Biomechanical assessment predicts aneurysm-related events in patients with abdominal aortic aneurysm

Barry Doyle, Bappoo Nikhilesh, Maaz Syed, Rachael Forsythe, Janet T Powell, Noel Conlisk, Peter Hoskins, Grand Roman Joldes, Olivia McBride, Anoop Shah, Paul Norman, David Newby

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives
Improved methods of rupture prediction are a priority in abdominal aortic aneurysm (AAA). Biomechanical analysis of risk in AAA has major clinical potential but lacks robust evidence that it adds clinical value. We aimed to test if the aneurysm biomechanical ratio (ABR, a dimensionless ratio of wall stress and wall strength) can predict aneurysm-related events.
Methods
In a prospective multicentre clinical study of 295 patients with AAA (diameter ≥ 40 mm), we used three-dimensional reconstruction and computational biomechanical analyses to compute ABR at baseline. Participants were followed for at least two years and the primary endpoint was the composite of aneurysm rupture or repair.
Results
The majority were male (87%) current or former smokers (86%), most (72%) had hypertension (mean systolic blood pressure of 140±22 mmHg) and mean baseline diameter was 49.0±6.9 mm. Mean ABR was 0.49±0.27. Participants were followed up for a mean of 848±379 days and rupture (n=13) or repair (n=102) occurred in 115 (39%) cases. The number of repairs increased across tertiles of ABR; low (n=24), medium (n=34), high ABR (n=44) (p=0.010). Rupture or repair occurred more frequently in those with higher ABR (log rank p=0.009) and ABR was independently predictive of this outcome after adjusting for diameter and other clinical risk factors, including gender and smoking (hazard ratio, 1.41; 95% confidence interval, 1.09-1.83; p=0.010).
Conclusions
We have shown that the biomechanical ABR is a strong independent predictor of AAA rupture or repair in a model incorporating known risk factors, including diameter. Determining ABR at baseline could help guide the management of patients with AAA.

Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
Early online date3 Apr 2020
DOIs
Publication statusE-pub ahead of print - 3 Apr 2020

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