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Annals of Biomedical Engineering

, Volume 45, Issue 8, pp 1908–1916 | Cite as

The Association Between Geometry and Wall Stress in Emergently Repaired Abdominal Aortic Aneurysms

  • Sathyajeeth S. Chauhan
  • Carlos A. Gutierrez
  • Mirunalini Thirugnanasambandam
  • Victor De Oliveira
  • Satish C. Muluk
  • Mark K. Eskandari
  • Ender A. Finol
Article

Abstract

Abdominal aortic aneurysm (AAA) is a prevalent cardiovascular disease characterized by the focal dilation of the aorta, which supplies blood to all the organs and tissues in the systemic circulation. With the AAA increasing in diameter over time, the risk of aneurysm rupture is generally associated with the size of the aneurysm. If diagnosed on time, intervention is recommended to prevent AAA rupture. The criterion to decide on surgical intervention is determined by measuring the maximum diameter of the aneurysm relative to the critical value of 5.5 cm. However, a more reliable approach could be based on understanding the biomechanical behavior of the aneurysmal wall. In addition, geometric features that are proven to be significant predictors of the AAA wall mechanics could be used as surrogates of the AAA biomechanical behavior and, subsequently, of the aneurysm’s risk of rupture. The aim of this work is to identify those geometric indices that have a high correlation with AAA wall stress in the population of patients who received an emergent repair of their aneurysm. In-house segmentation and meshing algorithms were used to model 75 AAAs followed by estimation of the spatially distributed wall stress by performing finite element analysis. Fifty-two shape and size geometric indices were calculated for the same models using MATLAB scripting. Hypotheses testing were carried out to identify the indices significantly correlated with wall stress by constructing a Pearson’s correlation coefficient matrix. The analyses revealed that 12 indices displayed high correlation with the wall stress, amongst which wall thickness and curvature-based indices exhibited the highest correlations. Stepwise regression analysis of these correlated indices indicated that wall stress can be predicted by the following four indices with an accuracy of 76%: maximum aneurysm diameter, aneurysm sac length, average wall thickness at the maximum diameter cross-section, and the median of the wall thickness variance. The primary outcome of this work emphasizes the use of global measures of size and wall thickness as geometric surrogates of wall stress for emergently repaired AAAs.

Keywords

Finite element modeling Arterial biomechanics Geometric modeling 

Notes

Acknowledgments

The authors have no conflicts of interest to disclose and would like to acknowledge research funding from National Institutes of Health Award R01HL121293 and American Heart Association Award 15PRE25700288. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the American Heart Association.

Supplementary material

10439_2017_1837_MOESM1_ESM.pdf (700 kb)
Supplementary material 1 (PDF 700 kb)

References

  1. 1.
    Beller, C. J., M. M. Gebhard, M. Karck, and M. R. Labrosse. Usefulness and limitations of computational models in aortic disease risk stratification. J. Vasc. Surg. 52(6):1572–1579, 2010.CrossRefPubMedGoogle Scholar
  2. 2.
    Brown, P. M., D. T. Zelt, and B. Sobolev. The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J. Vasc. Surg. 37(2):280–284, 2003.CrossRefPubMedGoogle Scholar
  3. 3.
    Darling, R. C., C. R. Messina, D. C. Brewster, and L. W. Ottinger. Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circ. J. 56(3 Suppl):II161–II164, 1977.Google Scholar
  4. 4.
    Di Martino, E. S., A. Bohra, J. P. VandeGeest, N. Gupta, M. S. Makaroun, and D. A. Vorp. Biomechanical properties of ruptured versus electively repaired abdominal aortic aneurysm wall tissue. J. Vasc. Surg. 43(3):570–576, 2006.CrossRefPubMedGoogle Scholar
  5. 5.
    Fillinger, M. F., M. L. Raghavan, S. P. Marra, J. L. Cronenwett, and F. E. Kennedy. In vivo analysis of mechanical wall stress and abdominal aortic aneurysm rupture risk. J. Vasc. Surg. 36(3):589–597, 2002.CrossRefPubMedGoogle Scholar
  6. 6.
    Georgakarakos, E., C. V. Ioannou, Y. Kamarianakis, Y. Papaharilaou, T. Kostas, E. Manousaki, and A. N. Katsamouris. The role of geometric parameters in the prediction of abdominal aortic aneurysm wall stress. Eur. J. Vasc. Endovasc. Surg. 39(1):42–48, 2010.CrossRefPubMedGoogle Scholar
  7. 7.
    Giannoglou, G., G. Giannakoulas, J. Soulis, Y. Chatzizisis, T. Perdikides, N. Melas, G. Parcharidis, and G. Louridas. Predicting the risk of rupture of abdominal aortic aneurysms by utilizing various geometrical parameters: revisiting the diameter criterion. Angiology 57(4):487–494, 2006.CrossRefPubMedGoogle Scholar
  8. 8.
    Khosla, S., D. R. Morris, J. V. Moxon, P. J. Walker, T. C. Gasser, and J. Golledge. Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms. Br. J. Surg. 101(11):1350–1357, 2014.CrossRefPubMedGoogle Scholar
  9. 9.
    Lederle, F. A., G. R. Johnson, S. E. Wilson, D. J. Ballard, W. D. Jordan, Jr., J. Blebea, F. N. Littooy, J. A. Freischlag, D. Bandyk, J. H. Rapp, and A. A. Salam. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA 287(22):2968–2972, 2002.CrossRefPubMedGoogle Scholar
  10. 10.
    Lee, K., J. Zhu, J. Shum, Y. Zhang, S. C. Muluk, A. Chandra, and E. A. Finol. Surface curvature as a classifier of abdominal aortic aneurysms: a comparative analysis. Ann. Biomed. Eng. 41(3):562–576, 2013.CrossRefPubMedGoogle Scholar
  11. 11.
    Lindquist, L. M., R. Hultgren, T. C. Gasser, and J. Roy. Volume growth of abdominal aortic aneurysms correlates with baseline volume and increasing finite element analysis-derived rupture risk. J. Vasc. Surg. 63(6):1434.e3–1442.e3, 2016.Google Scholar
  12. 12.
    Martufi, G., E. S. Di Martino, C. H. Amon, S. C. Muluk, and E. A. Finol. Three-dimensional geometrical characterization of abdominal aortic aneurysms: image-based wall thickness distribution. J. Biomech. Eng. 131(6):061015, 2009.CrossRefPubMedGoogle Scholar
  13. 13.
    Mower, W. R., L. J. Baraff, and J. Sneyd. Stress distributions in vascular aneurysms: factors affecting risk of aneurysm rupture. J. Surg. Res. 55(2):155–161, 1993.CrossRefPubMedGoogle Scholar
  14. 14.
    Polzer, S., and T. C. Gasser. Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index. J. R. Soc. Interface 12(113):20150852, 2015.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Raghavan, M. L., and D. A. Vorp. 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. Biomech. 33(4):475–482, 2000.CrossRefPubMedGoogle Scholar
  16. 16.
    Raghavan, M. L., J. Kratzberg, E. M. C. de Tolosa, M. M. Hanaoka, P. Walker, and E. S. da Silva. Regional distribution of wall thickness and failure properties of human abdominal aortic aneurysm. J. Biomech. 39(16):3010–3016, 2006.CrossRefPubMedGoogle Scholar
  17. 17.
    Raut, S. S. Patient-specific 3D vascular reconstruction and computational assessment of biomechanics—an application to abdominal aortic aneurysm. PhD Thesis, Carnegie Mellon University, Pittsburgh, 2012.Google Scholar
  18. 18.
    Sacks, M. S., D. A. Vorp, M. L. Raghavan, M. P. Federle, and M. W. Webster. In vivo three-dimensional surface geometry of abdominal aortic aneurysms. Ann. Biomed. Eng. 27(4):469–479, 1999.CrossRefPubMedGoogle Scholar
  19. 19.
    Shaffer, J. P. Multiple hypothesis testing. Annu. Rev. Psychol. 46:561–584, 1995.CrossRefGoogle Scholar
  20. 20.
    Shum, J. Risk assessment of abdominal aortic aneurysms by geometry quantification measures. PhD Thesis, Carnegie Mellon University, Pittsburgh, 2011.Google Scholar
  21. 21.
    Shum, J., E. S. Di Martino, A. Goldhammer, D. H. Goldman, L. C. Acker, G. Patel, J. H. Ng, G. Martufi, and E. A. Finol. Semiautomatic vessel wall detection and quantification of wall thickness in computed tomography images of human abdominal aortic aneurysms. Med. Phys. 37(2):638–648, 2010.CrossRefPubMedGoogle Scholar
  22. 22.
    Shum, J., G. Martufi, E. S. Di Martino, C. B. Washington, J. Grisafi, S. C. Muluk, and E. A. Finol. Quantitative assessment of abdominal aortic aneurysm geometry. Ann. Biomed. Eng. 39(1):277–286, 2011.CrossRefPubMedGoogle Scholar
  23. 23.
    Shum, J., A. Xu, I. Chatnuntawech, and E. A. Finol. A framework for the automatic generation of surface topologies for abdominal aortic aneurysm models. Ann. Biomed. Eng. 39(1):249–259, 2011.CrossRefPubMedGoogle Scholar
  24. 24.
    Tang, A., C. Kauffmann, S. Tremblay-Paquet, S. Elkouri, O. Steinmetz, F. Morin-Roy, L. Cloutier-Gill, and G. Soulez. Morphologic evaluation of ruptured and symptomatic abdominal aortic aneurysm by three-dimensional modeling. J. Vasc. Surg. 59(4):894–902, 2014.CrossRefPubMedGoogle Scholar
  25. 25.
    Venkatasubramaniam, A. K., M. J. Fagan, T. Mehta, K. J. Mylankal, B. Ray, G. Kuhan, I. C. Chetter, and P. T. McCollum. A comparative study of aortic wall stress using finite element analysis for ruptured and non-ruptured abdominal aortic aneurysms. Eur. J. Vasc. Endovasc. Surg. 28(2):168–176, 2004.PubMedGoogle Scholar
  26. 26.
    Woolson, R. F., and W. R. Clarke. Statistical Methods for the Analysis of Biomedical Data (2nd ed.). Hoboken, NJ: Wiley, p. 608, 2002.CrossRefGoogle Scholar

Copyright information

© Biomedical Engineering Society 2017

Authors and Affiliations

  • Sathyajeeth S. Chauhan
    • 1
  • Carlos A. Gutierrez
    • 1
  • Mirunalini Thirugnanasambandam
    • 1
  • Victor De Oliveira
    • 2
  • Satish C. Muluk
    • 3
  • Mark K. Eskandari
    • 4
  • Ender A. Finol
    • 1
    • 5
  1. 1.UTSA/UTHSCSA Joint Graduate Program in Biomedical EngineeringUniversity of Texas at San AntonioSan AntonioUSA
  2. 2.Department of Management Science and StatisticsUniversity of Texas at San AntonioSan AntonioUSA
  3. 3.Department of Thoracic & Cardiovascular Surgery, Allegheny General HospitalAllegheny Health NetworkPittsburghUSA
  4. 4.Division of Vascular Surgery and Department of Radiology, Northwestern Memorial Hospital, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  5. 5.Department of Mechanical EngineeringUniversity of Texas at San AntonioSan AntonioUSA

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