The Relationship Between Wall Stress and 3D Asymmetry in Repaired and Ruptured Abdominal Aortic Aneurysms

Abdominal aortic aneurysm (AAA) is a permanent dilation of the infrarenal aorta and is defined as having a diameter 50% greater than the original diameter. If left untreated, an AAA will continue to expand until rupture. The maximum diameter is currently the primary indicator of rupture-risk with AAAs > 5.5 cm deemed a likely to rupture. There have, however, been many reports identifying the inadequacies of the maximum diameter criterion to accurately determine the threat of rupture. It is believed by many researchers that there is a need to review the decision of surgical intervention based solely on aneurysm diameter, and rather include other relevant risk factors. These additional risk factors could, for example, include, AAA wall stress, AAA expansion rate, degree of asymmetry, presence of intraluminal thrombus (ILT), and hypertension. The addition of these parameters may aid the surgical decision-making process. A previous report by our group identified the relationship between asymmetry and posterior wall stress in patient-specific cases [1,2] and as over 80% of ruptures occur on the posterior wall [3] this finding may have significant clinical relevance. In this previous report, the study group was limited to 15 cases and asymmetry was only measured in the anterior-posterior plane. This current paper furthers this previous work by increasing the cohort to 40 cases of electively repaired AAAs and also examines 8 cases of ruptured AAAs. The methodology has been improved to now measure asymmetry in all three dimensions (3D).