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Measuring and modeling patient-specific distributions of material properties in abdominal aortic aneurysm wall

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Abstract

Both the clinically established diameter criterion and novel approaches of computational finite element (FE) analyses for rupture risk stratification of abdominal aortic aneurysms (AAA) are based on assumptions of population-averaged, uniform material properties for the AAA wall. The presence of inter-patient and intra-patient variations in material properties is known, but has so far not been addressed sufficiently. In order to enable the preoperative estimation of patient-specific AAA wall properties in the future, we investigated the relationship between non-invasively assessable clinical parameters and experimentally measured AAA wall properties. We harvested n = 163 AAA wall specimens (n = 50 patients) during open surgery and recorded the exact excision sites. Specimens were tested for their thickness, elastic properties, and failure loads using uniaxial tensile tests. In addition, 43 non-invasively assessable patient-specific or specimen-specific parameters were obtained from recordings made during surgery and patient charts. Experimental results were correlated with the non-invasively assessable parameters and simple regression models were created to mathematically describe the relationships. Wall thickness was most significantly correlated with the metabolic activity at the excision site assessed by PET/CT (ρ = 0.499, P = 4 × 10−7) and to thrombocyte counts from laboratory blood analyses (ρ = 0.445, P = 3 × 10−9). Wall thickness was increased in patients suffering from diabetes mellitus, while it was significantly thinner in patients suffering from chronic kidney disease (CKD). Elastic AAA wall properties had significant correlations with the metabolic activity at the excision site (PET/CT), with existent calcifications, and with the diameter of the non-dilated aorta proximal to the AAA. Failure properties (wall strength and failure tension) had correlations with the patient’s medical history and with results from laboratory blood analyses. Interestingly, AAA wall failure tension was significantly reduced for patients with CKD and elevated blood levels of potassium and urea, respectively, both of which are associated with kidney disease. This study is a first step to a future preoperative estimation of AAA wall properties. Results can be conveyed to both the diameter criterion and FE analyses to refine rupture risk prediction. The fact that AAA wall from patients suffering from CKD featured reduced failure tension implies an increased AAA rupture risk for this patient group at comparably smaller AAA diameters.

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References

  • Alberti KGMM, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO consultation. Diabetes Med 15(7): 539–553

    Article  Google Scholar 

  • Breeuwer M, de Putter S, Kose U, Speelman L, Visser K, Gerritsen F, Hoogeveen R, Krams R, van den Bosch H, Buth J, Gunther T, Wolters B, van Dam E, van de Vosse F (2008) Towards patient-specific risk assessment of abdominal aortic aneurysm. Med Biol Eng Comp 46(11): 1085–1095

    Article  Google Scholar 

  • Choke E, Cockerill G, Wilson WRW, Sayed S, Dawson J, Loftus I, Thompson MM (2005) A review of biological factors implicated in abdominal aortic aneurysm rupture. Eur J Vasc Endovasc Surg 30(3): 227–244

    Article  Google Scholar 

  • CKD-MBD Work Group (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney disease: improving global outcomes (kdigo) CKD-MBD work group. Kidney Int Suppl 113:1–130

    Google Scholar 

  • Defawe OD, Hustinx R, Defraigne JO, Limet R, Sakalihasan N (2005) Distribution of F-18 fluorodeoxyglucose (F-18 FDG) in abdominal aortic aneurysm: high accumulation in macrophages seen on PET imaging and immunohistology. Clin Nucl Med 30(5): 340–341

    Article  Google Scholar 

  • Doyle BJ, Hoskins PR, McGloughlin TM (2011) Commentary: computational rupture prediction of aaas: what needs to be done next?. J Endovasc Ther 18(2): 226–229

    Article  Google Scholar 

  • Fillinger MF, Marra SP, Raghavan ML, Kennedy FE (2003) Prediction of rupture risk in abdominal aortic aneurysm during observation: wall stress versus diameter. J Vasc Surg 37(4): 724–732

    Article  Google Scholar 

  • Folco EJ, Sheikine Y, Rocha VZ, Christen T, Shvartz E, Sukhova GK, Di Carli MF, Libby P (2011) Hypoxia but not inflammation augments glucose uptake in human macrophages: implications for imaging atherosclerosis with 18fluorine-labeled 2-deoxy-d-glucose positron emission tomography. J Am Coll Cardiol 58(6): 603–614

    Article  Google Scholar 

  • Forsdahl SH, Singh K, Solberg S, Jacobsen BK (2009) Risk factors for abdominal aortic aneurysms. Circulation 119(16): 2202–2208

    Article  Google Scholar 

  • Fung YC (1993) Biomechanics—mechanical properties of living tissues, 2nd edn. Springer, New York

    Google Scholar 

  • Gasser TC, Görgülü G, Folkesson M, Swedenborg J (2008) Failure properties of intraluminal thrombus in abdominal aortic aneurysm under static and pulsating mechanical loads. J Vasc Surg 48(1): 179–188

    Article  Google Scholar 

  • Gasser TC, Auer M, Labruto F, Swedenborg J, Roy J (2010) Biomechanical rupture risk assessment of abdominal aortic aneurysms: model complexity versus predictability of finite element simulations. Eur J Vasc Endovasc Surg 40(2): 176–185

    Article  Google Scholar 

  • Gee MW, Reeps C, Eckstein HH, Wall WA (2009) Prestressing in finite deformation abdominal aortic aneurysm simulation. J Biomech 42(11): 1732–1739

    Article  Google Scholar 

  • Gee MW, Förster C, Wall WA (2010) A computational strategy for prestressing patient specific biomechanical problems under finite deformation. Int J Numer Meth Biomed Eng 26(1): 52–72

    Article  MATH  Google Scholar 

  • Greenhalgh RM (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364(9437): 843–848

    Article  Google Scholar 

  • Holzapfel GA (2000) Nonlinear solid mechanics: a contiuum approach for engineering. Wiley, Chichester

    Google Scholar 

  • Holzapfel GA, Ogden RW (2010) Constitutive modelling of arteries. Proc R Soc A 466: 1551–1597

    Article  MathSciNet  MATH  Google Scholar 

  • Humphrey JD (2002) Cardiovascular solid mechanics—cells, tissues, and organs. Springer, New York

    Book  Google Scholar 

  • Humphrey JD, Holzapfel GA (2012) Mechanics, mechanobiology, and modeling of human abdominal aorta and aneurysms. J Biomech 45(5): 805–814

    Article  Google Scholar 

  • Humphrey JD, Rajagopal KR (2003) A constrained mixture model for arterial adaptations to a sustained step change in blood flow. Biomech Model Mechanobiol 2(2): 109–126

    Article  Google Scholar 

  • Humphrey JD, Taylor CA (2008) Intracranial and abdominal aortic aneurysms: similarities, differences, and need for a new class of computational models. Annu Rev Biomed Eng 10(1): 221–246

    Article  Google Scholar 

  • Hyhlik-Dürr A, Krieger T, Geisbüsch P, Kotelis D, Able T, Böckler D (2011) Reproducibility of deriving parameters of AAA rupture risk from patient-specific 3D finite element models. J Endovasc Ther 18(3): 289–298

    Article  Google Scholar 

  • Kotze C, Groves A, Menezes L, Harvey R, Endozo R, Kayani I, Ell P, Yusuf S (2011) What is the relationship between 18F-FDG aortic aneurysm uptake on PET/CT and future growth rate?. Eur J Nucl Med Mol Imaging 38(8): 1493–1499

    Article  Google Scholar 

  • Li ZY, U-King-Im J, Tang TY, Soh E, See TC, Gillard JH (2008) Impact of calcification and intraluminal thrombus on the computed wall stresses of abdominal aortic aneurysm. J Vasc Surg 47(5): 928–935

    Article  Google Scholar 

  • Lim ST, Kim YK, Hwang JK, Kim SD, Park SC, Won YS, Park JS, Kim JI, Yun SS, Moon IS (2011) A clinical consideration of abdominal aortic aneurysm rupture. Korean J Vasc Endovasc Surg 27(3): 103–107

    Article  Google Scholar 

  • Maier A, Gee MW, Reeps C, Eckstein HH, Wall WA (2010) Impact of calcifications on patient-specific wall stress analysis of abdominal aortic aneurysms. Biomech Model Mechanobiol 9(5): 511–521

    Article  Google Scholar 

  • Maier A, Gee MW, Reeps C, Pongratz J, Eckstein HH, Wall WA (2010) A comparison of diameter, wall stress, and rupture potential index for abdominal aortic aneurysm rupture risk prediction. Ann Biomed Eng 38(10): 3124–3134

    Article  Google Scholar 

  • Maier A, Essler M, Gee MW, Eckstein HH, Wall WA, Reeps C (2012) Correlation of biomechanics to tissue reaction in aortic aneurysms assessed by finite elements and [18F]-fluorodeoxyglucose-PET/CT. Int J Numer Meth Biomed Eng 28(4): 456–471

    Article  MathSciNet  Google Scholar 

  • Marini G, Maier A, Reeps C, Eckstein HH, Wall WA, Gee MW (2012) A continuum description of the damage process in the arterial wall of abdominal aortic aneurysms. Int J Numer Meth Biomed Eng 28(1): 87–99

    Article  MathSciNet  MATH  Google Scholar 

  • Ockert S, Boeckler D, Allenberg J, Schumacher H (2007) Rupturiertes abdominelles Aortenaneurysma. Gefaesschirurgie 12(5): 379–391

    Article  Google Scholar 

  • Okamoto R, Wagenseil J, DeLong W, Peterson S, Kouchoukos N, Sundt T (2002) Mechanical properties of dilated human ascending aorta. Ann Biomed Eng 30(5): 624–635

    Article  Google Scholar 

  • Pelisek J, Assadian A, Sarkar O, Eckstein HH, Frank H (2010) Carotid plaque composition in chronic kidney disease: a retrospective analysis of patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg 39(1): 11–16

    Article  Google Scholar 

  • Pelisek J, Hahntow IN, Eckstein HH, Ockert S, Reeps C, Heider P, Luppa PB, Frank H (2011) Impact of chronic kidney disease on carotid plaque vulnerability. J Vasc Surg 54(6): 1643–1649

    Article  Google Scholar 

  • Polzer S, Gasser T, Swedenborg J, Bursa J (2011) The impact of intraluminal thrombus failure on the mechanical stress in the wall of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 41(4): 467–473

    Article  Google Scholar 

  • Raghavan ML, Vorp DA (2000) Toward a biomechanical tool to evaluate rupture potential of abdominal aortic aneurysm: identification of a finite strain constitutive model and evaluation of its applicability. J Biomech 33(4): 475–482

    Article  Google Scholar 

  • Raghavan ML, Webster MW, Vorp DA (1996) Ex vivo biomechanical behavior of abdominal aortic aneurysm: assessment using a new mathematical model. Ann Biomed Eng 24(5): 573–582

    Article  Google Scholar 

  • Raghavan ML, Hanaoka MM, Kratzberg JA, Higuchi MdL, da Silva ES (2011a) Biomechanical failure properties and microstructural content of ruptured and unruptured abdominal aortic aneurysms. J Biomech 44(13): 2501–2507

    Article  Google Scholar 

  • Raghavan ML, Lin K, Ramachandran M, Nadereishvili A, Amelon R, Lu J (2011b) Planar radial extension for constitutive modeling of anisotropic biological soft tissues. Int J Struct Changes Sol 3(2): 23–31

    Google Scholar 

  • Rausch SMK, Martin C, Bornemann PB, Uhlig S, Wall WA (2011) Material model of lung parenchyma based on living precision-cut lung slice testing. J Mech Behav Biomed Mater 4(4): 583–592

    Article  Google Scholar 

  • Reeps C, Essler M, Pelisek J, Seidl S, Eckstein HH, Krause BJ (2008) Increased 18F-fluorodeoxyglucose uptake in abdominal aortic aneurysms in positron emission/computed tomography is associated with inflammation, aortic wall instability, and acute symptoms. J Vasc Surg 48(2): 417–423

    Article  Google Scholar 

  • Reeps C, Gee MW, Maier A, Pelisek J, Gurdan M, Wall WA, Mariss J, Eckstein HH, Essler M (2009) Glucose metabolism in the vessel wall correlates with mechanical instability and inflammatory changes in a patient with a growing aneurysm of the abdominal aorta. Circ Cardiovasc Imaging 2(6): 507–509

    Article  Google Scholar 

  • Reeps C, Gee M, Maier A, Gurdan M, Eckstein HH, Wall WA (2010) The impact of model assumptions on results of computational mechanics in abdominal aortic aneurysm. J Vasc Surg 51(3): 679–688

    Article  Google Scholar 

  • Royston P, Ambler G, Sauerbrei W (1999) The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol 28(5): 964–974

    Article  Google Scholar 

  • Sakalihasan N, Hustinx R, Limet R (2004) Contribution of PET scanning to the evaluation of abdominal aortic aneurysm. Sem Vasc Surg 17(2): 144–153

    Article  Google Scholar 

  • Sauerbrei W, Meier-Hirmer C, Benner A, Royston P (2006) Multivariable regression model building by using fractional polynomials: description of SAS, STATA and R programs. Comput Stat Data Anal 50(12): 3464–3485

    Article  MathSciNet  MATH  Google Scholar 

  • The UK Small Aneurysm Trial Participants with Brown LC and Powell JT (1999) Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. Ann Surg 230(3):289–297 (2006)

    Google Scholar 

  • Thubrikar MJ, Labrosse F, Robicsek J, Al-Soudi B, Fowler M (2001) Mechanical properties of abdominal aortic aneurysm wall. J Med Eng Technol 25(4): 133–142

    Article  Google Scholar 

  • Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX (2006) Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17(7): 2034–2047

    Article  Google Scholar 

  • Truijers M, Kurvers HAJM, Bredie SJH, Oyen WJG, Blankensteijn JD (2008) In vivo imaging of abdominal aortic aneurysms: increased FDG uptake suggests inflammation in the aneurysm wall. J Endovasc Ther 15(4): 462–467

    Article  Google Scholar 

  • Vallabhaneni S, Gilling-Smith G, How T, Carter S, Brennan J, Harris P (2004) Heterogeneity of tensile strength and matrix metalloproteinase activity in the wall of abdominal aortic aneurysms. J Endovasc Ther 11: 494–502

    Article  Google Scholar 

  • Vande Geest JP, Sacks MS, Vorp DA (2006) The effects of aneurysm on the biaxial mechanical behavior of human abdominal aorta. J Biomech 39(7): 1324–1334

    Article  Google Scholar 

  • Vande Geest JP, Wang DHJ, Wisniewski S, Makaroun M, Vorp D (2006) Towards a noninvasive method for determination of patient-specific wall strength distribution in abdominal aortic aneurysms. Ann Biomed Eng 34(7): 1098–1106

    Article  Google Scholar 

  • Wall WA, Gee MW (2010) Baci: a parallel multiphysics simulation environment. Technical report, Institute for Computational Mechanics, Technische Universität München

  • Watton P, Hill N (2009) Evolving mechanical properties of a model of abdominal aortic aneurysm. Biomech Model Mechanobiol 8(1): 25–42

    Article  Google Scholar 

  • Xenos M, Rambhia S, Alemu Y, Einav S, Labropoulos N, Tassiopoulos A, Ricotta J, Bluestein D (2010) Patient-based abdominal aortic aneurysm rupture risk prediction with fluid structure interaction modeling. Ann Biomed Eng 38(11): 3323–3337

    Article  Google Scholar 

  • Zeinali-Davarani S, Raguin L, Vorp DA, Baek S (2011) Identification of in vivo material and geometric parameters of a human aorta: toward patient-specific modeling of abdominal aortic aneurysm. Biomech Model Mechanobiol 10(5): 689–699

    Article  Google Scholar 

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Authors and Affiliations

  1. Clinic for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    C. Reeps, J. Pelisek, F. Härtl, V. Grabher-Meier & H.-H. Eckstein

  2. Institute for Computational Mechanics, Technische Universität München, Boltzmannstr. 15, 85747, Garching bei München, Germany

    A. Maier & W. A. Wall

  3. Clinic for Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    M. Essler

  4. Mechanics and High Performance Computing Group, Technische Universität München, Boltzmannstr. 15, 85747, Garching bei München, Germany

    M. W. Gee

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  1. C. Reeps
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  2. A. Maier
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  5. V. Grabher-Meier
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  6. W. A. Wall
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  7. M. Essler
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  8. H.-H. Eckstein
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  9. M. W. Gee
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Correspondence to M. W. Gee.

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Reeps, C., Maier, A., Pelisek, J. et al. Measuring and modeling patient-specific distributions of material properties in abdominal aortic aneurysm wall. Biomech Model Mechanobiol 12, 717–733 (2013). https://doi.org/10.1007/s10237-012-0436-1

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  • DOI: https://doi.org/10.1007/s10237-012-0436-1

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