Department of Vascular Surgery, Demokritus University of Thrace, University Hospital of Alexandroupolis, Greece.
J Endovasc Ther. 2011 Apr;18(2):214-25. doi: 10.1583/10-3244.1.
In current clinical practice, aneurysm diameter is one of the primary criteria used to decide when to treat a patient with an abdominal aortic aneurysm (AAA). It has been shown that simple association of aneurysm diameter with the probability of rupture is not sufficient, and other parameters may also play a role in causing or predisposing to AAA rupture. Peak wall stress (PWS), intraluminal thrombus (ILT), and AAA wall mechanics are the factors most implicated with rupture risk and have been studied by computational risk evaluation techniques. The objective of this review is to examine these factors that have been found to influence AAA rupture. The prediction rate of rupture among computational models depends on the level of model complexity and the predictive value of the biomechanical parameters used to assess risk, such as PWS, distribution of ILT, wall strength, and the site of rupture. There is a need for simpler geometric analogues, including geometric parameters (e.g., lumen tortuosity and neck length and angulation) that correlate well with PWS, conjugated with clinical risk factors for constructing rupture risk predictive models. Such models should be supported by novel imaging techniques to provide the required patient-specific data and validated through large, prospective clinical trials.
在当前的临床实践中，动脉瘤直径是决定何时治疗腹主动脉瘤（AAA）患者的主要标准之一。已经表明，单纯将动脉瘤直径与破裂的概率相关联是不够的，其他参数也可能在导致或易患 AAA 破裂方面发挥作用。壁峰值应力（PWS）、管腔内血栓（ILT）和 AAA 壁力学是与破裂风险最相关的因素，并已通过计算风险评估技术进行了研究。本综述的目的是检查这些已被发现影响 AAA 破裂的因素。破裂的计算模型的预测率取决于模型的复杂程度以及用于评估风险的生物力学参数的预测值，例如 PWS、ILT 分布、壁强度和破裂部位。需要更简单的几何模拟，包括与 PWS 相关性好的几何参数（例如，管腔迂曲度和颈部长度和角度），并结合临床危险因素构建破裂风险预测模型。此类模型应得到新型成像技术的支持，以提供所需的患者特定数据，并通过大型前瞻性临床试验进行验证。
