Rolf-Pissarczyk Malte, Schussnig Richard, Fries Thomas-Peter, Fleischmann Dominik, Elefteriades John A, Humphrey Jay D, Holzapfel Gerhard A
Institute of Biomechanics, Graz University of Technology, Austria.
High-Performance Scientific Computing, University of Augsburg, Germany.
Prog Mater Sci. 2025 Apr;150. doi: 10.1016/j.pmatsci.2024.101363. Epub 2024 Sep 12.
Aortic dissection continues to be responsible for significant morbidity and mortality, although recent advances in medical data assimilation and in experimental and models have improved our understanding of the initiation and progression of the accumulation of blood within the aortic wall. Hence, there remains a pressing necessity for innovative and enhanced models to more accurately characterize the associated pathological changes. Early on, experimental models were employed to uncover mechanisms in aortic dissection, such as hemodynamic changes and alterations in wall microstructure, and to assess the efficacy of medical implants. While experimental models were once the only option available, more recently they are also being used to validate models. Based on an improved understanding of the deteriorated microstructure of the aortic wall, numerous multiscale material models have been proposed in recent decades to study the state of stress in dissected aortas, including the changes associated with damage and failure. Furthermore, when integrated with accessible patient-derived medical data, models prove to be an invaluable tool for identifying correlations between hemodynamics, wall stresses, or thrombus formation in the deteriorated aortic wall. They are also advantageous for model-guided design of medical implants with the aim of evaluating the deployment and migration of implants in patients. Nonetheless, the utility of models depends largely on patient-derived medical data, such as chosen boundary conditions or tissue properties. In this review article, our objective is to provide a thorough summary of medical data elucidating the pathological alterations associated with this disease. Concurrently, we aim to assess experimental models, as well as multiscale material and patient data-informed models, that investigate various aspects of aortic dissection. In conclusion, we present a discourse on future perspectives, encompassing aspects of disease modeling, numerical challenges, and clinical applications, with a particular focus on aortic dissection. The aspiration is to inspire future studies, deepen our comprehension of the disease, and ultimately shape clinical care and treatment decisions.
主动脉夹层仍然是导致严重发病和死亡的原因，尽管医学数据同化以及实验和模型方面的最新进展增进了我们对主动脉壁内血液积聚的起始和进展的理解。因此，迫切需要创新和改进的模型来更准确地表征相关的病理变化。早期，实验模型被用于揭示主动脉夹层的机制，如血流动力学变化和壁微观结构改变，并评估医疗植入物的疗效。虽然实验模型曾经是唯一可用的选择，但最近它们也被用于验证模型。基于对主动脉壁恶化微观结构的更好理解，近几十年来提出了许多多尺度材料模型来研究夹层主动脉中的应力状态，包括与损伤和失效相关的变化。此外，当与可获取的患者源医学数据相结合时，模型被证明是识别恶化主动脉壁中血流动力学、壁应力或血栓形成之间相关性的宝贵工具。它们对于以评估植入物在患者体内的部署和迁移为目的的医疗植入物的模型指导设计也具有优势。尽管如此，模型的效用在很大程度上取决于患者源医学数据，如所选的边界条件或组织特性。在这篇综述文章中，我们的目标是全面总结阐明与该疾病相关病理改变的医学数据。同时，我们旨在评估研究主动脉夹层各个方面的实验模型以及多尺度材料和患者数据驱动的模型。总之，我们阐述了关于未来展望的论述，涵盖疾病建模、数值挑战和临床应用等方面，特别关注主动脉夹层。目的是激发未来的研究，加深我们对该疾病的理解，并最终塑造临床护理和治疗决策。
