Manta Anastasia, Tzirakis Konstantinos
Department of Mechanical Engineering, School of Engineering, Hellenic Mediterranean University, Heraklion, Greece; School of Medicine, University of Crete, Heraklion, Greece.
Department of Mechanical Engineering, School of Engineering, Hellenic Mediterranean University, Heraklion, Greece.
Ann Vasc Surg. 2025 Jan;110(Pt A):63-81. doi: 10.1016/j.avsg.2024.07.111. Epub 2024 Sep 28.
Abdominal aortic aneurysm (AAA) is a pathological condition characterized by the dilation of the lower part of the aorta, where significant hemodynamic forces are present. The prevalence and high mortality risk associated with AAA remain major concerns within the scientific community. There is a critical need for extensive research to understand the underlying mechanisms, pathophysiological characteristics, and effective detection methods for abdominal aortic abnormalities. Additionally, it is imperative to develop and refine both medical and surgical management strategies. This review aims to indicate the role of computational analysis in the comprehension and management of AAAs and covers recent research studies regarding the computational analysis approach conducted between 2021 and 2023. Computational analysis methods have emerged as sophisticated and noninvasive approaches, providing detailed insights into the complex dynamics of AAA and enhancing our ability to study and manage this condition effectively.
Computational analysis relies on fluid mechanics principles applied to arterial flow, using the Navier-Stokes equations to model blood flow dynamics. Key hemodynamic indicators relevant to AAAs include Time-Average Wall Shear Stress, Oscillatory Shear Index, Endothelial Cell Activation Potential, and Relative Residence Time. The primary methods employed for simulating the abdominal aorta and studying its biomechanical environment are computational fluid dynamics and Finite Element Methods. This review article encompasses a thorough examination of recent literature, focusing on studies conducted between 2021 and 2023.
The latest studies have elucidated crucial insights into the blood flow characteristics and geometric attributes of AAAs. Notably, blood flow patterns within AAAs are associated with increased rupture risk, along with elevated intraluminal thrombus volume and specific calcification thresholds. Asymmetric AAAs exhibit heightened risks of rupture and thrombus formation due to low and oscillating wall shear stresses. Moreover, larger aneurysms demonstrate increased wall stress, pressure, and energy loss. Advanced modeling techniques have augmented predictive capabilities concerning growth rates and surgical thresholds. Additionally, the influence of material properties and thrombus volume on wall stress levels is noteworthy, while inlet velocity profiles significantly modulate blood flow dynamics within AAAs.
This review highlights the potential utility of computational modeling. However, the clinical applicability of computational modeling has been limited by methodological variability despite the ongoing accumulation of evidence supporting the prognostic significance of biomechanical and hemodynamic indices in this field. The establishment of standardized reporting is critical for clinical implementation.
腹主动脉瘤（AAA）是一种以主动脉下部扩张为特征的病理状况，此处存在显著的血流动力学力量。与腹主动脉瘤相关的患病率和高死亡风险仍是科学界的主要关注点。迫切需要进行广泛研究，以了解腹主动脉异常的潜在机制、病理生理特征和有效的检测方法。此外，制定和完善医疗及手术管理策略也势在必行。本综述旨在阐明计算分析在腹主动脉瘤理解和管理中的作用，并涵盖2021年至2023年间有关计算分析方法的最新研究。计算分析方法已成为复杂且无创的方法，能深入洞察腹主动脉瘤的复杂动力学，并增强我们有效研究和管理这种疾病的能力。
计算分析依赖于应用于动脉血流的流体力学原理，使用纳维-斯托克斯方程对血流动力学进行建模。与腹主动脉瘤相关的关键血流动力学指标包括时间平均壁面剪应力、振荡剪应力指数、内皮细胞激活潜能和相对停留时间。用于模拟腹主动脉并研究其生物力学环境的主要方法是计算流体动力学和有限元方法。这篇综述文章全面审视了近期文献，重点关注2021年至2023年间开展的研究。
最新研究已阐明了腹主动脉瘤血流特征和几何属性的关键见解。值得注意的是，腹主动脉瘤内的血流模式与破裂风险增加、腔内血栓体积增大以及特定钙化阈值相关。不对称腹主动脉瘤由于壁面剪应力低且振荡，破裂和血栓形成风险更高。此外，较大的动脉瘤表现出壁应力、压力和能量损失增加。先进的建模技术增强了关于生长速率和手术阈值的预测能力。此外，材料特性和血栓体积对壁应力水平的影响值得关注，而入口速度剖面显著调节腹主动脉瘤内的血流动力学。
本综述强调了计算建模的潜在效用。然而，尽管越来越多的证据支持生物力学和血流动力学指标在该领域的预后意义，但计算建模的临床适用性仍受到方法变异性的限制。建立标准化报告对于临床应用至关重要。
