Abdominal Aortic Aneurysm: From Clinical Imaging to Realistic Replicas

2013 ◽  
Vol 136 (1) ◽  
Author(s):  
Sergio Ruiz de Galarreta ◽  
Aitor Cazón ◽  
Raúl Antón ◽  
Ender A. Finol
Keyword(s):  
Wall Thickness ◽  
Physiological Stress ◽  
Ex Vivo ◽  
Casting Process ◽  
Aortic Aneurysms ◽  
Optical Methods ◽  
Patient Specific ◽  
Uniaxial Tensile ◽  
Element Analysis ◽  
Abdominal Aortic

The goal of this work is to develop a framework for manufacturing nonuniform wall thickness replicas of abdominal aortic aneurysms (AAAs). The methodology was based on the use of computed tomography (CT) images for virtual modeling, additive manufacturing for the initial physical replica, and a vacuum casting process and range of polyurethane resins for the final rubberlike phantom. The average wall thickness of the resulting AAA phantom was compared with the average thickness of the corresponding patient-specific virtual model, obtaining an average dimensional mismatch of 180 μm (11.14%). The material characterization of the artery was determined from uniaxial tensile tests as various combinations of polyurethane resins were chosen due to their similarity with ex vivo AAA mechanical behavior in the physiological stress configuration. The proposed methodology yields AAA phantoms with nonuniform wall thickness using a fast and low-cost process. These replicas may be used in benchtop experiments to validate deformations obtained with numerical simulations using finite element analysis, or to validate optical methods developed to image ex vivo arterial deformations during pressure-inflation testing.

Use of the Photoelastic Method to Determine the Wall Stress in Realistic Abdominal Aortic Aneurysm Models

2011 ◽  
Author(s):  
Barry J. Doyle ◽  
Anthony Callanan ◽  
John Killion ◽  
Timothy M. McGloughlin
Keyword(s):  
Wall Stress ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Western World ◽  
Photoelastic Method ◽  
Element Analysis ◽  
Abdominal Aortic ◽  
The Us ◽  
Numerical Tools

Abdominal aortic aneurysms (AAAs) remain a significant cause of death in the Western world with over 15,000 deaths per year in the US linked to AAA rupture. Recent research [1] has questioned the use of maximum diameter as a definitive risk parameter as it is now believed that alternative factors may be important in rupture-prediction. Wall stress was shown to be a better predictor than diameter of rupture [1], with biomechanics-based rupture indices [2,3] and asymmetry also reported to have potential clinical applicability [4]. However, the majority of numerical methods used to form these alternative rupture parameters are without rigorous experimental validation, and therefore may not be as accurate as believed. Validated experiments are required in order to convince the clinical community of the worth of numerical tools such as finite element analysis (FEA) in AAA risk-prediction. Strain gauges have been used in the past to determine the strain on an AAA [5], however, the photoelastic method has also proved to be a useful tool in AAA biomechanics [6]. This paper examines the approach using three medium-sized patient-specific AAA cases at realistic pressure loadings.

scholarly journals On the Relative Impact of Intraluminal Thrombus Heterogeneity on Abdominal Aortic Aneurysm Mechanics

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Joseph R. Leach ◽  
Evan Kao ◽  
Chengcheng Zhu ◽  
David Saloner ◽  
Michael D. Hope
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Rupture Risk ◽  
Intraluminal Thrombus ◽  
Element Analysis ◽  
Aneurysm Wall ◽  
Abdominal Aortic

Intraluminal thrombus (ILT) is present in the majority of abdominal aortic aneurysms (AAA) of a size warranting consideration for surgical or endovascular intervention. The rupture risk of AAAs is thought to be related to the balance of vessel wall strength and the mechanical stress caused by systemic blood pressure. Previous finite element analyses of AAAs have shown that ILT can reduce and homogenize aneurysm wall stress. These works have largely considered ILT to be homogeneous in mechanical character or have idealized a stiffness distribution through the thrombus thickness. In this work, we use magnetic resonance imaging (MRI) to delineate the heterogeneous composition of ILT in 7 AAAs and perform patient–specific finite element analysis under multiple conditions of ILT layer stiffness disparity. We find that explicit incorporation of ILT heterogeneity in the finite element analysis is unlikely to substantially alter major stress analysis predictions regarding aneurysm rupture risk in comparison to models assuming a homogenous thrombus, provided that the maximal ILT stiffness is the same between models. Our results also show that under a homogeneous ILT assumption, the choice of ILT stiffness from values common in the literature can result in significantly larger variations in stress predictions compared to the effects of thrombus heterogeneity.

A Comparative Study of Biomechanical and Geometrical Attributes of Abdominal Aortic Aneurysms in the Asian and Caucasian Populations

2020 ◽  
Vol 142 (6) ◽  
Author(s):  
Tejas Canchi ◽  
Sourav S. Patnaik ◽  
Hong N. Nguyen ◽  
E. Y. K. Ng ◽  
Sriram Narayanan ◽  
...  
Keyword(s):  
Wall Thickness ◽  
Gaussian Curvature ◽  
Wall Stress ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Backward Elimination ◽  
Abdominal Aortic ◽  
Highly Correlated ◽  
Peak Wall Stress

Abstract In this work, we provide a quantitative assessment of the biomechanical and geometric features that characterize abdominal aortic aneurysm (AAA) models generated from 19 Asian and 19 Caucasian diameter-matched AAA patients. 3D patient-specific finite element models were generated and used to compute peak wall stress (PWS), 99th percentile wall stress (99th WS), and spatially averaged wall stress (AWS) for each AAA. In addition, 51 global geometric indices were calculated, which quantify the wall thickness, shape, and curvature of each AAA. The indices were correlated with 99th WS (the only biomechanical metric that exhibited significant association with geometric indices) using Spearman's correlation and subsequently with multivariate linear regression using backward elimination. For the Asian AAA group, 99th WS was highly correlated (R2 = 0.77) with three geometric indices, namely tortuosity, intraluminal thrombus volume, and area-averaged Gaussian curvature. Similarly, 99th WS in the Caucasian AAA group was highly correlated (R2 = 0.87) with six geometric indices, namely maximum AAA diameter, distal neck diameter, diameter–height ratio, minimum wall thickness variance, mode of the wall thickness variance, and area-averaged Gaussian curvature. Significant differences were found between the two groups for ten geometric indices; however, no differences were found for any of their respective biomechanical attributes. Assuming maximum AAA diameter as the most predictive metric for wall stress was found to be imprecise: 24% and 28% accuracy for the Asian and Caucasian groups, respectively. This investigation reveals that geometric indices other than maximum AAA diameter can serve as predictors of wall stress, and potentially for assessment of aneurysm rupture risk, in the Asian and Caucasian AAA populations.

scholarly journals Patient-specific modelling of abdominal aortic aneurysms: The influence of wall thickness on predicted clinical outcomes

2016 ◽  
Vol 38 (6) ◽  
pp. 526-537 ◽  
Author(s):  
Noel Conlisk ◽  
Arjan J. Geers ◽  
Olivia M.B. McBride ◽  
David E. Newby ◽  
Peter R. Hoskins
Keyword(s):  
Clinical Outcomes ◽  
Wall Thickness ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Abdominal Aortic

3D Reconstruction and Manufacture of Real Abdominal Aortic Aneurysms: From CT Scan to Silicone Model

2008 ◽  
Vol 130 (3) ◽  
Author(s):  
B. J. Doyle ◽  
L. G. Morris ◽  
A. Callanan ◽  
P. Kelly ◽  
D. A. Vorp ◽  
...  
Keyword(s):  
3D Reconstruction ◽  
Wall Thickness ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Infrarenal Aorta ◽  
Model Assessment ◽  
Percentage Difference ◽  
Abdominal Aortic ◽  
Computer Aided ◽  
Silicone Model

Abdominal aortic aneurysm (AAA) can be defined as a permanent and irreversible dilation of the infrarenal aorta. AAAs are often considered to be an aorta with a diameter 1.5 times the normal infrarenal aorta diameter. This paper describes a technique to manufacture realistic silicone AAA models for use with experimental studies. This paper is concerned with the reconstruction and manufacturing process of patient-specific AAAs. 3D reconstruction from computed tomography scan data allows the AAA to be created. Mould sets are then designed for these AAA models utilizing computer aided design∕computer aided manufacture techniques and combined with the injection-moulding method. Silicone rubber forms the basis of the resulting AAA model. Assessment of wall thickness and overall percentage difference from the final silicone model to that of the computer-generated model was performed. In these realistic AAA models, wall thickness was found to vary by an average of 9.21%. The percentage difference in wall thickness recorded can be attributed to the contraction of the casting wax and the expansion of the silicone during model manufacture. This method may be used in conjunction with wall stress studies using the photoelastic method or in fluid dynamic studies using a laser-Doppler anemometry. In conclusion, these patient-specific rubber AAA models can be used in experimental investigations, but should be assessed for wall thickness variability once manufactured.

Three-Dimensional Geometrical Characterization of Abdominal Aortic Aneurysms: Image-Based Wall Thickness Distribution

2009 ◽  
Vol 131 (6) ◽  
Author(s):  
Giampaolo Martufi ◽  
Elena S. Di Martino ◽  
Cristina H. Amon ◽  
Satish C. Muluk ◽  
Ender A. Finol
Keyword(s):  
Wall Thickness ◽  
Three Dimensional ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Patient Specific ◽  
Future Research ◽  
Geometrical Shape ◽  
Rupture Risk ◽  
Abdominal Aortic ◽  
Elective Repair

The clinical assessment of abdominal aortic aneurysm (AAA) rupture risk is based on the quantification of AAA size by measuring its maximum diameter from computed tomography (CT) images and estimating the expansion rate of the aneurysm sac over time. Recent findings have shown that geometrical shape and size, as well as local wall thickness may be related to this risk; thus, reliable noninvasive image-based methods to evaluate AAA geometry have a potential to become valuable clinical tools. Utilizing existing CT data, the three-dimensional geometry of nine unruptured human AAAs was reconstructed and characterized quantitatively. We propose and evaluate a series of 1D size, 2D shape, 3D size, 3D shape, and second-order curvature-based indices to quantify AAA geometry, as well as the geometry of a size-matched idealized fusiform aneurysm and a patient-specific normal abdominal aorta used as controls. The wall thickness estimation algorithm, validated in our previous work, is tested against discrete point measurements taken from a cadaver tissue model, yielding an average relative difference in AAA wall thickness of 7.8%. It is unlikely that any one of the proposed geometrical indices alone would be a reliable index of rupture risk or a threshold for elective repair. Rather, the complete geometry and a positive correlation of a set of indices should be considered to assess the potential for rupture. With this quantitative parameter assessment, future research can be directed toward statistical analyses correlating the numerical values of these parameters with the risk of aneurysm rupture or intervention (surgical or endovascular). While this work does not provide direct insight into the possible clinical use of the geometric parameters, we believe it provides the foundation necessary for future efforts in that direction.

Abstract 107: Increased Peak Wall Stress in Women With Abdominal Aortic Aneurysms

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Eric Shang ◽  
Grace Wang ◽  
Ronald Fairman ◽  
Benjamin Jackson
Keyword(s):  
Wall Thickness ◽  
Aortic Wall ◽  
Wall Stress ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Rupture Risk ◽  
Intraluminal Thrombus ◽  
Abdominal Aortic ◽  
Aortic Wall Thickness ◽  
Peak Wall Stress

Objective: Women with abdominal aortic aneurysms (AAA) exhibit more rapid aneurysm growth and greater rupture risk at equivalent diameters relative to men. Evidence suggests that biomechanical peak wall stress (PWS) derived from finite element analysis of AAAs is a superior predictor of rupture compared to maximum transverse diameter (MTD). This study aimed to investigate differences in the calculated PWS of AAAs between men and women. Method: Men (n=35) and women (n=35) with infrarenal AAAs with 45-55mm MTD undergoing CTA were identified. Customized image processing algorithms extracted patient-specific AAA geometries from raw DICOM images. The resulting aortic reconstructions incorporated patient-specific and regionally resolved aortic wall thickness, intraluminal thrombus, and wall calcifications. Aortic models were loaded with 120mmHg blood pressure using commercially available FEA solvers. Results: Peak wall stress was found to be significantly higher in women (299±51 vs 257±53 kPA, P=0.001, see Figure). Neither MTD (50.5±3.1 vs 49.8±2.9 mm, P=0.34), mean aortic wall thickness (2.38±0.52 vs 2.34±0.50 mm, P=0.69), nor wall thickness at location of PWS (2.36±0.60 vs 2.20±0.46 mm, P=0.20) varied by sex. While there were no sex-associated differences in aneurysm volume (86.6±27.0 vs 94.8±25.5 cm 3 , P=0.76) or intraluminal thrombus volume (14.2±11.7 vs 16.3±13.4 mm, P=0.33), women’s AAAs had significantly increased maximum Gaussian curvature (0.032±0.011 vs 0.025±0.015 mm -2 , P=0.03). Conclusion: Comparably sized AAAs in women were shown to have significantly higher peak wall stress. Maximum gaussian curvature, a measure of aneurysm morphology, was significantly different between the two groups. These results suggest that men and women possess distinct aneurysm geometries, and that PWS-derived rupture risk prediction may provide a more reliable estimator of rupture risk in all patients.

scholarly journals Importance of initial aortic properties on the evolving regional anisotropy, stiffness and wall thickness of human abdominal aortic aneurysms

2012 ◽  
Vol 9 (74) ◽  
pp. 2047-2058 ◽  
Author(s):  
J. S. Wilson ◽  
S. Baek ◽  
J. D. Humphrey
Keyword(s):  
Wall Thickness ◽  
Computational Modelling ◽  
Wall Stress ◽  
Abdominal Aortic Aneurysms ◽  
Clinical Decision ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Initial State ◽  
Non Invasive ◽  
Abdominal Aortic

Complementary advances in medical imaging, vascular biology and biomechanics promise to enable computational modelling of abdominal aortic aneurysms to play increasingly important roles in clinical decision processes. Using a finite-element-based growth and remodelling model of evolving aneurysm geometry and material properties, we show that regional variations in material anisotropy, stiffness and wall thickness should be expected to arise naturally and thus should be included in analyses of aneurysmal enlargement or wall stress. In addition, by initiating the model from best-fit material parameters estimated for non-aneurysmal aortas from different subjects, we show that the initial state of the aorta may influence strongly the subsequent rate of enlargement, wall thickness, mechanical behaviour and thus stress in the lesion. We submit, therefore, that clinically reliable modelling of the enlargement and overall rupture-potential of aneurysms may require both a better understanding of the mechanobiological processes that govern the evolution of these lesions and new methods of determining the patient-specific state of the pre-aneurysmal aorta (or correlation to currently unaffected portions thereof) through knowledge of demographics, comorbidities, lifestyle, genetics and future non-invasive or minimally invasive tests.

Abstract 236: Local Wall Thickness in Finite Element Models Improves Prediction of Abdominal Aortic Aneurysm Growth

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Eric K Shang ◽  
Derek P Nathan ◽  
Ronald M Fairman ◽  
Edward Y Woo ◽  
Grace J Wang ◽  
...  
Keyword(s):  
Growth Rate ◽  
Finite Element ◽  
Clinical Outcomes ◽  
Wall Thickness ◽  
Aortic Aneurysms ◽  
Element Analysis ◽  
Abdominal Aortic ◽  
Variable Wall Thickness ◽  
Aneurysm Growth ◽  
Variable Wall

Objective Growing evidence suggests that peak wall stress (PWS) derived from finite element analysis (FEA) of abdominal aortic aneurysms (AAAs) predicts clinical outcomes better than diameter alone. Prior models assume uniform wall thickness (UWT). We hypothesize that inclusion of locally variable wall thickness (VWT) into FEA of AAAs will improve the ability to predict clinical outcomes. Methods Patients with AAAs (n=26) undergoing radiologic surveillance were identified. Custom MATLAB algorithms generated UWT and VWT aortic geometries from CTA images, which were subsequently loaded with systolic blood pressure using FEA. PWS and aneurysm growth (as a proxy for rupture risk and the need for repair) were examined. Results The average radiologic follow-up time was 22.0±13.6 months and the average aneurysm growth rate was 2.8±1.7 mm/year. PWS in VWT models significantly differed from PWS in UWT models (238±68 vs 212±73 kPa, P=0.025). In our sample, initial aortic diameter was not found to be correlated with aneurysm growth (r=0.26, P=0.19). A stronger correlation was found between aneurysm growth and PWS derived from VWT models as compared to PWS from UWT models (r=0.86 vs r=0.58, P=0.032 by Fisher’s r to Z transformation). The three panels in the figure demonstrate the correlation between aneurysm growth rate and (1) initial diameter, (2) PWS using UWT model, and (3) PWS using VWT model, respectively. Conclusion The inclusion of locally variable wall thickness significantly improved the correlation between PWS and aneurysm growth. Aortic wall thickness should be incorporated into future FEA models to accurately predict clinical outcomes.

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