Wall Stress Distributions in Abdominal Aortic Aneurysms Do Not Correlate With Symptoms

TL;DR

This study used a rapid, geometry-based computational method to estimate wall stress in abdominal aortic aneurysms and found no correlation between stress levels and symptoms, challenging previous assumptions.

Contribution

The paper introduces a fast, automated wall stress computation method that accounts for residual stress and is insensitive to tissue properties, applied to clinical cases.

Findings

Wall stress does not correlate with symptoms in AAA cases.

The method is efficient and suitable for clinical workflows.

Stress distribution alone is not a predictor of rupture risk.

Abstract

Abdominal aortic aneurysm (AAA) is a permanent and irreversible dilation of the lower region of the aorta. It is typically an asymptomatic condition that if left untreated can expand to the point of rupture. Mechanically-speaking, rupture of an artery occurs when the local wall stress exceeds the local wall strength. It is therefore understandable that numerous studies have attempted to estimate the AAA wall stress. Recently the Intelligent Systems for Medicine Laboratory (ISML) presented a very efficient method to compute AAA wall stress using geometry from Computed Tomography (CT) images, and median arterial pressure as the applied load. The ISML's method is embedded in the software platform BioPARR - Biomechanics based Prediction of Aneurysm Rupture Risk, freely available from http://bioparr.mech.uwa.edu.au/. The uniqueness of our stress computation approach is three-fold: i) the results are insensitive to unknown patient-specific mechanical properties of arterial wall tissue; ii) the residual stress is accounted for, according to Y.C. Fung's Uniform Stress Hypothesis; and iii) the analysis is automated and quick, making our approach compatible with clinical workflows. In this study we evaluated 19 cases of AAA. A proportion of these were classified as symptomatic. The results of the analysis demonstrate, contrary to the common view, that neither the wall stress magnitude nor the stress distribution correlate with the presence of clinical symptoms.