Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms

Singh, T.P., Moxon, J.V., Iyer, V., Gasser, T.C., Jenkins, J., and Golledge, J. (2021) Comparison of peak wall stress and peak wall rupture index in ruptured and asymptomatic intact abdominal aortic aneurysms. British Journal of Surgery, 108 (6). pp. 652-658.

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Background: Previous studies have suggested that finite element analysis (FEA) can estimate the rupture risk of an abdominal aortic aneurysm (AAA); however, the value of biomechanical estimates over measurement of AAA diameter alone remains unclear. This study aimed to compare peak wall stress (PWS) and peak wall rupture index (PWRI) in participants with ruptured and asymptomatic intact AAAs.

Methods: The reproducibility of semiautomated methods for estimating aortic PWS and PWRI from CT images was assessed. PWS and PWRI were estimated in people with ruptured AAAs and those with asymptomatic intact AAAs matched by orthogonal diameter on a 1 : 2 basis. Spearman's correlation coefficient was used to assess the association between PWS or PWRI and AAA diameter. Independent associations between PWS or PWRI and AAA rupture were identified by means of logistic regression analyses.

Results: Twenty individuals were included in the analysis of reproducibility. The main analysis included 50 patients with an intact AAA and 25 with a ruptured AAA. Median orthogonal diameter was similar in ruptured and intact AAAs (82·3 (i.q.r. 73·5–92·0) versus 81·0 (73·2–92·4) mm respectively; P = 0·906). Median PWS values were 286·8 (220·2–329·6) and 245·8 (215·2–302·3) kPa respectively (P = 0·192). There was no significant difference in PWRI between the two groups (P = 0·982). PWS and PWRI correlated positively with orthogonal diameter (both P < 0·001). Participants with high PWS, but not PWRI, were more likely to have a ruptured AAA after adjusting for potential confounders (odds ratio 5·84, 95 per cent c.i. 1·22 to 27·95; P = 0·027). This association was not maintained in all sensitivity analyses.

Conclusion: High aortic PWS had an inconsistent association with greater odds of aneurysm rupture in patients with a large AAA.

Item ID: 64684
Item Type: Article (Research - C1)
ISSN: 1365-2168
Keywords: peak wall stress; peak wall rupture index; PWS; PWRI; abdominal aortic aneurysm; AAA
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Copyright Information: © 2020 BJS Society Ltd.
Funders: Townsville Hospital and Health Services Study, Education and Research Trust Fund, Queensland Government (QG), National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC Practitioner Fellowship 1117061, QG Senior Clinical Research Fellowship, QG Advance Queensland Mid-Career fellowship, QG Junior Doctor Research Fellowship
Date Deposited: 21 Oct 2020 07:52
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320199 Cardiovascular medicine and haematology not elsewhere classified @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 100%
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