhD Thesis 2004. University of Limerick

  14. EVAR Trial Participants (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848. doi:10.1016/S0140-6736(04)16979-1

    Article  Google Scholar 

  15. EVAR trial participants (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised control trial. Lancet 365:2179–2186

    Article  Google Scholar 

  16. Schermerhorn M, O’Malley J, Jhaveri A et al (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358:464–474. doi:10.1056/NEJMoa0707348

    Article  PubMed  CAS  Google Scholar 

  17. Corbet TJ, Callanan A, Morris LG et al (2008) In vivo and in vitro biomechanical behaviour and performance of post-operative abdominal aortic aneurysms and implanted stent-grafts: a review. J Endovasc Ther 15(4):468–484. doi:10.1583/08-2370.1

    Article  Google Scholar 

  18. Resch TA. TeraRecon clinical case studies: endograft planning for complex aortic aneurysms. Available via TeraRecon. http://www.terarecon.com/downloads/news/clinical_case_studies_v2/casestudy_Resch-EndograftPlanning.pdf. Accessed 10 March 2008

  19. Vorp DA, Raghavan ML, Webster MW (1998) Mechanical wall stress in abdominal aortic aneurysm: influence of diameter and asymmetry. J Vasc Surg 27(4):632–639. doi:10.1016/S0741-5214(98)70227-7

    Article  PubMed  CAS  Google Scholar 

  20. Raghavan ML, Vorp DA, Federle MP et al (2000) Wall stress distribution on three-dimensionally reconstructed models of human abdominal aortic aneurysm. J Vasc Surg 31:760–769. doi:10.1067/mva.2000.103971

    Article  PubMed  CAS  Google Scholar 

  21. Doyle BJ, Callanan A, Walsh MT et al (2009) A finite element analysis rupture index (FEARI) as an additional tool for abdominal aortic aneurysm burst prediction. Vasc Dis Prev 6:75–82

    Article  Google Scholar 

  22. Doyle BJ, Callanan A, Burke PE et al (2009) Vessel asymmetry as an additional diagnostic tool for the assessment of abdominal aortic aneurysms. J Vasc Surg 43:443–454

    Article  Google Scholar 

  23. Doyle BJ, Morris LG, Callanan A et al (2008) 3D reconstruction and manufacture of real abdominal aortic aneurysms: from CT scan to silicone model. J Biomech Eng 130:034501–034505. doi:10.1115/1.2907765

    Article  PubMed  CAS  Google Scholar 

  24. Doyle BJ, Callanan A, McGloughlin TM (2007) A comparison of modelling techniques for computing wall stress in abdominal aortic aneurysms. Biomed Eng Online 6:38. doi:10.1186/1475-925X-6-38

    Article  PubMed  Google Scholar 

  25. Vorp DA, Shiro BJ, Ehrlich MP et al (2003) Effect of aneurysm on the tensile strength and biomechanical behaviour of the ascending thoracic aorta. Ann Thorac Surg 75:1210–1214. doi:10.1016/S0003-4975(02)04711-2

    Article  PubMed  Google Scholar 

  26. Thubrikar MJ, Al-Soudi J, Robicsek F (2001) Wall stress studies of abdominal aortic aneurysm in a clinical model. Ann Vasc Surg 15:355–366. doi:10.1007/s100160010080

    Article  PubMed  CAS  Google Scholar 

  27. Truijers M, Pol JA, SchultzeKool LJ et al (2007) Wall stress analysis in small asymptomatic, symptomatic and ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 33:401–407. doi:10.1016/j.ejvs.2006.10.009

    Article  PubMed  CAS  Google Scholar 

  28. Speelman L, Bohra A, Bosboom EMH et al (2007) Effects of wall calcifications in patient-specific wall stress analyses of abdominal aortic aneurysms. J Biomech Eng 129:1–5. doi:10.1115/1.2401189

    Article  Google Scholar 

  29. Faries PL, Dayal R, Rhee J et al (2004) Stent graft treatment for abdominal aortic aneurysm repair: recent developments in therapy. Diseases of the aorta, pulmonary, and peripheral vessels. Curr Opin Cardiol 19(6):551–557. doi:10.1097/01.hco.0000141267.26503.ed

    Article  PubMed  Google Scholar 

  30. Molony DS, Callanan A, Morris LG et al (2008) Geometrical enhancements for abdominal aortic stent grafts. J Endovasc Ther 15:518–529

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank (1) the Irish Research Council for Science, Engineering and Technology (IRCSET) Grant RS/2005/340 (2) Grant #R01-HL-060670 from the US National Heart Lung and Blood Institute (3) the Department of Vascular Surgery in the HSE Midwestern Regional Hospital, Ireland (4) the Department of Radiology in the HSE Midwestern Regional Hospital, Ireland (5) Prof. David A. Vorp from the Departments of Surgery and Bioengineering, Centre for Vascular Remodelling and Regeneration, McGowan Institute of Regenerative Medicine, University of Pittsburgh, USA and (6) Mr. Prakash Madhavan, Consultant Vascular Surgeon, St. James Hospital, Dublin, Ireland.

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Authors and Affiliations

  1. Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, Materials and Surface Science Institute, University of Limerick, Limerick, Ireland

    B. J. Doyle, P. A. Grace, E. G. Kavanagh, P. E. Burke, F. Wallis, M. T. Walsh & T. M. McGloughlin

  2. Department of Vascular Surgery, Midwestern Regional Hospital, Limerick, Ireland

    P. A. Grace, E. G. Kavanagh & P. E. Burke

  3. Department of Radiology, Midwestern Regional Hospital, Limerick, Ireland

    F. Wallis

Authors
  1. B. J. Doyle
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  2. P. A. Grace
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  3. E. G. Kavanagh
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  4. P. E. Burke
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  5. F. Wallis
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  6. M. T. Walsh
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  7. T. M. McGloughlin
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Corresponding author

Correspondence to T. M. McGloughlin.

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Doyle, B.J., Grace, P.A., Kavanagh, E.G. et al. Improved assessment and treatment of abdominal aortic aneurysms: the use of 3D reconstructions as a surgical guidance tool in endovascular repair. Ir J Med Sci 178, 321–328 (2009). https://doi.org/10.1007/s11845-009-0318-4

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  • DOI: https://doi.org/10.1007/s11845-009-0318-4

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