Angiology, Vascular Biology and Inflammation Laboratory, Institute of Biomedical Research (II-B Sant Pau), Barcelona, Spain; Department of Vascular and Endovascular Surgery, Universitat Autonoma de Barcelona, Institute of Biomedical Research (II-B Sant Pau), Barcelona, Spain.
Angiology, Vascular Biology and Inflammation Laboratory, Institute of Biomedical Research (II-B Sant Pau), Barcelona, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Eur J Vasc Endovasc Surg. 2017 Dec;54(6):706-711. doi: 10.1016/j.ejvs.2017.09.010. Epub 2017 Oct 16.
Maximum diameter (MD) is the established rupture predictor for abdominal aortic aneurysm (AAA). However, biomechanical markers from finite element analysis (FEA) could be more accurate predictors for these patients. In this study, the association between peak wall stress (PWS) and MD with symptoms of AAA was evaluated.
Patients diagnosed with infrarenal non-ruptured AAA at the centre between 2009 and 2015 were included. Clinical data, morphological variables (including MD), and the biomechanical variables PWS and diameter normalised PWS (dnPWS) in symptomatic (sAAA) and asymptomatic AAA patients (aAAA) were included.
A total of 170 patients were analysed, 153 aAAA and 17 sAAA. MD was significantly greater in sAAA patients than in aAAA patients (70.4 mm, 95% CI 66.4-86.0 vs. 59.1 mm, 95% CI 53.7-67.8, respectively; p = .002). PWS was also significantly higher in the sAAA group (324.6 kPa, 95% CI 217.4-399.5 vs. 199.2 kPa, 95% CI 165.6-239.5; p < .01). No differences in MD were found in patients with an AAA ≥ 65 mm (43 aAAA and 14 sAAA); however, both PWS (327.4 kPa, 95% CI 239.0-473.3 vs. 229.4 kPa, 95% CI 210.0 to 289.4; p = .020) and dnPWS (4.3, 95% CI 3.17-4.67 vs. 3.03, 95% CI 2.8-3.49; p = .004) were higher in sAAA than in aAAA.
This study suggests that MD and the biomechanical parameters obtained by finite element analysis are greater in sAAA than in aAAA. However, considering patients with MD ≥ 65 mm alone, only PWS, and particularly dnPWS, were able to differentiate sAAA from aAAA.
最大直径（MD）是腹主动脉瘤（AAA）破裂的既定预测指标。然而，来自有限元分析（FEA）的生物力学标志物可能是这些患者更准确的预测指标。本研究评估了峰值壁应力（PWS）与 MD 与 AAA 症状之间的关系。
纳入 2009 年至 2015 年间中心诊断为肾下非破裂性 AAA 的患者。纳入有症状（sAAA）和无症状 AAA 患者（aAAA）的临床数据、形态学变量（包括 MD）以及生物力学变量 PWS 和直径标准化 PWS（dnPWS）。
共分析了 170 名患者，其中 153 名 aAAA 和 17 名 sAAA。sAAA 患者的 MD 明显大于 aAAA 患者（70.4mm，95%CI66.4-86.0 与 59.1mm，95%CI53.7-67.8；p=0.002）。sAAA 组的 PWS 也明显更高（324.6kPa，95%CI217.4-399.5 与 199.2kPa，95%CI165.6-239.5；p<0.01）。在 AAA≥65mm 的患者中，MD 无差异（43 名 aAAA 和 14 名 sAAA）；然而，PWS（327.4kPa，95%CI239.0-473.3 与 229.4kPa，95%CI210.0 至 289.4；p=0.020）和 dnPWS（4.3，95%CI3.17-4.67 与 3.03，95%CI2.8-3.49；p=0.004）在 sAAA 中均高于 aAAA。
本研究表明，sAAA 的 MD 和通过有限元分析获得的生物力学参数大于 aAAA。然而，仅考虑 MD≥65mm 的患者，只有 PWS，特别是 dnPWS，能够区分 sAAA 和 aAAA。
