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Polzer S, Gasser TC. Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index. J R Soc Interface 2016; 12:20150852. [PMID: 26631334 DOI: 10.1098/rsif.2015.0852] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n = 7) and intact (n = 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly (p = 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach.
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Affiliation(s)
- Stanislav Polzer
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Brno University of Technology, Brno, Czech Republic
| | - T Christian Gasser
- KTH Solid Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Stockholm, Sweden
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Indrakusuma R, Jalalzadeh H, Planken RN, Marquering HA, Legemate DA, Koelemay MJW, Balm R. Biomechanical Imaging Markers as Predictors of Abdominal Aortic Aneurysm Growth or Rupture: A Systematic Review. Eur J Vasc Endovasc Surg 2016; 52:475-486. [PMID: 27558090 DOI: 10.1016/j.ejvs.2016.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Biomechanical characteristics, such as wall stress, are important in the pathogenesis of abdominal aortic aneurysms (AAA) and can be visualised and quantified using imaging techniques. This systematic review aims to present an overview of all biomechanical imaging markers that have been studied in relation to AAA growth and rupture. METHODS This systematic review followed the PRISMA guidelines. A search in Medline, Embase, and the Cochrane Library identified 1503 potentially relevant articles. Studies were included if they assessed biomechanical imaging markers and their potential association with growth or rupture. RESULTS Twenty-seven articles comprising 1730 patients met the inclusion criteria. Eighteen studies performed wall stress analysis using finite element analysis (FEA), 13 of which used peak wall stress (PWS) to quantify wall stress. Ten of 13 case control FEA studies reported a significantly higher PWS for symptomatic or ruptured AAAs than for intact AAAs. However, in some studies there was confounding bias because of baseline differences in aneurysm diameter between groups. Clinical heterogeneity in methodology obstructed a meaningful meta-analysis of PWS. Three of five FEA studies reported a significant positive association between several wall stress markers, such as PWS and 99th percentile stress, and growth. One study reported a significant negative association and one other study reported no significant association. Studies assessing wall compliance, the augmentation index and wall stress analysis using Laplace's law, computational fluid dynamics and fluid structure interaction were also included in this systematic review. CONCLUSIONS Although PWS is significantly higher in symptomatic or ruptured AAAs in most FEA studies, confounding bias, clinical heterogeneity, and lack of standardisation limit the interpretation and generalisability of the results. Also, there is conflicting evidence on whether increased wall stress is associated with growth.
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Affiliation(s)
- R Indrakusuma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - H Jalalzadeh
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - H A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - D A Legemate
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M J W Koelemay
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R Balm
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Martufi G, Lindquist Liljeqvist M, Sakalihasan N, Panuccio G, Hultgren R, Roy J, Gasser TC. Local Diameter, Wall Stress, and Thrombus Thickness Influence the Local Growth of Abdominal Aortic Aneurysms. J Endovasc Ther 2016; 23:957-966. [DOI: 10.1177/1526602816657086] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To investigate the influence of the local diameter, the intraluminal thrombus (ILT) thickness, and wall stress on the local growth rate of abdominal aortic aneurysms. Methods: The infrarenal aortas of 90 asymptomatic abdominal aortic aneurysm (AAA) patients (mean age 70 years; 77 men) were retrospectively reconstructed from at least 2 computed tomography angiography scans (median follow-up of 1 year) and biomechanically analyzed with the finite element method. Each individual AAA model was automatically sliced orthogonally to the lumen centerline and represented by 100 cross sections with corresponding diameters, ILT thicknesses, and wall stresses. The data were grouped according to these parameters for comparison of differences among the variables. Results: Diameter growth was continuously distributed over the entire aneurysm sac, reaching absolute and relative median peaks of 3.06 mm/y and 7.3%/y, respectively. The local growth rate was dependent on the local baseline diameter, the local ILT thickness, and for wall segments not covered by ILT, also on the local wall stress level (all p<0.001). For wall segments that were covered by a thick ILT layer, wall stress did not affect the growth rate (p=0.08). Conclusion: Diameter is not only a strong global predictor but also a local predictor of aneurysm growth. In addition, and independent of the diameter, the ILT thickness and wall stress (for the ILT-free wall) also influence the local growth rate. The high stress sensitivity of nondilated aortic walls suggests that wall stress peaks could initiate AAA formation. In contrast, local diameters and ILT thicknesses determine AAA growth for dilated and ILT-covered aortic walls.
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Affiliation(s)
- Giampaolo Martufi
- Department of Civil Engineering, University of Calgary, Alberta, Canada
- Department of Solid Mechanics, Royal Institute of Technology, Stockholm, Sweden
| | | | - Natzi Sakalihasan
- Department of Cardiovascular Surgery, University Hospital of Liege, Belgium
| | - Giuseppe Panuccio
- Division of Vascular and Endovascular Surgery, University of Perugia, Hospital S. M. Misericordia, Perugia, Italy
- Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany
| | - Rebecka Hultgren
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Joy Roy
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - T. Christian Gasser
- Department of Solid Mechanics, Royal Institute of Technology, Stockholm, Sweden
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Volume growth of abdominal aortic aneurysms correlates with baseline volume and increasing finite element analysis-derived rupture risk. J Vasc Surg 2016; 63:1434-1442.e3. [DOI: 10.1016/j.jvs.2015.11.051] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
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55
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Villard C, Eriksson P, Hanemaaijer R, Lindeman JH, Hultgren R. The composition of collagen in the aneurysm wall of men and women. J Vasc Surg 2016; 66:579-585.e1. [PMID: 27234441 DOI: 10.1016/j.jvs.2016.02.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Loss of vessel wall integrity by degradation is essential for the development of abdominal aortic aneurysm (AAA) and ultimately its rupture. The observed greater rupture rate in women with AAA might be related to gender differences in the biomechanical properties of the aneurysm wall. The aim of the study was to compare the biomechanically important structure of collagen between men and women with AAA. METHODS Biopsies of the aneurysm walls were obtained during elective open repair of men (n = 14) and women (n = 14) treated for AAA. High-performance liquid chromatography (HPLC), Western blot, messenger RNA expression, and histochemical analyses were performed to assess the cross-linking and the amount and the composition of collagen. RESULTS There was neither a difference in the thickness of the aneurysm wall, nor in the histological evaluation of the collagen composition between the sexes. Relative collagen content in the aneurysm wall was similar in men and women, as assessed by messenger RNA expression and HPLC. Collagen cross-linking differed between the sexes; women had more lysyl pyridinoline (LP) than men (0.140 vs 0.07; P = .005), resulting in a lower hydroxyl pyridinoline (HP):LP ratio (3.28 vs 8.41; P = .003). There was no difference in messenger RNA and protein expressions of lysyl hydroxylase and lysyl oxidase to associate with the lower HP:LP ratio in women. CONCLUSIONS The composition of collagen in the aneurysm wall of men and women are in several aspects similar, with the exception of collagen cross-linking, suggesting that the difference in rupture rate between the sexes rather depend on the composition of other vessel wall structures.
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Affiliation(s)
- Christina Villard
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jan H Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Joldes GR, Miller K, Wittek A, Doyle B. A simple, effective and clinically applicable method to compute abdominal aortic aneurysm wall stress. J Mech Behav Biomed Mater 2016; 58:139-148. [PMID: 26282385 DOI: 10.1016/j.jmbbm.2015.07.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/22/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Grand Roman Joldes
- Vascular Engineering, Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Karol Miller
- Vascular Engineering, Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia.
| | - Adam Wittek
- Vascular Engineering, Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Barry Doyle
- Vascular Engineering, Intelligent Systems for Medicine Laboratory, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia; Centre for Cardiovascular Science, The University of Edinburgh, UK
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57
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Gasser TC. Biomechanical Rupture Risk Assessment: A Consistent and Objective Decision-Making Tool for Abdominal Aortic Aneurysm Patients. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2016; 4:42-60. [PMID: 27757402 DOI: 10.12945/j.aorta.2015.15.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/04/2016] [Indexed: 12/20/2022]
Abstract
Abdominal aortic aneurysm (AAA) rupture is a local event in the aneurysm wall that naturally demands tools to assess the risk for local wall rupture. Consequently, global parameters like the maximum diameter and its expansion over time can only give very rough risk indications; therefore, they frequently fail to predict individual risk for AAA rupture. In contrast, the Biomechanical Rupture Risk Assessment (BRRA) method investigates the wall's risk for local rupture by quantitatively integrating many known AAA rupture risk factors like female sex, large relative expansion, intraluminal thrombus-related wall weakening, and high blood pressure. The BRRA method is almost 20 years old and has progressed considerably in recent years, it can now potentially enrich the diameter indication for AAA repair. The present paper reviews the current state of the BRRA method by summarizing its key underlying concepts (i.e., geometry modeling, biomechanical simulation, and result interpretation). Specifically, the validity of the underlying model assumptions is critically disused in relation to the intended simulation objective (i.e., a clinical AAA rupture risk assessment). Next, reported clinical BRRA validation studies are summarized, and their clinical relevance is reviewed. The BRRA method is a generic, biomechanics-based approach that provides several interfaces to incorporate information from different research disciplines. As an example, the final section of this review suggests integrating growth aspects to (potentially) further improve BRRA sensitivity and specificity. Despite the fact that no prospective validation studies are reported, a significant and still growing body of validation evidence suggests integrating the BRRA method into the clinical decision-making process (i.e., enriching diameter-based decision-making in AAA patient treatment).
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Affiliation(s)
- T Christian Gasser
- KTH Royal Institute of Technology, KTH Solid Mechanics, Stockholm, Sweden
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58
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Phan L, Courchaine K, Azarbal A, Vorp D, Grimm C, Rugonyi S. A Geodesics-Based Surface Parameterization to Assess Aneurysm Progression. J Biomech Eng 2016; 138:054503. [PMID: 27003915 DOI: 10.1115/1.4033082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Indexed: 12/15/2022]
Abstract
Abdominal aortic aneurysm (AAA) intervention and surveillance is currently based on maximum transverse diameter, even though it is recognized that this might not be the best strategy. About 10% of patients with small AAA transverse diameters, for whom intervention is not considered, still rupture; while patients with large AAA transverse diameters, for whom intervention would have been recommended, have stable aneurysms that do not rupture. While maximum transverse diameter is easy to measure and track in clinical practice, one of its main drawbacks is that it does not represent the whole AAA and rupture seldom occurs in the region of maximum transverse diameter. By following maximum transverse diameter alone clinicians are missing information on the shape change dynamics of the AAA, and clues that could lead to better patient care. We propose here a method to register AAA surfaces that were obtained from the same patient at different time points. Our registration method could be used to track the local changes of the patient-specific AAA. To achieve registration, our procedure uses a consistent parameterization of the AAA surfaces followed by strain relaxation. The main assumption of our procedure is that growth of the AAA occurs in such a way that surface strains are smoothly distributed, while regions of small and large surface growth can be differentiated. The proposed methodology has the potential to unravel different patterns of AAA growth that could be used to stratify patient risks.
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59
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Schmitz-Rixen T, Keese M, Hakimi M, Peters A, Böckler D, Nelson K, Grundmann RT. Ruptured abdominal aortic aneurysm—epidemiology, predisposing factors, and biology. Langenbecks Arch Surg 2016; 401:275-88. [DOI: 10.1007/s00423-016-1401-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/04/2016] [Indexed: 12/19/2022]
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60
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Batagini NC, Ventura CAP, Raghavan ML, Chammas MC, Tachibana A, da Silva ES. Volumetry and biomechanical parameters detected by 3D and 2D ultrasound in patients with and without an abdominal aortic aneurysm. Vasc Med 2016; 21:209-16. [DOI: 10.1177/1358863x16629727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective was to demonstrate the ability of ultrasound (US) with 3D properties to evaluate volumetry and biomechanical parameters of the aorta in patients with and without abdominal aortic aneurysm (AAA). Thirty-one patients with normal aortas (group 1), 46 patients with AAA measuring 3.0–5.5 cm (group 2) and 31 patients with AAA ⩾ 5.5 cm (group 3) underwent a 2D/3D-US examination of the infra-renal aorta, and the images were post-processed prior to being analyzed. In the maximum diameter, the global circumferential strain and the global maximum rotation assessed by 2D speckle-tracking algorithms were compared among the three groups. The volumetry data obtained using 3D-US from 40 AAA patients were compared with the volumetry data obtained by a contemporary computed tomography (CT) scan. The median global circumferential strain was 2.0% (interquartile range (IR): 1.0–3.0), 1.0% (IR: 1.0–2.0) and 1.0% (IR: 1.0–1.75) in groups 1, 2 and 3, respectively ( p < 0.001). The median global maximum rotation decreased progressively from group 1 to group 3 (1.38º (IR: 0.77–2.13), 0.80º (IR: 0.57–1.0) and 0.50º (IR: 0.31–0.75), p < 0.001). AAA volume estimations by 3D-US correlated well with CT ( R2 = 0.76). In conclusion, US with 3D properties is non-invasive and has the potential to evaluate volumetry and biomechanical characteristics of AAA.
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Affiliation(s)
| | | | - Madhavan L Raghavan
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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61
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van Disseldorp EMJ, Hobelman KH, Petterson NJ, van de Vosse FN, van Sambeek MRHM, Lopata RGP. Influence of limited field-of-view on wall stress analysis in abdominal aortic aneurysms. J Biomech 2016; 49:2405-12. [PMID: 26924662 DOI: 10.1016/j.jbiomech.2016.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/29/2016] [Indexed: 11/29/2022]
Abstract
Abdominal aortic aneurysms (AAAs) are local dilations of the aorta which can lead to a fatal hemorrhage when ruptured. Wall stress analysis of AAAs has been widely reported in literature to predict the risk of rupture. Usually, the complete AAA geometry including the aortic bifurcation is obtained by computed tomography (CT). However, performing wall stress analysis based on 3D ultrasound (3D US) has many advantages over CT, although, the field-of-view (FOV) of 3D US is limited and the aortic bifurcation is not easily imaged. In this study, the influence of a limited FOV is examined by performing wall stress analysis on CT-based (total) AAA geometries in 10 patients, and observing the changes in 99th percentile stresses and median stresses while systematically limiting the FOV. Results reveal that changes in the 99th percentile wall stresses are less than 10% when the proximal and distal shoulders of the aneurysm are in the shortened FOV. Wall stress results show that the presence of the aortic bifurcation in the FOV does not influence the wall stresses in high stress regions. Hence, the necessity of assessing the complete FOV, including the aortic bifurcation, is of minor importance. When the proximal and distal shoulders of the AAA are in the FOV, peak wall stresses can be detected adequately.
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Affiliation(s)
- Emiel M J van Disseldorp
- Cardiovascular Biomechanics Group, department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Koen H Hobelman
- Cardiovascular Biomechanics Group, department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Niels J Petterson
- Cardiovascular Biomechanics Group, department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Cardiovascular Biomechanics Group, department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R H M van Sambeek
- Department of Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Cardiovascular Biomechanics Group, department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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High Resolution Strain Analysis Comparing Aorta and Abdominal Aortic Aneurysm with Real Time Three Dimensional Speckle Tracking Ultrasound. Eur J Vasc Endovasc Surg 2016; 51:187-93. [DOI: 10.1016/j.ejvs.2015.07.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/29/2015] [Indexed: 11/22/2022]
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63
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Wanhainen A, Mani K, Golledge J. Surrogate Markers of Abdominal Aortic Aneurysm Progression. Arterioscler Thromb Vasc Biol 2016; 36:236-44. [DOI: 10.1161/atvbaha.115.306538] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/14/2015] [Indexed: 12/25/2022]
Abstract
The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Standardized reporting of reproducible methods of measuring AAA diameter is essential. Newer imaging assessments, such as volume measurements, biomechanical analyses, and functional and molecular imaging, as well as circulating biomarkers, have potential to add important information about AAA progression. Currently, however, there is insufficient evidence to recommend their routine use in clinical practice.
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Affiliation(s)
- Anders Wanhainen
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| | - Kevin Mani
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
| | - Jonathan Golledge
- From the Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden (A.W., K.M.); The Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia (J.G.)
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64
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Doyle BJ, Miller K, Newby DE, Hoskins PR. Commentary: Computational Biomechanics–Based Rupture Prediction of Abdominal Aortic Aneurysms. J Endovasc Ther 2016; 23:121-4. [DOI: 10.1177/1526602815615821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Barry J. Doyle
- Vascular Engineering, Intelligent Systems for Medicine Laboratory, School of Mechanical and Chemical Engineering, The University of Western Australia, Perth, Australia
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Scotland, UK
| | - Karol Miller
- Vascular Engineering, Intelligent Systems for Medicine Laboratory, School of Mechanical and Chemical Engineering, The University of Western Australia, Perth, Australia
- Institute of Mechanics and Advanced Materials, Cardiff University, Cardiff, Wales, UK
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Scotland, UK
- Clinical Research Imaging Centre, University of Edinburgh, Scotland, UK
| | - Peter R. Hoskins
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Scotland, UK
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65
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Hendy K, Gunnarsson R, Cronin O, Golledge J. Infra-renal abdominal aortic calcification volume does not predict small abdominal aortic aneurysm growth. Atherosclerosis 2015; 243:334-8. [DOI: 10.1016/j.atherosclerosis.2015.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 01/16/2023]
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66
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Morris PD, Narracott A, von Tengg-Kobligk H, Silva Soto DA, Hsiao S, Lungu A, Evans P, Bressloff NW, Lawford PV, Hose DR, Gunn JP. Computational fluid dynamics modelling in cardiovascular medicine. Heart 2015; 102:18-28. [PMID: 26512019 PMCID: PMC4717410 DOI: 10.1136/heartjnl-2015-308044] [Citation(s) in RCA: 218] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022] Open
Abstract
This paper reviews the methods, benefits and challenges associated with the adoption and translation of computational fluid dynamics (CFD) modelling within cardiovascular medicine. CFD, a specialist area of mathematics and a branch of fluid mechanics, is used routinely in a diverse range of safety-critical engineering systems, which increasingly is being applied to the cardiovascular system. By facilitating rapid, economical, low-risk prototyping, CFD modelling has already revolutionised research and development of devices such as stents, valve prostheses, and ventricular assist devices. Combined with cardiovascular imaging, CFD simulation enables detailed characterisation of complex physiological pressure and flow fields and the computation of metrics which cannot be directly measured, for example, wall shear stress. CFD models are now being translated into clinical tools for physicians to use across the spectrum of coronary, valvular, congenital, myocardial and peripheral vascular diseases. CFD modelling is apposite for minimally-invasive patient assessment. Patient-specific (incorporating data unique to the individual) and multi-scale (combining models of different length- and time-scales) modelling enables individualised risk prediction and virtual treatment planning. This represents a significant departure from traditional dependence upon registry-based, population-averaged data. Model integration is progressively moving towards ‘digital patient’ or ‘virtual physiological human’ representations. When combined with population-scale numerical models, these models have the potential to reduce the cost, time and risk associated with clinical trials. The adoption of CFD modelling signals a new era in cardiovascular medicine. While potentially highly beneficial, a number of academic and commercial groups are addressing the associated methodological, regulatory, education- and service-related challenges.
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Affiliation(s)
- Paul D Morris
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Andrew Narracott
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Hendrik von Tengg-Kobligk
- University Institute for Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Daniel Alejandro Silva Soto
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Sarah Hsiao
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Angela Lungu
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Paul Evans
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Neil W Bressloff
- Faculty of Engineering & the Environment, University of Southampton, Southampton, UK
| | - Patricia V Lawford
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - D Rodney Hose
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Julian P Gunn
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK Insigneo Institute for In Silico Medicine, Sheffield, UK Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Erhart P, Roy J, de Vries JPPM, Liljeqvist ML, Grond-Ginsbach C, Hyhlik-Dürr A, Böckler D. Prediction of Rupture Sites in Abdominal Aortic Aneurysms After Finite Element Analysis. J Endovasc Ther 2015; 23:115-20. [PMID: 26496955 DOI: 10.1177/1526602815612196] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To associate regions of highest local rupture risk from finite element analysis (FEA) to subsequent rupture sites in abdominal aortic aneurysms (AAA). METHODS This retrospective multicenter study analyzed computed tomography angiography (CTA) data from 13 asymptomatic AAA patients (mean age 76 years; 8 men) experiencing rupture at a later point in time between 2005 and 2011. All patients had CTA scans before and during the rupture event. FEA was performed to calculate peak wall stress (PWS), peak wall rupture risk (PWRR), rupture risk equivalent diameters (RRED), and the intraluminal thrombus volume (ILTV). PWS and PWRR locations in the prerupture state were compared with subsequent CTA rupture findings. Visible contrast extravasation was considered a definite (n=5) rupture sign, while a periaortic hematoma was an indefinite (n=8) sign. A statistical comparison was performed between the 13-patient asymptomatic AAA group before and during rupture and a 23-patient diameter-matched asymptomatic AAA control group that underwent elective surgery. RESULTS The asymptomatic AAAs before rupture showed significantly higher PWRR and RRED values compared to the matched asymptomatic AAA control group (median values 0.74 vs 0.52 and 77 vs 59 mm, respectively; p<0.0001 for both). No statistical differences could be found for PWS and ILTV. Ruptured AAAs showed the highest maximum diameters, PWRR, and RRED values. In 7 of the ruptured AAAs (2 definite and 5 indefinite rupture signs), CTA rupture sites correlated with prerupture PWRR locations. CONCLUSION The location of the PWRR in unruptured AAAs predicted future rupture sites in several cases. Asymptomatic AAA patients with high PWRR and RRED values have an increased rupture risk.
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Affiliation(s)
- Philipp Erhart
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany
| | - Joy Roy
- Department of Surgical Sciences, Karolinska Hospital, Stockholm, Sweden
| | | | | | | | - Alexander Hyhlik-Dürr
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Germany
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Georg Y, Delay C, Schwein A, Lejay A, Thaveau F, Gaertner S, Stephan D, Heim F, Chakfe N. [Contribution of mathematical models and biomechanical properties in predicting the risk of abdominal aortic aneurysm rupture]. ACTA ACUST UNITED AC 2015; 41:63-8. [PMID: 26318549 DOI: 10.1016/j.jmv.2015.07.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/17/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rupture is the worst outcome of abdominal aortic aneurysm (AAA). The decision to operate should include counterbalancing the risk of aneurysm rupture against the risk of aneurysm repair, within the context of a patient's overall life expectancy. Current surgical guidelines are based on population studies, and important variables are missed in predicting individual risk of rupture. METHODS In this literature review, we focused on the contribution of biomechanical and mathematical models in predicting risk of AAA rupture. RESULTS Anatomical features as diameter asymmetry and lack of tortuosity are shown to be anatomical risk factors of rupture. Wall stiffness (due to modifications of elastin and collagen composition) and increased inflammatory response are also factors that affect the structural integrity of the AAA wall. Biomechanical studies showed that wall strength is lower in ruptured than non-ruptured AAA. Intra-luminal thrombus also has a big role to play in the occurrence of rupture. Current mathematical models allow more variables to be included in predicting individual risk of rupture. CONCLUSION Moving away from using maximal transverse diameter of the AAA as a unique predictive factor and instead including biological, structural and biomechanical variables in predicting individual risk of rupture will be essential in the future and will help gain precision and accuracy in surgical indications.
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Affiliation(s)
- Y Georg
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - C Delay
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - A Schwein
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - A Lejay
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - F Thaveau
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France
| | - S Gaertner
- Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Stephan
- Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - F Heim
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Laboratoire de physique et mécanique textile, ENSISA, 11, rue Alfred-Werner, 68093 Mulhouse cedex, France
| | - N Chakfe
- Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France.
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Sultan S, Hynes N, Kavanagh EP, Diethrich EB. How does the multilayer flow modulator work? The science behind the technical innovation. J Endovasc Ther 2015; 21:814-21. [PMID: 25453884 DOI: 10.1583/14-4858.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sherif Sultan
- 1 Western Vascular Institute and the Department of Vascular and Endovascular Surgery, University College Hospital Galway, Ireland
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Delay C, Lejay A, Deglise S, Mantz F, Schwein A, Gaertner S, Georg Y, Saucy F, Thaveau F, Corpataux JM, Chakfe N. [Should we treat abdominal aortic aneurysms from 5.0 cm in France while the cutoff is 5.5 cm in english-speaking countries?]. ACTA ACUST UNITED AC 2015; 41:1-3. [PMID: 26188688 DOI: 10.1016/j.jmv.2015.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/29/2015] [Indexed: 01/16/2023]
Affiliation(s)
- C Delay
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Lejay
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
| | - S Deglise
- Service de chirurgie vasculaire, CHU Vaudois, rue du Bugnon 21, 1011 Lausanne, Suisse
| | - F Mantz
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - A Schwein
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - S Gaertner
- Service de maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - Y Georg
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - F Saucy
- Service de chirurgie vasculaire, CHU Vaudois, rue du Bugnon 21, 1011 Lausanne, Suisse
| | - F Thaveau
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
| | - J-M Corpataux
- Service de chirurgie vasculaire, CHU Vaudois, rue du Bugnon 21, 1011 Lausanne, Suisse
| | - N Chakfe
- Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France
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Georgakarakos E, Gasser TC, Xenos M, Kontopodis N, Georgiadis GS, Ioannou CV. Applying findings of computational studies in vascular clinical practice: fact, fiction, or misunderstanding? J Endovasc Ther 2015; 21:434-8. [PMID: 24915594 DOI: 10.1583/14-4718e.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
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Determining the influence of calcification on the failure properties of abdominal aortic aneurysm (AAA) tissue. J Mech Behav Biomed Mater 2015; 42:154-67. [DOI: 10.1016/j.jmbbm.2014.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/21/2014] [Accepted: 11/03/2014] [Indexed: 11/20/2022]
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73
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Riveros F, Martufi G, Gasser TC, Rodriguez-Matas JF. On the Impact of Intraluminal Thrombus Mechanical Behavior in AAA Passive Mechanics. Ann Biomed Eng 2015; 43:2253-64. [DOI: 10.1007/s10439-015-1267-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022]
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Zhang P, Sun A, Zhan F, Luan J, Deng X. Hemodynamic study of overlapping bare-metal stents intervention to aortic aneurysm. J Biomech 2014; 47:3524-30. [DOI: 10.1016/j.jbiomech.2014.08.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/16/2014] [Accepted: 08/22/2014] [Indexed: 11/25/2022]
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75
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Georgakarakos E, Georgiadis GS, Ioannou CV. Finite element analysis methods in clinical practice: we have nothing to fear but fear itself! J Endovasc Ther 2014; 21:565-7. [PMID: 25101587 DOI: 10.1583/14-4695c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
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Erhart P, Grond-Ginsbach C, Hakimi M, Lasitschka F, Dihlmann S, Böckler D, Hyhlik-Dürr A. Finite Element Analysis of Abdominal Aortic Aneurysms: Predicted Rupture Risk Correlates With Aortic Wall Histology in Individual Patients. J Endovasc Ther 2014; 21:556-64. [DOI: 10.1583/14-4695.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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