%0 Journal Article
%T Aortic Lumen Area Is Increased in Ruptured Abdominal Aortic Aneurysms and Correlates to Biomechanical Rupture Risk
%A Antti Siika
%A Joy Roy
%A Moritz Lindquist Liljeqvist
%A Rebecka Hultgren
%A T. Christian Gasser
%J Journal of Endovascular Therapy
%@ 1545-1550
%D 2018
%R 10.1177/1526602818808292
%X Purpose: To investigate how 2-dimensional geometric parameters differ between ruptured and asymptomatic abdominal aortic aneurysms (AAAs) and provide a biomechanical explanation for the findings. Methods: The computed tomography angiography (CTA) scans of 30 patients (mean age 77¡À10 years; 23 men) with ruptured AAAs and 60 patients (mean age 76¡À8 years; 46 men) with asymptomatic AAAs were used to measure maximum sac diameter along the center lumen line, the cross-sectional lumen area, the total vessel area, the intraluminal thrombus (ILT) area, and corresponding volumes. The CTA data were segmented to create 3-dimensional patient-specific models for finite element analysis to compute peak wall stress (PWS) and the peak wall rupture index (PWRI). To reduce confounding from the maximum diameter, 2 diameter-matched groups were selected from the initial patient cohorts: 28 ruptured AAAs and another with 15 intact AAAs (diameters 74¡À12 vs 73¡À11, p=0.67). A multivariate model including the maximum diameter, the lumen area, and the ILT area of the 60 intact aneurysms was employed to predict biomechanical rupture risk parameters. Results: In the diameter-matched subgroup comparison, ruptured AAAs had a significantly larger cross-sectional lumen area (1954¡À1254 vs 1120¡À623 mm2, p=0.023) and lower ILT area ratio (55¡À24 vs 68¡À24, p=0.037). The ILT area (2836¡À1462 vs 2385¡À1364 mm2, p=0.282) and the total vessel area (3956¡À1170 vs 4338¡À1388 mm2, p=0.384) did not differ statistically between ruptured and intact aneurysms. The PWRI was increased in ruptured AAAs (0.80 vs 0.48, p<0.001), but the PWS was similar (249 vs 284 kPa, p=0.194). In multivariate regression analysis, lumen area was significantly positively associated with both PWS (p<0.001) and PWRI (p<0.01). The ILT area was also significantly positively associated with PWS (p<0.001) but only weakly with PWRI (p<0.01). The lumen area conferred a higher risk increase in both PWS and PWRI when compared with the ILT area. Conclusion: The lumen area is increased in ruptured AAAs compared to diameter-matched asymptomatic AAAs. Furthermore, this finding may in part be explained by a relationship with biomechanical rupture risk parameters, in which lumen area, irrespective of maximum diameter, increases PWS and PWRI. These observations thus suggest a possible method to improve prediction of rupture risk in AAAs by measuring the lumen area without the use of computational modeling
%K abdominal aortic aneurysm
%K aneurysm diameter
%K biomechanics
%K computed tomography angiography
%K finite element analysis
%K intraluminal thrombus
%K lumen area
%K rupture risk
%K ruptured aneurysm
%U https://journals.sagepub.com/doi/full/10.1177/1526602818808292