Centre for Applied Biomedical Engineering Research, Department of Mechanical and Aeronautical Engineering, and Materials and Surface Science Institute, University of Limerick, Ireland.
Arterioscler Thromb Vasc Biol. 2010 Sep;30(9):1687-94. doi: 10.1161/ATVBAHA.110.204529. Epub 2010 May 27.
Abdominal aortic aneurysm (AAA) rupture remains a significant cause of death in the developed world. Current treatment approaches rely heavily on the size of the aneurysm to decide on the most appropriate time for clinical intervention and treatment. However, in recent years, several alternative rupture risk indicators have been proposed. This brief review examines some of these new approaches to AAA rupture risk assessment, from both numeric and experimental aspects and also what the future may hold for AAA rupture risk. Although numerically predicted wall stress, finite element analysis rupture index, rupture potential index, severity parameter, and geometric factors, such as asymmetry, have all been developed and show promise in possibly helping to predict AAA rupture risk, validation of these tools remains a significant challenge. Validation of biomechanics-based rupture indicators may be feasible by combining in vitro modeling of realistic AAA analogues with both retrospective and prospective monitoring and modeling of AAA cases. Peak wall stress is arguably the primary result obtained from numeric analyses; however, as the majority of ruptures occur in the posterior and posterior-lateral regions, the role of posterior wall stress has also recently been highlighted as potentially significant. It is also known that wall stress alone is not enough to cause rupture, as wall strength plays an equal role. Therefore, should a biomechanics-based rupture risk be implemented? There have been some significant steps, both numerically and experimentally, toward answering this and other questions relating to AAA rupture risk prediction, yet regardless of the efforts that are under way in several laboratories, the introduction of a numerically predicted rupture risk parameter into the clinicians' decision-making process may still be quite some time away.
腹主动脉瘤 (AAA) 破裂仍然是发达国家死亡的一个重要原因。目前的治疗方法主要依赖于动脉瘤的大小来决定何时进行临床干预和治疗。然而，近年来，已经提出了几种替代的破裂风险指标。本综述从数值和实验两个方面探讨了这些新的 AAA 破裂风险评估方法，以及 AAA 破裂风险的未来可能走向。尽管数值预测的壁应力、有限元分析破裂指数、破裂潜能指数、严重程度参数和几何因素，如不对称性，都已经得到了发展，并显示出在预测 AAA 破裂风险方面有一定的潜力，但这些工具的验证仍然是一个重大挑战。通过将真实 AAA 模拟的体外建模与 AAA 病例的回顾性和前瞻性监测和建模相结合，验证基于生物力学的破裂指标可能是可行的。峰值壁应力可以说是数值分析的主要结果；然而，由于大多数破裂发生在后壁和后侧壁，后壁应力的作用最近也被强调为可能具有重要意义。人们还知道，仅仅壁应力不足以导致破裂，因为壁强度也起着同等的作用。因此，是否应该采用基于生物力学的破裂风险呢？在数值和实验方面都已经取得了一些重大进展，以回答这个问题和其他与 AAA 破裂风险预测相关的问题，然而，无论几个实验室正在进行什么样的努力，将数值预测的破裂风险参数引入临床医生的决策过程可能还需要一段时间。
