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Research Papers

Review: The Role of Biomechanical Modeling in the Rupture Risk Assessment for Abdominal Aortic Aneurysms

[+] Author and Article Information
Giampaolo Martufi

e-mail: martufi@kth.se

T. Christian Gasser

e-mail: tg@hallf.kth.se
Department of Solid Mechanics,
School of Engineering Sciences,
Royal Institute of Technology (KTH),
Osquars Backe 1,
SE-100 44 Stockholm, Sweden

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received October 17, 2012; final manuscript received December 21, 2012; accepted manuscript posted December 26, 2012; published online February 7, 2013. Editor: Victor H. Barocas.

J Biomech Eng 135(2), 021010 (Feb 07, 2013) (10 pages) Paper No: BIO-12-1491; doi: 10.1115/1.4023254 History: Received October 17, 2012; Revised December 21, 2012; Accepted December 26, 2012

AAA disease is a serious condition and a multidisciplinary approach including biomechanics is needed to better understand and more effectively treat this disease. A rupture risk assessment is central to the management of AAA patients, and biomechanical simulation is a powerful tool to assist clinical decisions. Central to such a simulation approach is a need for robust and physiologically relevant models. Vascular tissue senses and responds actively to changes in its mechanical environment, a crucial tissue property that might also improve the biomechanical AAA rupture risk assessment. Specifically, constitutive modeling should not only focus on the (passive) interaction of structural components within the vascular wall, but also how cells dynamically maintain such a structure. In this article, after specifying the objectives of an AAA rupture risk assessment, the histology and mechanical properties of AAA tissue, with emphasis on the wall, are reviewed. Then a histomechanical constitutive description of the AAA wall is introduced that specifically accounts for collagen turnover. A test case simulation clearly emphasizes the need for constitutive descriptions that remodels with respect to the mechanical loading state. Finally, remarks regarding modeling of realistic clinical problems and possible future trends conclude the article.

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Figures

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Fig. 1

Box and whisker plots of peak wall stress (PWS) of ruptured (gray) and diameter-matching nonruptured (white) aneurysms. The number of aneurysms included in the analysis is given by n, whereas ratios between the 25% trimmed means and the p-value are denoted by k and p, respectively. Image taken from [47].

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Fig. 2

Three-dimensional collagen fiber orientation in the AAA wall. Bingham distribution function (red) fitted to the experimentally measured fiber orientation distribution (light blue) in the AAA wall. Image taken from [78].

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Fig. 3

Conceptual model of a collagen fiber

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Fig. 4

Definition of the homeostatic deformation λph of a collagen fiber aligned along the referential orientation N. Collagen fiber stretches below and above λph define mechanical stimuli ζ<1 and ζ>1, respectively. The PDF denotes the triangular probability density function that defines the undulation of collagen fibrils within the collagen fiber. The stress in the collagen fiber is defined according to Eq. (1).

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Fig. 5

Wall stress prediction neglecting (left column) and considering (right column) the turnover of collagen in a patient-specific AAA. Top row shows the maximum principal Cauchy stress at the outer surface. Bottom row presents a view inside the AAA and shows the maximum principal Cauchy stress distally the maximum diameter. Note the inhomogeneous stress across the wall and the elevated stress levels at the inner surface shown in (c).

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