Mechanical stresses in abdominal aortic aneurysms: influence of diameter, asymmetry, and material anisotropy

Biomechanical studies suggest that one determinant of abdominal aortic aneurysm (AAA) rupture is related to the stress in the wall. In this regard, a reliable and accurate stress analysis of an in vivo AAA requires a suitable 3D constitutive model. To date, stress analysis conducted on AAA is mainly driven by isotropic tissue models. However, recent biaxial tensile tests performed on AAA tissue samples demonstrate the anisotropic nature of this tissue. The purpose of this work is to study the influence of geometry and material anisotropy on the magnitude and distribution of the peak wall stress in AAAs. Three-dimensional computer models of symmetric and asymmetric AAAs were generated in which the maximum diameter and length of the aneurysm were individually controlled. A five parameter exponential type structural strain-energy function was used to model the anisotropic behavior of the AAA tissue. The anisotropy is determined by the orientation of the collagen fibers (one parameter of the model). The results suggest that shorter aneurysms are more critical when asymmetries are present. They show a strong influence of the material anisotropy on the magnitude and distribution of the peak stress. Results confirm that the relative aneurysm length and the degree of aneurysmal asymmetry should be considered in a rupture risk decision criterion for AAAs.     

Mechanical properties and microstructure of intraluminal thrombus from abdominal aortic aneurysm.

Accurate estimation of the wall stress distribution in an abdominal aortic aneurysm (AAA) may prove clinically useful by predicting when a particular aneurysm will rupture. Appropriate constitutive models for both the wall and the intraluminal thrombus (ILT) found in most AAA are necessary for this task. The purpose of this work was to determine the mechanical properties of ILT within AAA and to derive a more suitable constitutive model for this material. Uniaxial tensile testing was carried out on 50 specimens, including 14 longitudinally oriented and 14 circumferentially oriented specimens from the luminal region of the ILT, and 11 longitudinally oriented and 11 circumferentially oriented specimens from the medial region. A two-parameter, large-strain, hyperelastic constitutive model was developed and used to fit the uniaxial tensile testing data for determination of the material parameters. Maximum stiffness and strength were also determined from the data for each specimen. Scanning electron microscopy (SEM) was conducted to study the regional microstructural difference. Our results indicate that the microstructure of ILT differs between the luminal, medial, and abluminal regions, with the luminal region stronger and stiffer than the medial region. In all cases, the constitutive model fit the experimental data very well (R2>0.98). No significant difference was found for either of the two material parameters between longitudinal and circumferential directions, but a significant difference in material parameters, stiffness, and strength between the laminal and medial regions was determined (p<0.01). Therefore, our results suggest that ILT is an inhomogeneous and possibly isotropic material. The two-parameter, hyperelastic, isotropic, incompressible material model derived here for ILT can be easily incorporated into finite element models for simulation of wall stress distribution in AAA.     

Toward a biomechanical tool to evaluate rupture potential of abdominal aortic aneurysm: identification of a finite strain constitutive model and evaluation of its applicability

Knowledge of the wall stresses in an abdominal aortic aneurysm (AAA) may be helpful in evaluating the need for surgical intervention to avoid rupture. This must be preceded by the development of a more suitable finite strain constitutive model for AAA, as none currently exists. Additionally, reliable stress analysis of in vivo AAA for the purposes of clinical diagnostics requires patient-specific values of the material parameters, which are difficult to determine noninvasively. The purpose of this work, therefore, was three-fold: (1) to develop a finite strain constitutive model for AAA; (2) to estimate the variation of model parameters within a sample population; and (3) to evaluate the sensitivity of computed stress distribution in AAA due to this biologic variation. We propose here a two parameter, hyperelastic, isotropic, incompressible material model and utilize experimental data from 69 freshly excised AAA specimens to both develop the functional form of the model and estimate its material parameters. Parametric analyses were performed via repeated finite element computations to determine the effect of varying each of the two model parameters on the stress distribution in a three-dimensional AAA model. The agreement between experimental data and the proposed functional form of the constitutive law was very good (R2 > 0.9). Our finite element simulations showed that the computed AAA wall stresses changed by only 4% or less when both the parameters were varied within the 95% confidence intervals for the patient population studied. This observation indicates that in lieu of the patient-specific material parameters, which are difficult to determine the use of population mean values is sufficiently accurate for the model to be reasonably employed in a clinical setting. We believe that this is an important advancement toward the development of a computational tool for the estimation of rupture potential for individual AAA, for which there is great clinical need.     

3D reconstruction and manufacture of real abdominal aortic aneurysms: from CT scan to silicone model

Abdominal aortic aneurysm (AAA) can be defined as a permanent and irreversible dilation of the infrarenal aorta. AAAs are often considered to be an aorta with a diameter 1.5 times the normal infrarenal aorta diameter. This paper describes a technique to manufacture realistic silicone AAA models for use with experimental studies. This paper is concerned with the reconstruction and manufacturing process of patient-specific AAAs. 3D reconstruction from computed tomography scan data allows the AAA to be created. Mould sets are then designed for these AAA models utilizing computer aided designcomputer aided manufacture techniques and combined with the injection-moulding method. Silicone rubber forms the basis of the resulting AAA model. Assessment of wall thickness and overall percentage difference from the final silicone model to that of the computer-generated model was performed. In these realistic AAA models, wall thickness was found to vary by an average of 9.21%. The percentage difference in wall thickness recorded can be attributed to the contraction of the casting wax and the expansion of the silicone during model manufacture. This method may be used in conjunction with wall stress studies using the photoelastic method or in fluid dynamic studies using a laser-Doppler anemometry. In conclusion, these patient-specific rubber AAA models can be used in experimental investigations, but should be assessed for wall thickness variability once manufactured.     

The influence of fiber dispersion on the mechanical response of aortic tissues in health and disease: a computational study

Changes in the structural components of aortic tissues have been shown to play a significant role in the pathogenesis of aortic degeneration. Therefore, reliable stress analyses require a suitable and meaningful constitutive model that captures micro-structural changes. As recent data show, in-plane and out-of-plane collagen fiber dispersions vary significantly between healthy and aneurysmatic aortic walls. The aim of this study is to computationally investigate the influence of fiber dispersion on the mechanical response of aortic tissues in health and disease. In particular, the influence of three different fiber dispersions is studied: (i) non-rotationally symmetric dispersion, the most realistic assumption for aortic tissues; (ii) transversely isotropic dispersion, a special case; (iii) perfectly aligned fibers (no dispersion in either plane), another special case. Explicit expressions for the stress and elasticity tensors as needed for the implementation in a finite element code are provided. Three representative numerical examples are studied: planar biaxial extension, inflation of residually stressed and pre-stretched aortic segments and inflation of an idealized abdominal aortic aneurysm (AAA) geometry. For the AAA geometry the case of isotropic dispersion is additionally analyzed. Documented structural and mechanical parameters are taken from human aortas (healthy media/adventitia and AAA). The influence of fiber dispersions upon magnitudes and distributions of stresses and deformations are presented and analyzed. Stresses vary significantly, especially in the AAA case, where material stiffening is significantly influenced by fiber dispersion. The results highlight the need to incorporate the structural differences into finite element simulations to obtain more accurate stress predictions. Additionally, results show the capability of one constitutive model to represent different scenarios of aortic micro-structures allowing future studies of collagen reorientation during disease progression.     

Probabilistic noninvasive prediction of wall properties of abdominal aortic aneurysms using Bayesian regression

Multiple patient-specific parameters, such as wall thickness, wall strength, and constitutive properties, are required for the computational assessment of abdominal aortic aneurysm (AAA) rupture risk. Unfortunately, many of these quantities are not easily accessible and could only be determined by invasive procedures, rendering a computational rupture risk assessment obsolete. This study investigates two different approaches to predict these quantities using regression models in combination with a multitude of noninvasively accessible, explanatory variables. We have gathered a large dataset comprising tensile tests performed with AAA specimens and supplementary patient information based on blood analysis, the patients medical history, and geometric features of the AAAs. Using this unique database, we harness the capability of state-of-the-art Bayesian regression techniques to infer probabilistic models for multiple quantities of interest. After a brief presentation of our experimental results, we show that we can effectively reduce the predictive uncertainty in the assessment of several patient-specific parameters, most importantly in thickness and failure strength of the AAA wall. Thereby, the more elaborate Bayesian regression approach based on Gaussian processes consistently outperforms standard linear regression. Moreover, our study contains a comparison to a previously proposed model for the wall strength.     

Wall stress and flow dynamics in abdominal aortic aneurysms: finite element analysis vs. fluid–structure interaction

Abdominal aortic aneurysm (AAA) rupture is the clinical manifestation of an induced force exceeding the resistance provided by the strength of the arterial wall. This force is most frequently assumed to be the product of a uniform luminal pressure acting along the diseased wall. However fluid dynamics is a known contributor to the pathogenesis of AAAs, and the dynamic interaction of blood flow and the arterial wall represents the in vivo environment at the macro-scale. The primary objective of this investigation is to assess the significance of assuming an arbitrary estimated peak fluid pressure inside the aneurysm sac for the evaluation of AAA wall mechanics, as compared with the non-uniform pressure resulting from a coupled fluid–structure interaction (FSI) analysis. In addition, a finite element approach is utilised to estimate the effects of asymmetry and wall thickness on the wall stress and fluid dynamics of ten idealised AAA models and one non-aneurysmal control. Five degrees of asymmetry with uniform and variable wall thickness are used. Each was modelled under a static pressure-deformation analysis, as well as a transient FSI. The results show that the inclusion of fluid flow yields a maximum AAA wall stress up to 20% higher compared to that obtained with a static wall stress analysis with an assumed peak luminal pressure of 117 mmHg. The variable wall models have a maximum wall stress nearly four times that of a uniform wall thickness, and also increasing with asymmetry in both instances. The inclusion of an axial stretch and external pressure to the computational domain decreases the wall stress by 17%.     

Wall stress and flow dynamics in abdominal aortic aneurysms: finite element analysis vs. fluid-structure interaction

Abdominal aortic aneurysm (AAA) rupture is the clinical manifestation of an induced force exceeding the resistance provided by the strength of the arterial wall. This force is most frequently assumed to be the product of a uniform luminal pressure acting along the diseased wall. However fluid dynamics is a known contributor to the pathogenesis of AAAs, and the dynamic interaction of blood flow and the arterial wall represents the in vivo environment at the macro-scale. The primary objective of this investigation is to assess the significance of assuming an arbitrary estimated peak fluid pressure inside the aneurysm sac for the evaluation of AAA wall mechanics, as compared with the non-uniform pressure resulting from a coupled fluid-structure interaction (FSI) analysis. In addition, a finite element approach is utilised to estimate the effects of asymmetry and wall thickness on the wall stress and fluid dynamics of ten idealised AAA models and one non-aneurysmal control. Five degrees of asymmetry with uniform and variable wall thickness are used. Each was modelled under a static pressure-deformation analysis, as well as a transient FSI. The results show that the inclusion of fluid flow yields a maximum AAA wall stress up to 20% higher compared to that obtained with a static wall stress analysis with an assumed peak luminal pressure of 117 mmHg. The variable wall models have a maximum wall stress nearly four times that of a uniform wall thickness, and also increasing with asymmetry in both instances. The inclusion of an axial stretch and external pressure to the computational domain decreases the wall stress by 17%.     

Automated methodology for determination of stress distribution in human abdominal aortic aneurysm

Knowledge of impending abdominal aortic aneurysm (AAA) rupture can help in surgical planning. Typically, aneurysm diameter is used as the indicator of rupture, but recent studies have hypothesized that pressure-induced biomechanical stress may be a better predictor Verification of this hypothesis on a large study population with ruptured and unruptured AAA is vital if stress is to be reliably used as a clinical prognosticator for AAA rupture risk. We have developed an automated algorithm to calculate the peak stress in patient-specific AAA models. The algorithm contains a mesh refinement module, finite element analysis module, and a postprocessing visualization module. Several aspects of the methodology used are an improvement over past reported approaches. The entire analysis may be run from a single command and is completed in less than 1 h with the peak wall stress recorded for statistical analysis. We have used our algorithm for stress analysis of numerous ruptured and unruptured AAA models and report some of our results here. By current estimates, peak stress in the aortic wall appears to be a better predictor of rupture than AAA diameter. Further use of our algorithm is ongoing on larger study populations to convincingly verify these findings.     

Flow behaviour in an asymmetric compliant experimental model for abdominal aortic aneurysm

An experimental study was carried out on asymmetrical abdominal aortic aneurysm (AAA) to analyse the physiological flows involved. Velocity measurements were performed using particle image velocimetry. Resting and exercise flow rates were investigated in models with rigid and compliant walls to assess the parameters affecting the flow behaviour. The secondary flow patterns, and especially the evolution of the vortices within the AAA, were found to be highly dependent on both the flow waveforms and the wall behaviour. Vortices impacts on the distal walls of the AAA occur in the compliant model and can increase the local pressure on the AAA walls and thus increase the wall stresses; AAA wall stresses are one of the most important factors contributing to ruptured aneurysm.     

Fluid structure interaction of patient specific abdominal aortic aneurysms: a comparison with solid stress models

Background  

Abdominal aortic aneurysm (AAA) is a dilatation of the aortic wall, which can rupture, if left untreated. Previous work has shown that, maximum diameter is not a reliable determinant of AAA rupture. However, it is currently the most widely accepted indicator. Wall stress may be a better indicator and promising patient specific results from structural models using static pressure, have been published. Since flow and pressure inside AAA are non-uniform, the dynamic interaction between the pulsatile flow and wall may influence the predicted wall stress. The purpose of the present study was to compare static and dynamic wall stress analysis of patient specific AAAs.     

Three-dimensional mechanical properties of porcine coronary arteries: a validated two-layer model

The normal coronary artery consists of two mechanically distinct layers: intima-media and adventitia. The objective of this study is to establish a two-layer three-dimensional (3-D) stress-strain relation of porcine coronary arteries. Experimental measurements were made by a series of biaxial tests (inflation and axial extension) of intact coronary arteries and, subsequently, their corresponding intima-media or adventitia layer. The Fung-type exponential strain energy function was used to describe the 3-D strain-stress relation for each layer and the intact wall. A genetic algorithm was used to determine the material constants in the Fung-type constitutive equation by curve fitting the experimental data. Because one layer must be sacrificed before the other layer can be tested, the material property of the missing layer was computed from the material constants of the intact vessel and the tested layer. A total of 20 porcine hearts were used: one group of 10 hearts for the left anterior descending artery and another group of 10 hearts for the right coronary artery. Each group was further divided into two subgroups of five specimens tested for the intact wall and the intima-media layer and for the intact wall and the adventitia layer. Our results show statistically significant differences in the material properties of the two layers. The mathematical model was validated by experimental stress-strain data for individual layers. The validated 3-D constitutive model will serve as a foundation for formulation of layer-specific boundary value problems in coronary physiology and cardiology.     

A methodology for developing anisotropic AAA phantoms via additive manufacturing

An Abdominal Aortic Aneurysm (AAA) is a permanent focal dilatation of the abdominal aorta at least 1.5 times its normal diameter. The criterion of maximum diameter is still used in clinical practice, although numerical studies have demonstrated the importance of biomechanical factors for rupture risk assessment. AAA phantoms could be used for experimental validation of the numerical studies and for pre-intervention testing of endovascular grafts. We have applied multi-material 3D printing technology to manufacture idealized AAA phantoms with anisotropic mechanical behavior. Different composites were fabricated and the phantom specimens were characterized by biaxial tensile tests while using a constitutive model to fit the experimental data. One composite was chosen to manufacture the phantom based on having the same mechanical properties as those reported in the literature for human AAA tissue; the strain energy and anisotropic index were compared to make this choice. The materials for the matrix and fibers of the selected composite are, respectively, the digital materials FLX9940 and FLX9960 developed by Stratasys. The fiber proportion for the composite is equal to 0.15. The differences between the composite behavior and the AAA tissue are small, with a small difference in the strain energy (0.4%) and a maximum difference of 12.4% in the peak Green strain ratio. This work represents a step forward in the application of 3D printing technology for the manufacturing of AAA phantoms with anisotropic mechanical behavior.     

The association of wall mechanics and morphology: a case study of abdominal aortic aneurysm growth

The purpose of this study is to evaluate the potential correlation between peak wall stress (PWS) and abdominal aortic aneurysm (AAA) morphology and how it relates to aneurysm rupture potential. Using in-house segmentation and meshing software, six 3-dimensional (3D) AAA models from a single patient followed for 28 months were generated for finite element analysis. For the AAA wall, both isotropic and anisotropic materials were used, while an isotropic material was used for the intraluminal thrombus (ILT). These models were also used to calculate 36 geometric indices characteristic of the aneurysm morphology. Using least squares regression, seven significant geometric features (p?相似文献   

Fundamental role of axial stress in compensatory adaptations by arteries

Arteries exhibit a remarkable ability to adapt to diverse genetic defects and sustained alterations in mechanical loading. For example, changes in blood flow induced wall shear stress tend to control arterial caliber and changes in blood pressure induced circumferential wall stress tend to control wall thickness. We submit, however, that the axial component of wall stress plays a similarly fundamental role in controlling arterial geometry, structure, and function, that is, compensatory adaptations. This observation comes from a review of findings reported in the literature and a comparison of four recent studies from our laboratory that quantified changes in the biaxial mechanical properties of mouse carotid arteries in cases of altered cell-matrix interactions, extracellular matrix composition, blood pressure, or axial extension. There is, therefore, a pressing need to include the fundamental role of axial wall stress in conceptual and theoretical models of arterial growth and remodeling and, consequently, there is a need for increased attention to evolving biaxial mechanical properties in cases of altered genetics and mechanical stimuli.     

Impact of calcifications on patient-specific wall stress analysis of abdominal aortic aneurysms

As a degenerative and inflammatory desease of elderly patients, about 80% of abdominal aortic aneurysms (AAA) show considerable wall calcification. Effect of calcifications on computational wall stress analyses of AAAs has been rarely treated in literature so far. Calcifications are heterogeneously distributed, non-fibrous, stiff plaques which are most commonly found near the luminal surface in between the intima and the media layer of the vessel wall. In this study, we therefore investigate the influence of calcifications as separate AAA constituents on finite element simulation results. Thus, three AAAs are reconstructed with regard to intraluminal thrombus (ILT), calcifications and vessel wall. Each patient-specific AAA is simulated twice, once including all three AAA constituents and once neglecting calcifications as it is still common in literature. Parameters for constitutive modeling of calcifications are thereby taken from experiments performed by the authors, showing that calcifications exhibit an almost linear stress–strain behavior with a Young’s modulus E ≥ 40 MPa. Simulation results show that calcifications exhibit significant load-bearing effects and reduce stress in adjacent vessel wall. Average stress within the vessel wall is reduced by 9.7 to 59.2%. For two out of three AAAs, peak wall stress decreases when taking calcifications into consideration (8.9 and 28.9%). For one AAA, simulated peak wall stress increases by 5.5% due to stress peaks near calcification borders. However, such stress singularities due to sudden stiffness jumps are physiologically doubtful. It can further be observed that large calcifications are mostly situated in concavely shaped regions of the AAA wall. We deduce that AAA shape is influenced by existent calcifications, thus crucial errors occur if they are neglected in computational wall stress analyses. A general increase in rupture risk for calcified AAAs is doubted.     

Approaches for treatment of aortic arch aneurysm,a numerical study

Aortic arch aneurysm is a complex pathology which requires coverage of one or more aortic arch vessels. In this study we explore the hemodynamic behavior of the aortic arch in aneurysmatic and treated cases with three currently available treatment approaches: Surgery Graft, hybrid Stent-Graft and chimney Stent Graft. The analysis included four models of the time-dependent fluid domains of aneurysmatic arch and of the surgery, hybrid and chimney endovascular techniques. Dimensions of the models are based on typical anatomy, and boundary conditions are based on typical physiological flow.The simulations used computational fluid dynamics (CFD) methods to delineate the time-dependent flow dynamics in the four geometric models.Results of velocity vectors, flow patterns, blood pressure and wall shear stress distributions are presented.The results delineate disturbed and recirculating flow in the aortic arch aneurysm accompanied with low wall shear stress and velocities, compared to a uniformly directed flow and nominal wall shear stress (WSS) in the model of Surgery graft. Out of the two endograft procedures, the hybrid procedure clearly exhibits better hemodynamic performances over the chimney model, with lower WSS, lower pressure drop and less disturbed and vortical flow regions. Although the chimney procedure requires less manufacturing time and cost, it is associated with higher risk rates, and therefore, it is recommended only for emergency cases. This study may shed light on the hemodynamic factors for these complications and provide insight into ways to improve the procedure.