Microstructure and mechanics of healthy and aneurysmatic abdominal aortas: experimental analysis and modelling

A viscoelastic constitutive framework for aging muscular and elastic arteries

The evolution of arterial biomechanics and microstructure with age and disease plays a critical role in understanding the health and function of the cardiovascular system. Accurately capturing these adaptative processes and their effects on the mechanical environment is critical for predicting arterial responses. This challenge is exacerbated by the significant differences between elastic and muscular arteries, which have different structural organizations and functional demands. In this study, we aim to shed light to these adaptive processes by comparing the viscoelastic mechanics of autologous thoracic aortas (TA) and femoropopliteal arteries (FPA) in different age groups. We have extended our fractional viscoelastic framework, originally developed for FPA, to both types of arteries. To evaluate this framework, we analyzed experimental mechanical data from TA and FPA specimens from 21 individuals aged 13 to 73 years. Each specimen was subjected to a multi-ratio biaxial mechanical extension and relaxation test complemented by bidirectional histology to quantify the structural density and microstructural orientations. Our new constitutive model accurately captured the mechanical responses and microstructural differences of the tissues and closely matched the experimentally measured densities. It was found that the viscoelastic properties of collagen and smooth muscle cells (SMCs) in both the FPA and TA remained consistent with age, but the viscoelasticity of the SMCs in the FPA was twice that of the TA. Additionally, changes in collagen nonlinearity with age were similar in both TA and FPA. This model provides valuable insights into arterial mechanophysiology and the effects of pathological conditions on vascular biomechanics. STATEMENT OF SIGNIFICANCE: Developing durable treatments for arterial diseases necessitates a deeper understanding of how mechanical properties evolve with age in response to mechanical environments. In this work, we developed a generalized viscoelastic constitutive model for both elastic and muscular arteries and analyzed both the thoracic aorta (TA) and the femoropopliteal artery (FPA) from 21 donors aged 13 to 73. The derived parameters correlate well with histology, allowing further examination of how viscoelasticity evolves with age. Correlation between the TA and FPA of the same donors suggest that the viscoelasticity of the FPA may be influenced by the TA, necessitating more detailed analysis. In summary, our new model proves to be a valuable tool for studying arterial mechanophysiology and exploring pathological impacts.

Integration of cross-links, discrete fiber distributions and of a non-local theory in the Homogenized Constrained Mixture Model to Simulate Patient-Specific Thoracic Aortic Aneurysm Progression

Thoracic aortic aneurysms (TAA) represent a critical health issue for which computational models can significantly contribute to better understand the physiopathology. Among different computational frameworks, the Homogenized Constrained Mixture Theory has shown to be a computationally efficient option, allowing the inclusion of several mechanically significant constituents into a layer-specific mixture. Different patient-specific Growth and Remodeling (G&R) models correctly predicted TAA progression, although simplifications such as the inclusion of a limited number of collagen fibers and imposed boundary conditions might limit extensive analyses. The current study aims to enhance existing models by incorporating several discrete collagen fibers and to remove restrictive boundary conditions of the previous models. The implementation of discretized fiber dispersion presents a more realistic description of the vessel, while the removal of boundary conditions was addressed by including cross-links in the model to provide a supplemental stiffness against through-thickness shearing, a feature that was previously absent, and by the development of a non-local framework that ensures the stable deposition and degradation of collagen fibers. With these improvements, the current model represents a step forward towards more robust and comprehensive simulations of TAA growth.

Second harmonic generation microscopy, biaxial mechanical tests and fiber dispersion models in human skin biomechanics

Advanced numerical simulations of the mechanical behavior of human skin require thorough calibration of the material's constitutive models based on experimental ex vivo mechanical tests along with images of tissue microstructure for a variety of biomedical applications. In this work, a total of 14 human healthy skin samples and 4 additional scarred skin samples were experimentally analyzed to gain deep insights into the biomechanics of human skin. In particular, second harmonic generation (SHG) microscopy was used to extract detailed images of the distribution of collagen fibers, which were subsequently processed using a three-dimensional Fourier transform-based method recently proposed by the authors to quantify the distribution of fiber orientations. Mechanical tests under both biaxial and uniaxial loading were performed to calibrate the relevant mechanical parameters of two widely used constitutive models of soft fiber-reinforced biological tissues that account for non-symmetrical fiber dispersion. The calibration of the models allowed us to identify correlations between the mechanical parameters of the constitutive models considered. STATEMENT OF SIGNIFICANCE: Constitutive models for soft collagenous tissues can accurately reproduce the complex nonlinear and anisotropic mechanical behavior of skin. However, a comprehensive analysis of both microstructural and mechanical parameters is still missing for human skin. In this study, these parameters are determined by combining biaxial mechanical tests and SHG stacks of collagen fibers on ex vivo healthy human skin samples. The constitutive parameters are provided for two widely used hyperelastic models and enable accurate characterization of skin mechanical behavior for advanced numerical simulations.

Experimental Protocols to Test Aortic Soft Tissues: A Systematic Review

Experimental protocols are fundamental for quantifying the mechanical behaviour of soft tissue. These data are crucial for advancing the understanding of soft tissue mechanics, developing and calibrating constitutive models, and informing the development of more accurate and predictive computational simulations and artificial intelligence tools. This paper offers a comprehensive review of experimental tests conducted on soft aortic tissues, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, based on the Scopus, Web of Science, IEEE, Google Scholar and PubMed databases. This study includes a detailed overview of the test method protocols, providing insights into practical methodologies, specimen preparation and full-field measurements. The review also briefly discusses the post-processing methods applied to extract material parameters from experimental data. In particular, the results are analysed and discussed providing representative domains of stress-strain curves for both uniaxial and biaxial tests on human aortic tissue.

Mechanical, structural, and morphological differences in the iliac arteries

Iliac arteries play a crucial role in peripheral blood circulation. They are susceptible to various diseases, including aneurysms and atherosclerosis. Structure, material properties, and biomechanical forces acting on different regions of the iliac vasculature may contribute to the localization and progression of these pathologies. We examined 33 arterial specimens from common iliac (CI), external iliac (EI), and internal iliac (II) arteries obtained from 11 human donors (62 ± 12 years). We conducted morphometric, mechanical, and structural analyses using planar biaxial tests, constitutive modeling, and bi-directional histology on transverse and axial sections. The iliac arteries exhibited increased tortuosity and varying disease distribution with age. CI and II arteries displayed non-uniform age-related disease progression around their circumference, while EI remained healthy even in older individuals. Trends in load-free and stress-free thickness varied along the iliac vasculature. Longitudinally, EI exhibited the highest compliance compared to other iliac vessels. In contrast, CI was stiffest longitudinally, and EI was the stiffest circumferentially. Material parameters for all iliac vessels are reported for four common constitutive relations. Elastin near the internal elastic lamina displayed greater waviness in EI and II compared to CI. Also, EI had the least glycosaminoglycans (GAGs) and the highest elastin content. Our findings highlight variations in the morphological, mechanical, and structural properties of iliac arteries along their length. This data can inform vascular disease development and computational studies, and guide the development of biomimetic repair materials and devices tailored to specific iliac locations, improving vascular repair strategies.

Specimen width affects vascular tissue integrity for in-vitro characterisation

The preparation of slender specimens for in-vitro tissue characterisation could potentially alter mechanical tissue properties. To investigate this factor, rectangular specimens were prepared from the wall of the porcine aorta for uniaxial tensile loading. Varying strip widths of 16 mm, 8 mm, and 4 mm were achieved by excising zero, one, and three cuts within the specimen along the loading direction, respectively. While specimens loaded along the vessel's circumferential direction acquired consistent tissue properties, the width of test specimens influenced the results of axially loaded tissue; vascular wall stiffness was reduced by approximately 40% in specimens with strips 4 mm wide. In addition, the cross-loading stretch was strongly influenced by specimen strip width, and fiber sliding contributed to the softening of slender tensile specimens, an outcome from finite element analysis of test specimens. We may, therefore, conclude that cutting orthogonal to the main direction of collagen fibers introduces mechanical trauma that weakens slender tensile specimens, compromising the determination of representative mechanical vessel wall properties.

Multimodal Study of the Superior Mesenteric Artery Wall

BACKGROUND

To quantitatively analyze histological and fiber structure of the superior mesenteric artery (SMA) wall and to further explore the possible relationship between the architecture and histology changes of vessel wall and the occurrence of related diseases.

METHODS

Histological and fiber structure analysis were performed on SMA specimens obtained from 22 cadavers. The SMA specimens were divided into initial, curved, and distal segments, and each segment was separated into the anterior and posterior walls.

RESULTS

From the initial to the curved to the distal segment, the ratio of elastin decreased (31.4% ± 6.0%, 21.1% ± 5.8%, 18.6% ± 4.7%, respectively; P < 0.001), whereas the ratio of smooth muscle actin (24.5% ± 8.7%, 30.5% ± 6.8%, 36.1% ± 7.3%, respectively; P < 0.001) increased. Elastic fiber longitudinal amplitude of angular undulation was highest in the initial segment [7° (3.25°, 15°)] and lowest in the curved segment [2° (1°, 5°)]. In SMA curved segment, the anterior wall, when compared with the posterior wall, demonstrated a lower ratio of elastin (19.0% ± 5.8% vs. 23.3% ± 5.0%; P = 0.010) and collagen (41.4% ± 12.3% vs. 49.0% ± 10.2%; P = 0.032), a lower elastic fiber longitudinal amplitude of angular undulation [1° (1°, 5°) vs. 3° (2°, 5.25°); P = 0.013], a lower average fiber diameter (8.06 ± 0.36 pixels vs. 8.45 ± 0.50 pixels; P = 0.005), and a lower average segment length (17.96 ± 1.59 pixels vs. 20.05 ± 2.33 pixels; P = 0.001).

CONCLUSIONS

SMA wall structure varies along the circumferential and axial directions, the presence of dense undulated elastic fiber protects the SMA initial segment of from dissection and aneurysm, but highly cross-linked collagen fiber here increases the likelihood of plaque formation. In the anterior wall of the curved segment, lower elastin and collagen content, lower elastic fiber undulation, and higher degree of collagen fiber cross-linking leads to the occurrence of SMA dissection and aneurysm. In the distal segment, high levels of vascular smooth muscle cells and bundles of long collagen fiber offer protection against the development of SMA-related diseases.

Multimodal experimental studies of the passive mechanical behavior of human aortas: Current approaches and future directions

Cardiovascular diseases are the leading cause of death worldwide and include, among others, critical conditions of the aortic wall. Importantly, such critical conditions require effective diagnosis and treatment, which are not yet accurate enough. However, they could be significantly strengthened with predictive material models of the aortic wall. In particular, such predictive models could support surgical decisions, preoperative planning, and estimation of postoperative tissue remodeling. However, developing a predictive model requires experimental data showing both structural parameters and mechanical behavior. Such experimental data can be obtained using multimodal experiments. This review therefore discusses the current approaches to multimodal experiments. Importantly, the strength of the aortic wall is determined primarily by its passive components, i.e., mainly collagen, elastin, and proteoglycans. Therefore, this review focuses on multimodal experiments that relate the passive mechanical behavior of the human aortic wall to the structure and organization of its passive components. In particular, the multimodal experiments are classified according to the expected results. Multiple examples are provided for each experimental class and summarized with highlighted advantages and disadvantages of the method. Finally, future directions of multimodal experiments are envisioned and evaluated. STATEMENT OF SIGNIFICANCE: Multimodal experiments are innovative approaches that have gained interest very quickly, but also recently. This review presents therefore a first clear summary of groundbreaking research in the field of multimodal experiments. The benefits and limitations of various types of multimodal experiments are thoroughly discussed, and a comprehensive overview of possible results is provided. Although this review focuses on multimodal experiments performed on human aortic tissues, the methods used and described are not limited to human aortic tissues but can be extended to other soft materials.

Shape or size matters? Towards standard reporting of tensile testing parameters for human soft tissues: systematic review and finite element analysis

Material properties of soft-tissue samples are often derived through uniaxial tensile testing. For engineering materials, testing parameters (e.g., sample geometries and clamping conditions) are described by international standards; for biological tissues, such standards do not exist. To investigate what testing parameters have been reported for tensile testing of human soft-tissue samples, a systematic review of the literature was performed using PRISMA guidelines. Soft tissues are described as anisotropic and/or hyperelastic. Thus, we explored how the retrieved parameters compared against standards for engineering materials of similar characteristics. All research articles published in English, with an Abstract, and before 1 January 2023 were retrieved from databases of PubMed, Web of Science, and BASE. After screening of articles based on search terms and exclusion criteria, a total 1,096 articles were assessed for eligibility, from which 361 studies were retrieved and included in this review. We found that a non-tapered shape is most common (209 of 361), followed by a tapered sample shape (92 of 361). However, clamping conditions varied and were underreported (156 of 361). As a preliminary attempt to explore how the retrieved parameters might influence the stress distribution under tensile loading, a pilot study was performed using finite element analysis (FEA) and constitutive modeling for a clamped sample of little or no fiber dispersion. The preliminary FE simulation results might suggest the hypothesis that different sample geometries could have a profound influence on the stress-distribution under tensile loading. However, no conclusions can be drawn from these simulations, and future studies should involve exploring different sample geometries under different computational models and sample parameters (such as fiber dispersion and clamping effects). Taken together, reporting and choice of testing parameters remain as challenges, and as such, recommendations towards standard reporting of uniaxial tensile testing parameters for human soft tissues are proposed.

Uncertainty quantification of the wall thickness and stiffness in an idealized dissected aorta

Personalized treatment informed by computational models has the potential to markedly improve the outcome for patients with a type B aortic dissection. However, existing computational models of dissected walls significantly simplify the characteristic false lumen, tears and/or material behavior. Moreover, the patient-specific wall thickness and stiffness cannot be accurately captured non-invasively in clinical practice, which inevitably leads to assumptions in these wall models. It is important to evaluate the impact of the corresponding uncertainty on the predicted wall deformations and stress, which are both key outcome indicators for treatment optimization. Therefore, a physiology-inspired finite element framework was proposed to model the wall deformation and stress of a type B aortic dissection at diastolic and systolic pressure. Based on this framework, 300 finite element analyses, sampled with a Latin hypercube, were performed to assess the global uncertainty, introduced by 4 uncertain wall thickness and stiffness input parameters, on 4 displacement and stress output parameters. The specific impact of each input parameter was estimated using Gaussian process regression, as surrogate model of the finite element framework, and a δ moment-independent analysis. The global uncertainty analysis indicated minor differences between the uncertainty at diastolic and systolic pressure. For all output parameters, the 4th quartile contained the major fraction of the uncertainty. The parameter-specific uncertainty analysis elucidated that the material stiffness and relative thickness of the dissected membrane were the respective main determinants of the wall deformation and stress. The uncertainty analysis provides insight into the effect of uncertain wall thickness and stiffness parameters on the predicted deformation and stress. Moreover, it emphasizes the need for probabilistic rather than deterministic predictions for clinical decision making in aortic dissections.

Layer-Specific Properties of the Human Infra-Renal Aorta During Aging Considering Pre/Post-Failure Damage

There is little information on the layer-specific failure properties of the adult human abdominal aorta, and there has been no quantification of postfailure damage. Infra-renal aortas were thus taken from forty-seven autopsy subjects and cut into 870 intact-wall and layer strips that underwent uni-axial-tensile testing. Intact-wall failure stress did not differ significantly (p > 0.05) from the medial value longitudinally, nor from the intimal and medial values circumferentially, which were the lowest recorded values. Intact-wall failure stretch did not differ (p > 0.05) from the medial value in either direction. Intact-wall prefailure stretch (defined as failure stretch-stretch at the initiation of the concave phase of the stress-stretch response) did not differ (p > 0.05) from the intimal and medial values, and intact-wall postfailure stretch (viz., full-rupture stretch-failure stretch) did not differ (p > 0.05) from the adventitial value since the adventitia was the last layer to rupture, being most extensible albeit under residual tension. Intact-wall failure stress and stretch declined from 20 to 60 years, explained by steady declines throughout the lifetime of their medial counterparts, implicating beyond 60 years the less age-varying failure properties of the intima under minimal residual compression. The positive correlation of postfailure stretch with age counteracted the declining failure stretch, serving as a compensatory mechanism against rupture. Hypertension, diabetes, and coronary artery disease adversely affected the intact-wall and layer-specific failure stretches while increasing stiffness.

Computational Study of Abdominal Aortic Aneurysm Walls Accounting for Patient-Specific Non-Uniform Intraluminal Thrombus Thickness and Distinct Material Models: A Pre- and Post-Rupture Case

An intraluminal thrombus (ILT) is present in the majority of abdominal aortic aneurysms, playing a crucial role in their growth and rupture. Although most computational studies do not include the ILT, in the present study, this is taken into account, laying out the whole simulation procedure, namely, from computed tomography scans to medical image segmentation, geometry reconstruction, mesh generation, biomaterial modeling, finite element analysis, and post-processing, all carried out in open software. By processing the tomography scans of a patient's aneurysm before and after rupture, digital twins are reconstructed assuming a uniform aortic wall thickness. The ILT and the aortic wall are assigned different biomaterial models; namely, the first is modeled as an isotropic linear elastic material, and the second is modeled as the Mooney-Rivlin hyperelastic material as well as the transversely isotropic hyperelastic Holzapfel-Gasser-Ogden nonlinear material. The implementation of the latter requires the designation of local Cartesian coordinate systems in the aortic wall, suitably oriented in space, for the proper orientation of the collagen fibers. The composite aneurysm geometries (ILT and aortic wall structures) are loaded with normal and hypertensive static intraluminal pressure. Based on the calculated stress and strain distributions, ILT seems to be protecting the aneurysm from a structural point of view, as the highest stresses appear in the thrombus-free areas of the aneurysmal wall.

Fourier transform-based method for quantifying the three-dimensional orientation distribution of fibrous units

Several materials and tissues are characterized by a microstructure composed of fibrous units embedded in a ground matrix. In this paper, a novel three-dimensional (3D) Fourier transform-based method for quantifying the distribution of fiber orientations is presented. The method allows for an accurate identification of individual fiber families, their in-plane and out-of-plane dispersion, and showed fast computation times. We validated the method using artificially generated 3D images, in terms of fiber dispersion by considering the error between the standard deviation of the reconstructed and the prescribed distributions of the artificial fibers. In addition, we considered the measured mean orientation angles of the fibers and validated the robustness using a measure of fiber density. Finally, the method is employed to reconstruct a full 3D view of the distribution of collagen fiber orientations based on in vitro second harmonic generation microscopy of collagen fibers in human and mouse skin. The dispersion parameters of the reconstructed fiber network can be used to inform mechanical models of soft fiber-reinforced materials and biological tissues that account for non-symmetrical fiber dispersion.

Effect of Ultraviolet Radiation on the Enzymolytic and Biomechanical Profiles of Abdominal Aortic Adventitia Tissue

BACKGROUND

The abdominal aortic aneurysm (AAA) is defined as an increase in aortic diameter by more than 50% and is associated with a high risk of rupture and mortality without treatment. The aim of this study is to analyze the role of aortic adventitial collagen photocrosslinking by UV-A irradiation on the biomechanical profile of the aortic wall.

METHODS

This experimental study is structured in two parts: the first part includes in vitro uniaxial biomechanical evaluation of porcine adventitial tissue subjected to either short-term elastolysis or long-term collagenolysis in an attempt to duplicate two extreme situations as putative stages of aneurysmal degeneration. In the second part, we included biaxial biomechanical evaluation of in vitro human abdominal aortic adventitia and human AAA adventitia specimens. Biomechanical profiles were examined for porcine and human aortic tissue before and after irradiation with UV-A light (365 nm wavelength).

RESULTS

On the porcine aortic sample, the enhancing effect of irradiation was evident both on the tissue subjected to elastolysis, which had a high collagen-to-elastin ratio, and on the tissue subjected to prolonged collagenolysis despite being considerably depleted in collagen. Further, the effect of irradiation was conclusively demonstrated in the human adventitia samples, where significant post-irradiation increases in Cauchy stress (longitudinal axis: p = 0.001, circumferential axis: p = 0.004) and Young's modulus (longitudinal axis: p = 0.03, circumferential axis: p = 0.004) were recorded. Moreover, we have a stronger increase in the strengthening of the AAA adventitia samples following the exposure to UV-A irradiation (p = 0.007) and a statistically significant but not very important increase (p = 0.021) regarding the stiffness in the circumferential axis.

CONCLUSIONS

The favorable effect of UV irradiation on the strength and stiffness of degraded aortic adventitia in experimental situations mimicking early and later stages of aneurysmal degeneration is essential for the development and potential success of procedures to prevent aneurysmal ruptures. The experiments on human normal and aneurysmal adventitial tissue confirmed the validity and potential success of a procedure based on exposure to UV-A radiation.

Biomechanical characterization of the passive porcine stomach

The complex mechanics of the gastric wall facilitates the main digestive tasks of the stomach. However, the interplay between the mechanical properties of the stomach, its microstructure, and its vital functions is not yet fully understood. Importantly, the pig animal model is widely used in biomedical research for preliminary or ethically prohibited studies of the human digestion system. Therefore, this study aims to thoroughly characterize the mechanical behavior and microstructure of the porcine stomach. For this purpose, multiple quasi-static mechanical tests were carried out with three different loading modes, i.e., planar biaxial extension, radial compression, and simple shear. Stress-relaxation tests complemented the quasi-static experiments to evaluate the deformation and strain-dependent viscoelastic properties. Each experiment was conducted on specimens of the complete stomach wall and two separate layers, mucosa and muscularis, from each of the three gastric regions, i.e., fundus, body, and antrum. The significant preconditioning effects and the considerable regional and layer-specific differences in the tissue response were analyzed. Furthermore, the mechanical experiments were complemented with histology to examine the influence of the microstructural composition on the macrostructural mechanical response and vice versa. Importantly, the shear tests showed lower stresses in the complete wall compared to the single layers which the loose network of submucosal collagen might explain. Also, the stratum arrangement of the muscularis might explain mechanical anisotropy during tensile tests. This study shows that gastric tissue is characterized by a highly heterogeneous microstructure with regional variations in layer composition reflecting not only functional differences but also diverse mechanical behavior. STATEMENT OF SIGNIFICANCE: Unfortunately, only few experimental data on gastric tissue are available for an adequate material parameter and model estimation. The present study therefore combines layer- and region-specific stomach wall mechanics obtained under multiple loading conditions with histological insights into the heterogeneous microstructure. On the one hand, the extensive data sets of this study expand our understanding of the interplay between gastric mechanics, motility and functionality, which could help to identify and treat associated pathologies. On the other hand, such data sets are of high relevance for the constitutive modeling of stomach tissue, and its application in the field of medical engineering, e.g., in the development of surgical staplers and the improvement of bariatric surgical interventions.

A two-scale numerical study on the mechanobiology of abdominal aortic aneurysms

Abdominal aortic aneurysms (AAAs) are a serious condition whose pathophysiology is related to phenomena occurring at different length scales. To gain a better understanding of the disease, this work presents a multi-scale computational study that correlates AAA progression with microstructural and mechanical alterations in the tissue. Macro-scale geometries of a healthy aorta and idealized aneurysms with increasing diameter are developed on the basis of existing experimental data and subjected to physiological boundary conditions. Subsequently, microscopic representative volume elements of the abluminal side of each macro-model are employed to analyse the local kinematics at the cellular scale. The results suggest that the formation of the aneurysm disrupts the micromechanics of healthy tissue, which could trigger collagen growth and remodelling by mechanosensing cells. The resulting changes to the macro-mechanics and microstructure of the tissue seem to establish a new homeostatic state at the cellular scale, at least for the diameter range investigated.

Morpho-mechanical mapping of human dura mater microstructure

The human dura mater is known to impact vastly traumatic brain injury mechanopathology. In spite of this involvement, dura mater is typically neglected in computational and physical human head models. The lack of location-dependent microstructural and related mechanical data of dura mater may be considered a rationale behind this simplification. The anisotropic nature of dura mater under various loading conditions so far remains unelucidated. Furthermore, principal collagen fiber orientation is yet to be quantified for a morpho-mechanically-informed material model on the dura mater. This study aims to assess how location-dependent mechanical anisotropy is linked to principal collagen fiber orientation. Uniaxial extension tests were performed in a heated tissue bath for 60 samples from six individuals and correlated to the three-dimensional collagen structure in four individuals using second-harmonic generation (SHG) imaging. Failure stress and stretch at failure, elastic modulus, and a microstructurally motivated material model were integrated to examine local differences in dura mater morpho-mechanics. The quantitative observation of collagen fiber orientation and dispersion confirmed that collagen is highly aligned in the human dura mater and that both fiber orientation and dispersion differ depending on the location investigated. This observation provides a possible explanation for the previously observed isotropic mechanical behavior, as the main collagen fiber direction is not oriented along the anterior-posterior or medial-lateral direction at most of the mapped locations. Additionally, these site-dependent structural properties have implications for the mechanical load response and therefore potentially for the regional functions dura mater has to fulfill. The here chosen non-symmetrical fiber dispersion material model fits the data well and provides a comprehensive parameter base for further studies and future finite element models. STATEMENT OF SIGNIFICANCE: The human dura mater greatly affects traumatic brain injury mechanisms, but it is often ignored in computational and physical head models. This is because there is a lack of detailed microstructural and mechanical data specific to the dura mater. Its anisotropic nature and collagen fiber orientation have not been fully understood, hindering the development of an accurate material model. Hence, this study combines morphological data on collagen fiber orientation and dispersion at multiple locations of human cranial dura mater, and links microstructure to location-specific load-displacement behavior. It provides microstructurally informed mechanical information towards realistic head models for predicting location-dependent tissue behavior and failure for assessing brain injury and graft material development.

Numerical investigation on circular and elliptical bulge tests for inverse soft tissue characterization

The acquisition of insights concerning the mechanobiology of aneurysmatic aortic tissues is an important field of investigation. The complete characterization of aneurysm mechanical behaviour can be carried out by biaxial experimental tests on ex vivo specimens. In literature, several works proposed bulge inflation tests as a valid method to analyse aneurysmatic tissue. Bulge test data processing requires the adoption of digital image correlation and inverse analysis approaches to estimate strain and stress distributions, respectively. In this context, however, the accuracy of inverse analysis method has not been evaluated yet. This aspect appears particularly interesting given the anisotropic behaviour of the soft tissue and the possibility to adopt different die geometries. The goal of this study is to provide an accuracy characterization of the inverse analysis applied to the bulge test technique using a numerical approach. In particular, different cases of bulge inflation were simulated in a finite element environment as a reference. To investigate the effect of tissue anisotropic degree and bulge die geometries (circular and elliptical), different input parameters were considered to obtain multiple test cases. The specimen deformed shapes, resulting from the reference finite element simulations, were then analysed through an inverse analysis approach to produce an estimation of stress distributions. The estimated stresses were, at last, compared with the values from the reference finite element simulations. The results demonstrated that the circular die geometry produces a satisfactory estimation accuracy only under certain conditions of material quasi-isotropy. On the other hand, the choice of an elliptical bulge die was proven to be more suitable for the analysis of anisotropic tissues.

Changes in the microstructure of the human aortic adventitia under biaxial loading investigated by multi-photon microscopy

Among the three layers of the aortic wall, the media is primarily responsible for its mechanical properties, but the adventitia prevents the aorta from overstretching and rupturing. The role of the adventitia is therefore crucial with regard to aortic wall failure, and understanding the load-induced changes in tissue microstructure is of high importance. Specifically, the focus of this study is on the changes in collagen and elastin microstructure in response to macroscopic equibiaxial loading applied to the aortic adventitia. To observe these changes, multi-photon microscopy imaging and biaxial extension tests were performed simultaneously. In particular, microscopy images were recorded at 0.02 stretch intervals. The microstructural changes of collagen fiber bundles and elastin fibers were quantified with the parameters of orientation, dispersion, diameter, and waviness. The results showed that the adventitial collagen was divided from one into two fiber families under equibiaxial loading conditions. The almost diagonal orientation of the adventitial collagen fiber bundles remained unchanged, but the dispersion was substantially reduced. No clear orientation of the adventitial elastin fibers was observed at any stretch level. The waviness of the adventitial collagen fiber bundles decreased under stretch, but the adventitial elastin fibers showed no change. These original findings highlight differences between the medial and adventitial layers and provide insight into the stretching process of the aortic wall. STATEMENT OF SIGNIFICANCE: To provide accurate and reliable material models, it is essential to understand the mechanical behavior of the material and its microstructure. Such understanding can be enhanced with tracking of the microstructural changes caused by mechanical loading of the tissue. This study provides therefore a unique dataset of structural parameters of the human aortic adventitia obtained under equibiaxial loading. The structural parameters describe orientation, dispersion, diameter, and waviness of collagen fiber bundles and elastin fibers. Eventually, the microstructural changes in the human aortic adventitia are compared with the microstructural changes in the human aortic media from a previous study. This comparison reveals the cutting-edge findings on the differences in the response to the loading between these two human aortic layers.

Development and mechanical characterization of decellularized scaffolds for an active aortic graft

Decellularized porcine aortas are proposed as scaffolds for revolutionary active aortic grafts. A change in the static and dynamic mechanical properties, associated with the microstructure of elastin and collagen fibers, corresponds to alteration in the cyclic expansion and perfusion, in addition to possible graft damage. Therefore, the present study thoroughly investigates the mechanical response of the decellularized scaffolds of human and porcine origin to static and dynamic mechanical loads. The responses of the native human and porcine aortas are also compared; this is unavailable in the literature. Because the aorta is subjected to pulsatile blood pressure, dynamical responses to cyclic loads and their associated viscoelastic properties are particularly relevant for advanced graft design. In parallel, this study examines the microstructure of the decellularized aorta. The resulting data are compared to the analogous data obtained for the native human and porcine tissues. The results indicate that by using an optimized decellularization protocol - based on sodium dodecyl sulfate (SDS) and DNase - that minimizes mechanical and structural changes of the tissue, layered scaffolds with static and dynamic properties very similar to natural human aortas are obtained. In particular, a decellularized porcine aorta is non-inferior to a decellularized human aorta. STATEMENT OF SIGNIFICANCE: About 55,000 patients undergo abdominal aortic aneurysm repair annually in the USA. The currently implanted grafts present a large mechanical mismatch with the native tissue. This increases the pulsatile nature of the blood flow with negative consequences to the organ perfusion. For this reason, biomimetic and mechanically compatible grafts for aortic repair are urgently needed and they can be obtained through tissue engineering. In this study, scaffolds from porcine and human aortas are obtained from an optimized decellularization protocol. They are accurately compared to the native tissue and present the ideal static and dynamic mechanical properties for developing innovative aortic grafts.

Layer-specific fiber distribution in arterial tissue modeled as a constrained mixture

Collagen fibers and their orientation greatly influence an artery's mechanical characteristics, determining its transversely isotropic behavior. It is generally assumed that these fibers are deposited along a preferred direction to maximize the load bearing capacity of the vessel wall. This implies a large spatial variation in collagen orientation which can be reconstructed in numerical models using so-called reorientation algorithms. Until now, these algorithms have used the classical continuum mechanics modeling framework which requires knowledge of tissue-level parameters and the artery's stress-free reference state, which is inaccessible in a clinical context. We present an algorithm to compute the preferred fiber distribution compatible with the constrained mixture theory, which orients two collagen fiber families according to the loading experienced by the isotropic non-collagenous extracellular matrix, without requiring prior knowledge of the stress-free state. Because consensus is lacking whether stress or stretch is the determining factor behind the preferred fiber distribution, we implemented both approaches and compared the results with experimental microstructural data of an abdominal aorta. The stress-based algorithm was able to describe several experimentally observed transitions of the fiber distribution across the intima, media and adventitia.

A quarter of a century biomechanical rupture risk assessment of abdominal aortic aneurysms. Achievements, clinical relevance, and ongoing developments

Abdominal aortic aneurysm (AAA) disease, the local enlargement of the infrarenal aorta, is a serious condition that causes many deaths, especially in men exceeding 65 years of age. Over the past quarter of a century, computational biomechanical models have been developed towards the assessment of AAA risk of rupture, technology that is now on the verge of being integrated within the clinical decision-making process. The modeling of AAA requires a holistic understanding of the clinical problem, in order to set appropriate modeling assumptions and to draw sound conclusions from the simulation results. In this article we summarize and critically discuss the proposed modeling approaches and report the outcome of clinical validation studies for a number of biomechanics-based rupture risk indices. Whilst most of the aspects concerning computational mechanics have already been settled, it is the exploration of the failure properties of the AAA wall and the acquisition of robust input data for simulations that has the greatest potential for the further improvement of this technology.

Location specific multi-scale characterization and constitutive modeling of pig aorta

The mechanical and structural behavior of the aorta depend on physiological functions and vary from proximal to distal. Understanding the relation between regionally varying mechanical and multi-scale structural response of aorta can be helpful to assess the disease outcomes. Therefore, this study investigated the variation in mechanical and multi-scale structural properties among the major segments of aorta such as ascending aorta (AA), descending aorta (DA) and abdominal aorta (ABA), and established a relation between mechanical and multi-structural parameters. The obtained results showed significant increase in anisotropy and nonlinearity from proximal to distal aorta. The change in periphery length and radii between load and stress free configuration was also found increasing far from the heart. Opening angle was significantly large for ABA than AA and DA (AA/DA vs ABA; p = 0.001). Mean circumferential residual stretch (ratio of mean periphery length at load and stress free configurations) was found decreasing between AA and DA, and then increasing between DA to ABA and its value was significantly more for ABA (AA vs DA; p = 0.041, AA vs ABA; p = 0.001, DA vs ABA; p = 0.001). The waviness of collagen fibers, collagen fiber content, collagen fibril diameter and total protein content were found significantly increasing from proximal to distal. Pearson correlation test showed a significant linear correlation between variation in mechanical and multi-scale structural parameters over the aortic length. Residual stretch was found positively correlated with collagen fiber content (r = 0.82) whereas opening angel was found positively correlated with total protein content (TPC) (r = 0.76).

Pulse wave velocity: A clinical measure to aid material parameter estimation in computational arterial biomechanics

Determining proper material parameters from clinical data remains a large, though unavoidable, challenge in patient-specific computational cardiovascular modeling. In an attempt to couple the clinical and modelling practice, this study investigated whether pulse wave velocity (PWV), a clinical arterial stiffness measure, can guide in determining appropriate parameter values for the Gasser-Ogden-Holzapfel (GOH) constitutive model. The reduction and uncertainty analysis was demonstrated on a cylindrical descending thoracic aorta model. Starting from discretized ranges of GOH parameters and using a full factorial design, the parameter sets yielding a physiological PWV (3.5-12.5 m/s) at diastolic pressure (80 mmHg; PWV₈₀) were selected and their PWV at dicrotic notch pressure (110 mmHg; PWV₁₁₀) was determined. These PWV measures were applied to determine the reduction of the 7D GOH parameter space, the 2D subspaces and the remaining uncertainty in case only PWV₈₀ or both measurements are available. The resulting 12,032 parameter sets lead to a 7D parameter space reduction of ≥ 82.5 % using PWV₈₀, which increased to 96.0 % when including PWV₁₁₀, in particular at 3.5-8.5 m/s. A similar trend was observed for the remaining uncertainty and the 2D subspaces comprised of medial collagen fiber parameters, while scarce reductions were found for the adventitial and elastin parameters. In conclusion, PWV₈₀ and PWV₁₁₀ are complementary measures with the potential to reduce the GOH parameter space in arterial models, in particular for media- and collagen-related parameters. Moreover, this approach has the advantage that it allows the estimation of the remaining uncertainty after parameter space reduction.

Importance of experimental evaluation of structural parameters for constitutive modelling of aorta

The study compares stresses and strains in the aortic wall derived using different constitutive models for various stress-strain conditions. Structure-based constitutive models with two fibre families with (GOH) and without (HGO) dispersion of collagen fibres are compared. The constitutive models were fitted to data from equibiaxial tension tests of two separated layers of the porcine aortic wall. The initial fit was evaluated with unrestricted parameters and subsequently, the mean angles of the fibre families and the angular dispersion were fixed to the values obtained from histology. Surprisingly, none of the tested models was capable to provide a good quality fit with histologically obtained structural parameters. Fitting the HGO model to experimental data resulted in two fibre families under angles close to ±45°, while the GOH model resulted in a nearly isotropic fibre distribution. These results indicate that both of these models suffer from the absence of isotropic strain stiffening. After having modified both models with corresponding additional members based on the Yeoh model of matrix, we obtained a perfect fit to the measured data while keeping the structural histology-based parameters. Finally, significant differences in compliance and resulting stresses and strains between different models are shown by means of simulations of uniaxial tension test, equibiaxial tension tests and inflation of the aorta.

Region-dependent mechanical characterization of porcine thoracic aorta with a one-to-many correspondence method to create virtual datasets using uniaxial tensile tests

The simulation of the cardiovascular system and in silico clinical trials have garnered attention in the biomedical engineering field. Physics-based modeling is essential to associate with physical and clinical features. In physics-based constitutive modeling, the identification of the parameters and estimation of their ranges based on appropriate experiments are required. Uniaxial tests are commonly used in the field of vascular mechanics, but they have limitations in fully characterizing the regional mechanical behavior of the aorta. Therefore, this study is aimed at identifying a method to integrate constitutive models with experimental data to elucidate regional aortic behavior. To create a virtual two-dimensional dataset, a pair of uniaxial experimental datasets in the longitudinal and circumferential directions was combined using a one-to-many correspondence method such as bootstrap aggregation. The proposed approach is subsequently applied to three constitutive models, i.e., the Fung model, Holzapfel model, and constrained mixture model, to estimate the material parameters based on the four test regions of the porcine thoracic aorta. Finally, the regional difference in the mechanical behavior of the aorta, the correlation between the experimental characteristics and model parameters, and the inter-correlation of the material parameters are confirmed. This integrative approach will enhance the prediction capability of the model with respect to the regions of the aorta.

Changes in the microstructure of the human aortic medial layer under biaxial loading investigated by multi-photon microscopy

Understanding the correlation between tissue architecture, health status, and mechanical properties is essential for improving material models and developing tissue engineering scaffolds. Since structural-based material models are state of the art, there is an urgent need for experimentally obtained structural parameters. For this purpose, the medial layer of nine human abdominal aortas was simultaneously subjected to equibiaxial loading and multi-photon microscopy. At each loading interval of 0.02, collagen and elastin fibers were imaged based on their second-harmonic generation signal and two-photon excited autofluorescence, respectively. The structural alterations in the fibers were quantified using the parameters of orientation, diameter, and waviness. The results of the mechanical tests divided the sample cohort into the ruptured and non-ruptured, and stiff and non-stiff groups, which were covered by the findings from histological investigations. The alterations in structural parameters provided an explanation for the observed mechanical behavior. In addition, the waviness parameters of both collagen and elastin fibers showed the potential to serve as indicators of tissue strength. The data provided address deficiencies in current material models and bridge multiscale mechanisms in the aortic media. STATEMENT OF SIGNIFICANCE: Available material models can reproduce, but cannot predict, the mechanical behavior of human aortas. This deficiency could be overcome with the help of experimentally validated structural parameters as provided in this study. Simultaneous multi-photon microscopy and biaxial extension testing revealed the microstructure of human aortic media at different stretch levels. Changes in the arrangement of collagen and elastin fibers were quantified using structural parameters such as orientation, diameter and waviness. For the first time, structural parameters of human aortic tissue under continuous loading conditions have been obtained. In particular, the waviness parameters at the reference configuration have been associated with tissue stiffness, brittleness, and the onset of atherosclerosis.

Image-Based Finite Element Modeling Approach for Characterizing In Vivo Mechanical Properties of Human Arteries

Mechanical properties of the arterial walls could provide meaningful information for the diagnosis, management and treatment of cardiovascular diseases. Classically, various experimental approaches were conducted on dissected arterial tissues to obtain their stress-stretch relationship, which has limited value clinically. Therefore, there is a pressing need to obtain biomechanical behaviors of these vascular tissues in vivo for personalized treatment. This paper reviews the methods to quantify arterial mechanical properties in vivo. Among these methods, we emphasize a novel approach using image-based finite element models to iteratively determine the material properties of the arterial tissues. This approach has been successfully applied to arterial walls in various vascular beds. The mechanical properties obtained from the in vivo approach were compared to those from ex vivo experimental studies to investigate whether any discrepancy in material properties exists for both approaches. Arterial tissue stiffness values from in vivo studies generally were in the same magnitude as those from ex vivo studies, but with lower average values. Some methodological issues, including solution uniqueness and robustness; method validation; and model assumptions and limitations were discussed. Clinical applications of this approach were also addressed to highlight their potential in translation from research tools to cardiovascular disease management.

A fluid-structure interaction model accounting arterial vessels as a key part of the blood-flow engine for the analysis of cardiovascular diseases

According to the classical Windkessel model, the heart is the only power source for blood flow, while the arterial system is assumed to be an elastic chamber that acts as a channel and buffer for blood circulation. In this paper we show that in addition to the power provided by the heart for blood circulation, strain energy stored in deformed arterial vessels in vivo can be transformed into mechanical work to propel blood flow. A quantitative relationship between the strain energy increment and functional (systolic, diastolic, mean and pulse blood pressure) and structural (stiffness, diameter and wall thickness) parameters of the aorta is described. In addition, details of blood flow across the aorta remain unclear due to changes in functional and other physiological parameters. Based on the arterial strain energy and fluid-structure interaction theory, the relationship between physiological parameters and blood supply to organs was studied, and a corresponding mathematical model was developed. The findings provided a new understanding about blood-flow circulation, that is, cardiac output allows blood to enter the aorta at an initial rate, and then strain energy stored in the elastic arteries pushes blood toward distal organs and tissues. Organ blood supply is a key factor in cardio-cerebrovascular diseases (CCVD), which are caused by changes in blood supply in combination with multiple physiological parameters. Also, some physiological parameters are affected by changes in blood supply, and vice versa. The model can explain the pathophysiological mechanisms of chronic diseases such as CCVD and hypertension among others, and the results are in good agreement with epidemiological studies of CCVD.

Computationally Efficient Concept of Representative Directions for Anisotropic Fibrous Materials

The concept of representative directions allows for automatic generation of multi-axial constitutive equations, starting from simplified uni-axial material models. In this paper, a modification of the concept is considered suitable for the analysis of fibrous polymeric materials, which are anisotropic in the as-received state. The modification of the concept incorporates an orientation probability density function (OPDF), which explicitly accounts for the material anisotropy. Two versions of the concept are available. The first version utilizes the homogeneous distribution of the representative directions, with the entire anisotropy being contained in the weighting factors. The second encapsulates the anisotropy in the distribution of the representative directions. Due to its nature, the second version allows for a more efficient use of computational power. To promote this efficient version of the concept, we present new algorithms generating required sets of representative directions that match a given OPDF. These methods are based (i) on the minimization of a potential energy, (ii) on the equilibration method, and (iii) on the use of Voronoi cells. These three methods are tested and compared in terms of various OPDFs. The applicability of the computationally efficient modeling method to mechanical behavior of an anisotropic polymeric material is demonstrated. In particular, a calibration procedure is suggested for the practically important case when the OPDF is not known a-priori.

Mechanical and histological characteristics of aortic dissection tissues

AIMS

This study investigated the association between the macroscopic mechanical response of aortic dissection (AoD) flap, its fibre features, and patient physiological features and clinical presentations.

METHODS

Uniaxial test was performed with tissue strips in both circumferential and longitudinal directions from 35 patients with (AoD:CC) and without (AoD:w/oCC) cerebral/coronary complications, and 19 patients with rheumatic or valve-related heart diseases (RH). A Bayesian inference framework was used to estimate the expectation of material constants (C₁, D₁, and D₂) of the modified Mooney-Rivlin strain energy density function. Histological examination was used to visualise the elastin and collagen in the tissue strips and image processing was performed to quantify their area percentages, fibre misalignment and waviness.

RESULTS

The elastin area percentage was negatively associated with age (p = 0.008), while collagen increased about 6% from age 40 to 70 (p = 0.03). Elastin fibre was less dispersed and wavier in old patients and no significant association was found between patient age and collagen fibre dispersion or waviness. Features of fibrous microstructures, either elastin or collagen, were comparable between AoD:CC and AoD:w/oCC group. Elastin and collagen area percentages were positively correlated with C₁ and D₂, respectively, while the elastin and collagen waviness were negatively correlated with C₁ and D₂, respectively. Elastin dispersion was negatively correlated to D₂. Multivariate analysis showed that D₂ was an effective parameter which could differentiate patient groups with different age and clinical presentations, as well as the direction of tissue strip.

CONCLUSION

Fibre dispersion and waviness in the aortic dissection flap changed with patient age and clinical presentations, and these can be captured by the material constants in the strain energy density function.

STATEMENT OF SIGNIFICANCE

Aortic dissection (AoD) is a severe cardiovascular disease. Understanding the mechanical property of intimal flap is essential for its risk evaluation. In this study, mechanical testing and histology examination were combined to quantify the relationship between mechanical presentations and microstructure features. A Bayesian inference framework was employed to estimate the expectation of the material constants in the modified Mooney-Rivlin constitutive equation. It was found that fibre dispersion and waviness in the AoD flap changed with patient age and clinical presentations, and these could be captured by the material constants. This study firstly demonstrated that the expectation of material constants can be used to characterise tissue microstructures and differentiate patients with different clinical presentations.

Multiscale simulations suggest a protective role of neo-adventitia in abdominal aortic aneurysms

Abdominal aortic aneurysms (AAAs) are a dangerous cardiovascular disease, the pathogenesis of which is not yet fully understood. In the present work a recent mechanopathological theory, which correlates AAA progression with microstructural and mechanical alterations in the tissue, is investigated using multiscale models. The goal is to combine these changes, within the framework of mechanobiology, with possible mechanical cues that are sensed by vascular cells along the AAA pathogenesis. Particular attention is paid to the formation of a 'neo-adventitia' on the abluminal side of the aortic wall, which is characterized by a highly random (isotropic) distribution of collagen fibers. Macro- and micro-scale results suggest that the formation of an AAA, as expected, perturbs the micromechanical state of the aortic tissue and triggers a growth and remodeling (G&R) reaction by mechanosensing cells such as fibroblasts. This G&R then leads to the formation of a thick neo-adventitia that appears to bring the micromechanical state of the tissue closer to the original homeostatic level. In this context, this new layer could act like a protective sheath, similar to the tunica adventitia in healthy aortas. This potential 'attempt at healing' by vascular cells would have important implications on the stability of the AAA wall and thus on the risk of rupture. STATEMENT OF SIGNIFICANCE: Current clinical criteria for risk assessment in AAAs are still empirical, as the causes and mechanisms of the disease are not yet fully understood. The strength of the arterial tissue is closely related to its microstructure, which in turn is remodeled by mechanosensing cells in the course of the disease. In this study, multiscale simulations show a possible connection between mechanical cues at the microscopic level and collagen G&R in AAA tissue. It should be emphasized that these micromechanical cues cannot be visualized in vivo. Therefore, the results presented here will help to advance our current understanding of the disease and motivate future experimental studies, with important implications for AAA risk assessment.

On strain-based rupture criterion for ascending aortic aneurysm: the role of fiber waviness

We propose a new approach for constructing strain-based rupture criterion for ascending thoracic aortic aneurysm. The rupture metric is formulated using an effective strain, which is a measure of net strain that the collagen bundles experience after fiber uncrimping. The effective strain is a function of the total strain and the waviness properties of the collagen fibers. In the present work, the waviness properties are obtained from fitting biaxial response data to constitutive models that explicitly consider the collagen waviness and fiber recruitment. Inflation test data from 10 ascending thoracic aortic aneurysm specimens are analyzed. For each specimen, tension-strain data at ∼2300 material points are garnered. The effective strain fields in the configuration immediately before rupture are computed. It is found that the hotspots of the effective strain match the rupture sites very well in all 10 samples. More importantly, the values of effective strain at the hotsopts are closely clustered around 0.1, in contrast to a much wider distribution of the total strain. The study underscores the importance of considering the fiber recruitment in formulating strain-based rupture metric, and suggests that ϵ¯≈0.1, where ϵ¯ is the effective strain metric defined in this work, can be considered as a criterion for assessing the imminent rupture risk of ascending aortic aneurysms.

Predicting and understanding arterial elasticity from key microstructural features by bidirectional deep learning

Microstructural features and mechanical properties are closely related in all soft biological tissues. Both yet exhibit considerable inter-individual differences and are affected by factors such as aging and disease and its progression. Histological analysis, modern in situ imaging, and biomechanical testing have deepened our understanding of these complex interrelations, yet two key questions remain: (1) Given the specific microstructure, can one predict the macroscopic mechanical properties without mechanical testing? (2) Can one quantify individual contributions of the different microstructural features to the macroscopic mechanical properties in an automated, systematic and largely unbiased way? Here we propose a bidirectional deep learning architecture to address these two questions. Our architecture uses data from standard histological analyses, two-photon microscopy and biaxial biomechanical testing. Its capabilities are demonstrated by predicting with high accuracy (R²=0.92) the evolving mechanical properties of the murine aorta during maturation and aging. Moreover, our architecture reveals that the extracellular matrix composition and organization are the most prominent factors governing the macroscopic mechanical properties of the tissues studied herein. STATEMENT OF SIGNIFICANCE:  .

Through the cleared aorta: three-dimensional characterization of mechanical behaviors of rat thoracic aorta under intraluminal pressurization using optical clearing method

The media of aortic wall is characterized by altering layers of elastin and smooth muscle cells (SMCs), along with collagen fibers in both layers, and plays a central role in functional and pathological remodeling such as hypertension and atherosclerosis. Because the arterial function is linked closely to the arterial wall internal structure, it is essential to investigate the alteration of the arterial microstructure during macroscopic deformation to understand cardiovascular pathologies. The present study adopted a tissue clearing method in three-dimensional mechanical characterization of rat thoracic aorta, and successfully observed changes in the structure of each of the three primary components of the aorta under intraluminal pressurization while maintaining tissue mechanical integrity and flexibility. Layers of elastic fibers and SMCs deformed greater on the intimal side than those on the adventitial side. Furthermore, there was a structural agreement in the alignment angle between SMC nuclei and elastic fibers on their intimal side, but not on the adventitial side. This is the first study that changes in the microstructure of three primary components of the aorta were visualized and evaluated through the aorta. The method established here would also be useful to understand tissue mechanics of other load-bearing soft tissues.

Differences in Collagen Fiber Diameter and Waviness between Healthy and Aneurysmal Abdominal Aortas

Collagen plays a key role in the strength of aortic walls, so studying micro-structural changes during disease development is critical to better understand collagen reorganization. Second-harmonic generation microscopy is used to obtain images of human aortic collagen in both healthy and diseased states. Methods are being developed in order to efficiently determine the waviness, that is, tortuosity and amplitude, as well as the diameter, orientation, and dispersion of collagen fibers, and bundles in healthy and aneurysmal tissues. The results show layer-specific differences in the collagen of healthy tissues, which decrease in samples of aneurysmal aortic walls. In healthy tissues, the thick collagen bundles of the adventitia are characterized by greater waviness, both in the tortuosity and in the amplitude, compared to the relatively thin and straighter collagen fibers of the media. In contrast, most aneurysmal tissues tend to have a more uniform structure of the aortic wall with no significant difference in collagen diameter between the luminal and abluminal layers. An increase in collagen tortuosity compared to the healthy media is also observed in the aneurysmal luminal layer. The data set provided can help improve related material and multiscale models of aortic walls and aneurysm formation.

An ultrastructural 3D reconstruction method for observing the arrangement of collagen fibrils and proteoglycans in the human aortic wall under mechanical load

An insight into changes of soft biological tissue ultrastructures under loading conditions is essential to understand their response to mechanical stimuli. Therefore, this study offers an approach to investigate the arrangement of collagen fibrils and proteoglycans (PGs), which are located within the mechanically loaded aortic wall. The human aortic samples were either fixed directly with glutaraldehyde in the load-free state or subjected to a planar biaxial extension test prior to fixation. The aortic ultrastructure was recorded using electron tomography. Collagen fibrils and PGs were segmented using convolutional neural networks, particularly the ESPNet model. The 3D ultrastructural reconstructions revealed a complex organization of collagen fibrils and PGs. In particular, we observed that not all PGs are attached to the collagen fibrils, but some fill the spaces between the fibrils with a clear distance to the collagen. The complex organization cannot be fully captured or can be severely misinterpreted in 2D. The approach developed opens up practical possibilities, including the quantification of the spatial relationship between collagen fibrils and PGs as a function of the mechanical load. Such quantification can also be used to compare tissues under different conditions, e.g., healthy and diseased, to improve or develop new material models. STATEMENT OF SIGNIFICANCE: The developed approach enables the 3D reconstruction of collagen fibrils and proteoglycans as they are embedded in the loaded human aortic wall. This methodological pipeline comprises the knowledge of arterial mechanics, imaging with transmission electron microscopy and electron tomography, segmentation of 3D image data sets with convolutional neural networks and finally offers a unique insight into the ultrastructural changes in the aortic tissue caused by mechanical stimuli.

Micromechanical and Ultrastructural Properties of Abdominal Aortic Aneurysms

Abdominal aortic aneurysms are a common condition of uncertain pathogenesis that can rupture if left untreated. Current recommended thresholds for planned repair are empirical and based entirely on diameter. It has been observed that some aneurysms rupture before reaching the threshold for repair whilst other larger aneurysms do not rupture. It is likely that geometry is not the only factor influencing rupture risk. Biomechanical indices aiming to improve and personalise rupture risk prediction require, amongst other things, knowledge of the material properties of the tissue and realistic constitutive models. These depend on the composition and organisation of the vessel wall which has been shown to undergo drastic changes with aneurysmal degeneration, with loss of elastin, smooth muscle cells, and an accumulation of isotropically arranged collagen. Most aneurysms are lined with intraluminal thrombus, which has an uncertain effect on the underlying vessel wall, with some authors demonstrating a reduction in wall stress and others a reduction in wall strength. The majority of studies investigating biomechanical properties of ex vivo abdominal aortic aneurysm tissues have used low-resolution techniques, such as tensile testing, able to measure the global material properties at the macroscale. High-resolution engineering techniques such as nanoindentation and atomic force microscopy have been modified for use in soft biological tissues and applied to vascular tissues with promising results. These techniques have the potential to advance the understanding and improve the management of abdominal aortic aneurysmal disease.

The effects of viscoelasticity on residual strain in aortic soft tissues

Residual stress is thought to play a critical role in modulating stress distributions in soft biological tissues and in maintaining the mechanobiological stress environment of cells. Residual stresses in arteries and other tissues are classically assessed through opening angle experiments, which demonstrate the continuous release of residual stresses over hours. These results are then assessed through nonlinear biomechanical models to provide estimates of the residual stresses in the intact state. Although well studied, these analyses typically focus on hyperelastic material models despite significant evidence of viscoelastic phenomena over both short and long timescales. In this work, we extended the state-of-the-art structural tensor model for arterial tissues from Holzapfel and Ogden for fractional viscoelasticity. Models were tuned to capture consistent levels of hysteresis observed in biaxial experiments, while also minimizing the fractional viscoelastic weighting and opening angles to correctly capture opening angle dynamics. Results suggest that a substantial portion of the human abdominal aorta is viscoelastic, but exhibits a low fractional order (i.e. more elastically). Additionally, a significantly larger opening angle in the fully unloaded state is necessary to produce comparable hysteresis in biaxial testing. As a consequence, conventional estimates of residual stress using hyperelastic approaches over-estimate their viscoelastic counterparts by a factor of 2. Thus, a viscoelastic approach, such as the one illustrated in this study, in combination with an additional source of rate-controlled viscoelastic data is necessary to accurately analyze the residual stress distribution in soft biological tissues. STATEMENT OF SIGNIFICANCE: Residual stress plays a crucial role in achieving a homeostatic stress environment in soft biological tissues. However, the analysis of residual stress typically focuses on hyperelastic material models despite evidence of viscoelastic behavior. This work is the first attempt at analyzing the effects of viscoelasticity on residual stress. The application of viscoelasticity was crucial for producing realistic opening dynamics in arteries. The overall residual stresses were estimated to be 50% less than those from using hyperelastic material models, while the opening angles were projected to be 25% more than those measured after 16 hours, suggesting underestimated residual strain. This study highlights the importance viscoelasticity in the analysis of residual stress even in weakly dissipative materials like the human aorta.

Role of smooth muscle activation in the static and dynamic mechanical characterization of human aortas

The rupture of aortic aneurysms causes around 10,000 deaths each year in the United States. Prosthetic tubes for aortic repair present a large mismatch of mechanical properties with the natural aorta, which has negative consequences for perfusion. This motivates research into the mechanical characterization of human aortas to develop a new generation of mechanically compatible aortic grafts. Experimental data and a suitable material model for human aortas with vascular smooth muscle (VSM) activation are not available. Hence, the present study provides experimental data that are needed. These data made it possible to develop a precise structure-based model of active aortic tissue. The results show the importance of VSM activation on the static and dynamic mechanical response of human aortas.

Experimental data and a suitable material model for human aortas with smooth muscle activation are not available in the literature despite the need for developing advanced grafts; the present study closes this gap. Mechanical characterization of human descending thoracic aortas was performed with and without vascular smooth muscle (VSM) activation. Specimens were taken from 13 heart-beating donors. The aortic segments were cooled in Belzer UW solution during transport and tested within a few hours after explantation. VSM activation was achieved through the use of potassium depolarization and noradrenaline as vasoactive agents. In addition to isometric activation experiments, the quasistatic passive and active stress–strain curves were obtained for circumferential and longitudinal strips of the aortic material. This characterization made it possible to create an original mechanical model of the active aortic material that accurately fits the experimental data. The dynamic mechanical characterization was executed using cyclic strain at different frequencies of physiological interest. An initial prestretch, which corresponded to the physiological conditions, was applied before cyclic loading. Dynamic tests made it possible to identify the differences in the viscoelastic behavior of the passive and active tissue. This work illustrates the importance of VSM activation for the static and dynamic mechanical response of human aortas. Most importantly, this study provides material data and a material model for the development of a future generation of active aortic grafts that mimic natural behavior and help regulate blood pressure.

Fibrin prestress due to platelet aggregation and contraction increases clot stiffness

Efficient hemorrhagic control is attained through the formation of strong and stable blood clots at the site of injury. Although it is known that platelet-driven contraction can dramatically influence clot stiffness, the underlying mechanisms by which platelets assist fibrin in resisting external loads are not understood. In this study, we delineate the contribution of platelet-fibrin interactions to clot tensile mechanics using a combination of new mechanical measurements, image analysis, and structural mechanics simulation. Based on uniaxial tensile test data using custom-made microtensometer and fluorescence microscopy of platelet aggregation and platelet-fibrin interactions, we show that integrin-mediated platelet aggregation and actomyosin-driven platelet contraction synergistically increase the elastic modulus of the clots. We demonstrate that the mechanical and geometric response of an active contraction model of platelet aggregates compacting vicinal fibrin is consistent with the experimental data. The model suggests that platelet contraction induces prestress in fibrin fibers and increases the effective stiffness in both cross-linked and noncross-linked clots. Our results provide evidence for fibrin compaction at discrete nodes as a major determinant of mechanical response to applied loads.

Patient-specific computational modeling of endovascular aneurysm repair: State of the art and future directions

Endovascular aortic repair (EVAR) has become the preferred intervention option for aortic aneurysms and dissections. This is because EVAR is much less invasive than the alternative open surgery repair. While in-hospital mortality rates are smaller for EVAR than open repair (1%-2% vs. 3%-5%), the early benefits of EVAR are lost after 3 years due to larger rates of complications in the EVAR group. Clinicians follow instructions for use (IFU) when possible, but are left with personal experience on how to best proceed and what choices to make with respect to stent-graft (SG) model choice, sizing, procedural options, and their implications on long-term outcomes. Computational modeling of SG deployment in EVAR and tissue remodeling after intervention offers an alternative way of testing SG designs in silico, in a personalized way before intervention, to ultimately select the strategies leading to better outcomes. Further, computational modeling can be used in the optimal design of SGs in cases of complex geometries. In this review, we address some of the difficulties and successes associated with computational modeling of EVAR procedures. There is still work to be done in all areas of EVAR in silico modeling, including model validation, before models can be applied in the clinic, but much progress has already been made. Critical to clinical implementation are current efforts focusing on developing fast algorithms that can achieve (near) real-time solutions, as well as ways of dealing with inherent uncertainties related to patient aortic wall degradation on an individualized basis. We are optimistic that EVAR modeling in the clinic will soon become a reality to help clinicians optimize EVAR interventions and ultimately reduce EVAR-associated complications.

Microstructural and mechanical characterization of the layers of human descending thoracic aortas

The mechanical properties of human aortas are linked to the layered tissue and its microstructure at different length scales. Each layer has specific mechanical and structural properties. While the ground substance and the elastin play an important role in tissue stiffness at small strain, collagen fibers carry most of the load at larger strains, which corresponds to the physiological conditions of the aorta at maximum pulsatile blood pressure. In fact, collagen fibers are crimped in the unloaded state. Collagen fibers show different orientation distributions when they are observed in a plane that is tangent to the aortic wall (in-plane section) or along a direction orthogonal to it (out-of-plane section). This was systematically investigated using large images (2500 × 2500 µm) with high resolution obtained by second harmonic generation (SHG) in order to homogenize tissue heterogeneity after a convergence analysis, which is a main goal of the study. In addition, collagen fibers show lateral interactions due to entanglements and the presence of transverse elastin fibers, observed on varying length scales using atomic force microscopy and a three-dimensional rendering obtained by stacking a sequence of SHG and two-photon fluorescence images; this is another important contribution. Human descending thoracic aortas from 13 heartbeat donors aged 28 to 66 years were examined. Uniaxial tensile tests were carried out on the longitudinal and circumferential strips of the aortic wall and the three separated layers (intima, media and adventitia). A structurally-motivated material model with (i) a term to describe the combined response of ground substance and elastin and (ii) terms to consider four families of collagen fibers with different directions was applied. The exclusion of compressed fibers was implemented in the fitting process of the experimental data, which was optimized by a genetic algorithm. The results show that a single fiber family with directional and dispersion parameters measured from SHG images can describe the mechanical response of all 39 layers (3 layers for each of the 13 aortas) with very good accuracy when a second (auxiliary) family of aligned fibers is introduced in the orthogonal direction to account for lateral fiber interaction. Indeed, all observed distributions of collagen directions can be accurately fitted by a single bivariate von Mises distribution. Statistical analysis of in-plane and out-of-plane dispersion of fiber orientations reveals structural differences between the three layers and a change of collagen dispersion parameters with age. STATEMENT OF SIGNIFICANCE: The stiffness of healthy young aortas is adjusted so that a diameter expansion of about 10 % is possible during the heartbeat. This creates the Windkessel effect, which smooths out the pulsating nature of blood flow and benefits organ perfusion. The specific elastic properties of the aorta that are required to achieve this effect are related to the microstructure of the aortic tissue at different length scales. An increase in the aortic stiffness, in addition to reducing cyclic expansion and worsening perfusion, is a risk factor for clinical hypertension. The present study relates the microstructure of healthy human aortas to the mechanical response and examines the changes in microstructural parameters with age, which is a key factor in increasing stiffness.

Viscoelastic characterization of human descending thoracic aortas under cyclic load

Experiments were carried out on 15 human descending thoracic aortas from heart-beating healthy donors who donated organs for transplant. The aortas were kept refrigerated in organ preservation solution and tested were completed within 48 hours from explant. Donors' age was comprised between 25 and 70 years, with an average of 51.7 ± 12.8 years. Quasi-static and dynamic uniaxial tensile test were carried out in thermally controlled physiological saline solution in order to characterize the viscoelastic behavior. Strips were tested under harmonic deformation of different frequency, between 1 and 11 Hz, at three initial pre-stretches. Cyclic deformations of two different amplitudes were used: a physiological one and a small one, the latter one for comparison purposes to understand the accuracy limits of viscoelastic models. Aortic strips in circumferential and longitudinal directions were cut from each aorta. Some strips were dissected to separate the three layers: intima, media and adventitia. They were tested individually in order to obtain layer-specific data. However, strips of the intact wall were also tested. Therefore, 8 strips per donors were tested. Viscoelastic parameters are accurately evaluated from the hysteresis loops. Results show that small-amplitude cyclic strain over-estimate the storage modulus and under-estimate the loss-factor. Therefore, cyclic deformation of physiological amplitude is necessary to obtain correct viscoelastic data of aortic tissue. The value of the applied pre-stretch is significant on the dynamic stiffness ratio (storage modulus divided by the corresponding quasi-static stiffness), while it is less significant for the loss factor. The median of the dynamic stiffness ratios, in physiological conditions, varies between 1.14 and 1.33 for the different layers and the intact wall; the corresponding median of the loss factors varies between 0.050 and 0.066. The lowest dynamic stiffness ratios and loss factors were obtained from donors of the youngest age group. STATEMENT OF SIGNIFICANCE: There is an increasing interest in replacing traditional Dacron grafts used to repair thoracic aortas after acute dissection and aneurysm, with grafts in innovative biomaterials that mimic the mechanical properties and the dynamic behavior of the aorta. The human aorta is a complex laminated structure with hyperelastic and viscoelastic material properties and residual stresses. This study aims to characterize the nonlinear viscoelastic properties of ex-vivo human descending thoracic aortas by measuring hysteresis loops of physiological amplitude under harmonic strain. Results show the necessity to characterize the viscoelastic material properties of the aorta under physiological conditions, as well as the necessity to introduce improved models that take better into account the influence of the initial pre-stretch and amplitude of the cyclic load.

Mechanical role of intraluminal thrombus in aneurysm growth: A computational study

Models that seek to improve our current understanding of biochemical processes and predict disease progression have been increasingly in use over the last decades. Recently, we proposed a finite element implementation of arterial wall growth and remodeling with application to abdominal aortic aneurysms (AAAs). The study focused on changes within the aortic wall and did not include the complex role of intraluminal thrombus (ILT) during the AAA evolution. Thus, in this work, we extend the model with a gradual deposition of ILT and its mechanical influence on AAA growth. Despite neglecting the increased biochemical activity due to the presence of a proteolytically active luminal layer of ILT, and thus underestimating rupture risk potential, we show that ILT helps to slow down the growth of the aneurysm in the axial direction by redirecting blood pressure loading from the axial-radial plane to predominately radial direction. This very likely lowers rupture potential. We also show that the ratio of ILT volume to volume sac is an important factor in AAA stabilization and that fully thrombosed aneurysms could stabilize quicker and at smaller maximum diameters compared to partially thrombosed ones. Furthermore, we show that ILT formation and the associated mural stress decrease negatively impact the wall constituent production and thickness. Although further studies that include increased biochemical degradation of the wall after the formation of ILT and ILT deposition based on hemodynamics are needed, the present findings highlight the dual role an ILT plays during AAA progression.

Development of an FEA framework for analysis of subject-specific aortic compliance based on 4D flow MRI

This paper presents a subject-specific in-silico framework in which we uncover the relationship between the spatially varying constituents of the aorta and the non-linear compliance of the vessel during the cardiac cycle uncovered through our MRI investigations. A microstructurally motivated constitutive model is developed, and simulations reveal that internal vessel contractility, due to pre-stretched elastin and actively generated smooth muscle cell stress, must be incorporated, along with collagen strain stiffening, in order to accurately predict the non-linear pressure-area relationship observed in-vivo. Modelling of elastin and smooth muscle cell contractility allows for the identification of the reference vessel configuration at zero-lumen pressure, in addition to accurately predicting high- and low-compliance regimes under a physiological range of pressures. This modelling approach is also shown to capture the key features of elastin digestion and SMC activation experiments. The volume fractions of the constituent components of the aortic material model were computed so that the in-silico pressure-area curves accurately predict the corresponding MRI data at each location. Simulations reveal that collagen and smooth muscle volume fractions increase distally, while elastin volume fraction decreases distally, consistent with reported histological data. Furthermore, the strain at which collagen transitions from low to high stiffness is lower in the abdominal aorta, again supporting the histological finding that collagen waviness is lower distally. The analyses presented in this paper provide new insights into the heterogeneous structure-function relationship that underlies aortic biomechanics. Furthermore, this subject-specific MRI/FEA methodology provides a foundation for personalised in-silico clinical analysis and tailored aortic device development. STATEMENT OF SIGNIFICANCE: This study provides a significant advance in in-silico medicine by capturing the structure/function relationship of the subject-specific human aorta presented in our previous MRI analyses. A physiologically based aortic constitutive model is developed, and simulations reveal that internal vessel contractility must be incorporated, along with collagen strain stiffening, to accurately predict the in-vivo non-linear pressure-area relationship. Furthermore, this is the first subject-specific model to predict spatial variation in the volume fractions of aortic wall constituents. Previous studies perform phenomenological hyperelastic curve fits to medical imaging data and ignore the prestress contribution of elastin, collagen, and SMCs and the associated zero-pressure reference state of the vessel. This novel MRI/FEA framework can be used as an in-silico diagnostic tool for the early stage detection of aortic pathologies.

Bio-composites reinforced with unique coral collagen fibers: Towards biomimetic-based small diameter vascular grafts

Cardiovascular Diseases (CVDs) are the leading cause of death worldwide. Approximately 31% of all global deaths are caused by CVDs, of which 42% are attributable to coronary artery disease (CAD). CAD is characterized by a narrowing of arteries that restricts the normal blood flow. Over time, surgical intervention is required in severe cases of occlusions and includes implantation of autologous vessels. Today synthetic grafts are used successfully as replacements for blood vessels with a diameter larger than 6 mm. However, they often fail as small-diameter blood vessel replacements. This study introduces a new biocomposite material system consisting of unique and long (cm-scale) collagen fibers derived from soft corals embedded within an alginate hydrogel matrix. The new biocomposite layers were used to fabricate grafts, towards developing a new class of tissue-engineered small-diameter blood vessels. These constructs consisted of both circumferentially and longitudinally oriented collagen fibers. The mechanical properties of the grafts were investigated via a new experimental setup constructed in our lab for this purpose, which applied internal pressure levels of 0-300 mmHg. Similar to native coronary arteries, the biocomposite tubes demonstrated a compliance of 4.88 ± 0.99%/100 mmHg for a physiologic pressure range of 80-120 mmHg. Furthermore, a numerical finite element simulation model is proposed to generate the overall mechanical response of the construct. It is composed of axial and circumferential fibers embedded within the continuum alginate elements. Good prediction is demonstrated when compared with the measured pressure-strain response. Moreover, we examined biocompatibility and cell growth on the collagen fibers. Fibroblast cells proliferated during the experiment that lasted for 32 days and showed aligned configuration with the collagen fiber orientation. The novelty of this study is manifested in the use of naturally derived coral-based long collagen fibers for the development of a new class of tissue-engineered grafts. The proposed novel biocomposite graft demonstrated both mechanical and biological compatibility and can be further developed for small-diameter blood-vessel replacement.

Characterization of the dynamic viscoelastic response of the ascending aorta imposed via pulsatile flow

This study characterizes the material properties of a viscoelastic, ex vivo porcine ascending aorta under dynamic-loading conditions via pulsatile flow. The deformation of the opaque vessel wall and the pulsatile flow field inside the vessel were recorded using ultrasound imaging. The internal pressure was extracted from the pulsatile flow results and, when coupled with the vessel-wall expansion, was used to calculate the instantaneous elastic modulus from a novel, time-resolved two-dimensional (i.e. axial and circumferential) stress model. The circumferential instantaneous elasticity obtained from the two-dimensional stress model was found to match the uniaxial tensile test for strains below 50%. The agreement in elasticity between the two stress states reveals that the two-dimensional stress model accurately resolves the circumferential stress of the viscoelastic aorta at physiological strains (8%-30%). At higher strains, results from pulsatile flow generated a more compliant response than the uniaxial measurements. Viscoelastic properties (storage modulus and loss factor) were also calculated using the two-dimensional stress model and compared to those obtained from uniaxial tests. While instantaneous elasticity matched between the cylindrical and uniaxial loading, the viscoelastic behaviour significantly diverged between stress states. The storage modulus obtained from the pulsatile flow data was dependent on mean Reynolds number, while the uniaxial storage modulus results exhibited a strong inverse dependency on the frequency. The loss factor for the pulsatile flow data increased alongside the frequency, while the uniaxial data indicated a constant loss factor over the entire frequency range. The results of the current study show that the two-dimensional stress model can accurately extract the material properties of the ex vivo porcine aorta.