Bringing vascular biomechanics into clinical practice. Simulation-based decisions for elective abdominal aortic aneurysms repair

• Vascular diseases are the leading cause of death in the industrialized countries and some of the associated risk factors are increasing. A multi-disciplinary approach including biomechanics is needed to better understand and more effectively treat these diseases. Despite the tremendous progress made in modeling the biomechanics of the vasculature, so far this research has accomplished only very limited clinical relevance or acceptance. Establishing vascular biomechanical simulations in the clinical work-flow requires integrating (i) a robust reconstruction of vascular bodies from medical images, (ii) a non-linear biomechanical analysis and (iii) a clinically relevant interpretation of the derived results. Such an approach is outlined for the biomechanical rupture risk assessment of Abdominal Aortic Aneurysms (AAAs), i.e. a local dilatation of the infrarenal aorta that may form through irreversible pathological remodeling of the aortic wall. Rupture of an AAA is a frequent cause of death in the elderly male population and assessing this risk plays a central role in the clinical management of aneurysms. Specifically, the present chapter details an operator-insensitive method to reconstruct vascular bodies from Computer Tomography-Angiography data. The approach is based on beam and shell-like deformable (active) contour models and allows a hexahedral-dominated mesh generation for an efficient Finite Element computation. Laboratory experiments and histo-mechanical constitutive modeling of AAA tissue are reviewed. Finally, the clinical application of the biomechanical rupture risk assessment is demonstrated through the especially developed software A4clinics. Most critically, individual biomechanical parameters are related to the ‘average AAA patient’, which in turn provides a biomechanics-based index for elective AAA repair indication.

Subject headings

TEKNIK OCH TEKNOLOGIER  -- Medicinteknik -- Medicinsk bildbehandling (hsv//swe)

ENGINEERING AND TECHNOLOGY  -- Medical Engineering -- Medical Image Processing (hsv//eng)

Keyword

Anisotropy

Fatigue

Luminal

Obesity

Sugar

Publication and Content Type

ref (subject category)

art (subject category)