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Progression of abdominal aortic aneurysm towards rupture - refining clinical risk assessment using a fully coupled fluid-structure interaction method

机译：腹主动脉瘤破裂的进展-使用完全耦合的流固耦合方法完善临床风险评估

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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.
机译：腹主动脉瘤破裂（AAA）与高死亡率相关。破裂的风险是多方面的因素，包括AAA几何形状，血管曲折以及腔内病变的存在。在以患者为基础的计算机断层摄影（CT）扫描中对流体结构相互作用（FSI）进行了模拟，以重建几何形状，以监测从正常主动脉到未破裂并包含破裂AAA（rAAA）的动脉瘤疾病进展，并评估了AAA破裂的风险。研究了三组，每组8个受试者：8例正常和16例病理（8例未破裂和8例AAA破裂）。分割的AAA解剖结构包括血腔，腔内血栓（ILT），血管壁和包埋的钙化。用各向异性材料模型描述了血管壁，该材料模型与AAA组织样本的实验测量结果相匹配。统计模型用于估计局部壁强度分布，以生成破裂电位指数（RPI）的图，该图表示局部应力与局部强度分布之间的比率.FSI模拟遵循明显的趋势，即壁压力从正态增加病理情况。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。两组之间的收缩压峰值（PSS）和平均动脉压（MAP）峰值应力之间存在统计学差异。对于重建了完整动脉瘤的几何形状的破裂动脉瘤，FSI模拟的结果清楚地描述了先验已知破裂位置处的最大壁应力。 RPI映射表明高RPI的几个不同区域与实际的破裂位置相吻合.FSI方法论表明可以通过数值模拟来描述动脉瘤疾病，如研究组的主动脉壁应力增加的明显趋势所表明的那样，（正常主动脉，AAA和破裂AAA）。最终，结果表明FSI壁应力图和RPI可以用作通过预测实际破裂位置来预测AAA潜在破裂的工具，通过提供一种预测性诊断工具来决定是否进行手术或手术干预来补充当前的临床实践。使患者免于不必要的冒险操作。

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