Georg Y, Delay C, Schwein A, Lejay A, Thaveau F, Gaertner S, Stephan D, Heim F, Chakfe N
Groupe européen de recherche sur les prothèses appliquées à la chirurgie vasculaire (Geprovas), faculté de médecine, institut d'anatomie pathologique, 4, rue Kirschleger, 67085 Strasbourg cedex, France; Service de chirurgie vasculaire et transplantation rénale, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, BP n(o) 426, 67091 Strasbourg cedex, France.
Service des maladies vasculaires, hypertension artérielle et pharmacologie clinique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
J Mal Vasc. 2016 Feb;41(1):63-8. doi: 10.1016/j.jmv.2015.07.107. Epub 2015 Aug 28.
Rupture is the worst outcome of abdominal aortic aneurysm (AAA). The decision to operate should include counterbalancing the risk of aneurysm rupture against the risk of aneurysm repair, within the context of a patient's overall life expectancy. Current surgical guidelines are based on population studies, and important variables are missed in predicting individual risk of rupture.
In this literature review, we focused on the contribution of biomechanical and mathematical models in predicting risk of AAA rupture.
Anatomical features as diameter asymmetry and lack of tortuosity are shown to be anatomical risk factors of rupture. Wall stiffness (due to modifications of elastin and collagen composition) and increased inflammatory response are also factors that affect the structural integrity of the AAA wall. Biomechanical studies showed that wall strength is lower in ruptured than non-ruptured AAA. Intra-luminal thrombus also has a big role to play in the occurrence of rupture. Current mathematical models allow more variables to be included in predicting individual risk of rupture.
Moving away from using maximal transverse diameter of the AAA as a unique predictive factor and instead including biological, structural and biomechanical variables in predicting individual risk of rupture will be essential in the future and will help gain precision and accuracy in surgical indications.
破裂是腹主动脉瘤（AAA）最严重的后果。手术决策应在患者总体预期寿命的背景下，权衡动脉瘤破裂风险与动脉瘤修复风险。当前的手术指南基于人群研究，在预测个体破裂风险时遗漏了重要变量。
在本综述中，我们重点关注生物力学和数学模型在预测AAA破裂风险中的作用。
直径不对称和无迂曲等解剖学特征被证明是破裂的解剖学危险因素。壁僵硬度（由于弹性蛋白和胶原蛋白组成的改变）和炎症反应增加也是影响AAA壁结构完整性的因素。生物力学研究表明，破裂的AAA壁强度低于未破裂的AAA。腔内血栓在破裂的发生中也起很大作用。当前的数学模型在预测个体破裂风险时允许纳入更多变量。
未来，摒弃将AAA的最大横径作为唯一预测因素，转而在预测个体破裂风险时纳入生物学、结构和生物力学变量至关重要，这将有助于提高手术指征的精确性和准确性。
