Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter
Objectives: We previously showed that peak abdominal aortic aneurysm (AAA) wall stress calculated for aneurysms in vivo is higher at rupture than at elective repair. The purpose of this study was to analyze rupture risk over time in patients under observation. Methods: Computed tomography (CT) scans...
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| Veröffentlicht in: | Journal of vascular surgery 2003-04, Vol.37 (4), p.724-732 |
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| creator | Fillinger, Mark F. Marra, Steven P. Raghavan, M.L. Kennedy, Francis E. |
| description | Objectives: We previously showed that peak abdominal aortic aneurysm (AAA) wall stress calculated for aneurysms in vivo is higher at rupture than at elective repair. The purpose of this study was to analyze rupture risk over time in patients under observation. Methods: Computed tomography (CT) scans were analyzed for patients with AAA when observation was planned for at least 6 months. AAA wall stress distribution was computationally determined in vivo with CT data, three-dimensional computer modeling, finite element analysis (nonlinear hyperelastic model depicting aneurysm wall behavior), and blood pressure during observation. Results: Analysis included 103 patients and 159 CT scans (mean follow-up, 14 ± 2 months per CT). Forty-two patients were observed with no intervention for at least 1 year (mean follow-up, 28 ± 3 months). Elective repair was performed within 1 year in 39 patients, and emergent repair was performed in 22 patients (mean, 6 ± 1 month after CT) for rupture (n = 14) or acute severe pain. Significant differences were found for initial diameter (observation, 4.9 ±.1 cm; elective repair, 5.9 ±.1 cm; emergent repair, 6.1 ±.2 cm; P |
| doi_str_mv | 10.1067/mva.2003.213 |
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The purpose of this study was to analyze rupture risk over time in patients under observation. Methods: Computed tomography (CT) scans were analyzed for patients with AAA when observation was planned for at least 6 months. AAA wall stress distribution was computationally determined in vivo with CT data, three-dimensional computer modeling, finite element analysis (nonlinear hyperelastic model depicting aneurysm wall behavior), and blood pressure during observation. Results: Analysis included 103 patients and 159 CT scans (mean follow-up, 14 ± 2 months per CT). Forty-two patients were observed with no intervention for at least 1 year (mean follow-up, 28 ± 3 months). Elective repair was performed within 1 year in 39 patients, and emergent repair was performed in 22 patients (mean, 6 ± 1 month after CT) for rupture (n = 14) or acute severe pain. Significant differences were found for initial diameter (observation, 4.9 ±.1 cm; elective repair, 5.9 ±.1 cm; emergent repair, 6.1 ±.2 cm; P <.0001) and initial peak wall stress (38 ± 1 N/cm2, 42 ± 2 n/cm2, 58 ± 4 N/cm2, respectively; P <.0001), but peak wall stress appeared to better differentiate patients who later required emergent repair (elective vs emergent repair: diameter, 3% difference, P =.5; stress, 38% difference, P <.0001). Receiver operating characteristic (ROC) curves for predicting rupture were better for peak wall stress (sensitivity, 94%; specificity,81%; accuracy, 85% [with 44 N/cm2 threshold]) than for diameter (81%, 70%, 73%, respectively [with optimal 5.5 cm threshold). With proportional hazards analysis, peak wall stress (relative risk, 25×) and gender (relative risk, 3×) were the only significant independent predictors of rupture. Conclusions: For AAAs under observation, peak AAA wall stress seems superior to diameter in differentiating patients who will experience catastrophic outcome. Elevated wall stress associated with rupture is not simply an acute event near the time of rupture. (J Vasc Surg 2003;37:724-32.)</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1067/mva.2003.213</identifier><identifier>PMID: 12663969</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Anatomy, Cross-Sectional - methods ; Aorta, Abdominal - anatomy & histology ; Aorta, Abdominal - physiopathology ; Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - epidemiology ; Aortic Aneurysm, Abdominal - physiopathology ; Aortic Rupture - epidemiology ; Aortic Rupture - physiopathology ; Biological and medical sciences ; Blood and lymphatic vessels ; Body Weights and Measures ; Cardiology. Vascular system ; Computer Simulation ; Diseases of the aorta ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Medical sciences ; Observation ; Predictive Value of Tests ; Risk ; Stress, Mechanical ; Time Factors ; Tomography, Spiral Computed</subject><ispartof>Journal of vascular surgery, 2003-04, Vol.37 (4), p.724-732</ispartof><rights>2003 Society for Vascular Surgery and The American Association for Vascular Surgery</rights><rights>2003 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-daffc065d42303fd87af2e988980b57ead725824c2609aed9307d04fa4bba5743</citedby><cites>FETCH-LOGICAL-c468t-daffc065d42303fd87af2e988980b57ead725824c2609aed9307d04fa4bba5743</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521402753482$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14690145$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12663969$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fillinger, Mark F.</creatorcontrib><creatorcontrib>Marra, Steven P.</creatorcontrib><creatorcontrib>Raghavan, M.L.</creatorcontrib><creatorcontrib>Kennedy, Francis E.</creatorcontrib><title>Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Objectives: We previously showed that peak abdominal aortic aneurysm (AAA) wall stress calculated for aneurysms in vivo is higher at rupture than at elective repair. The purpose of this study was to analyze rupture risk over time in patients under observation. Methods: Computed tomography (CT) scans were analyzed for patients with AAA when observation was planned for at least 6 months. AAA wall stress distribution was computationally determined in vivo with CT data, three-dimensional computer modeling, finite element analysis (nonlinear hyperelastic model depicting aneurysm wall behavior), and blood pressure during observation. Results: Analysis included 103 patients and 159 CT scans (mean follow-up, 14 ± 2 months per CT). Forty-two patients were observed with no intervention for at least 1 year (mean follow-up, 28 ± 3 months). Elective repair was performed within 1 year in 39 patients, and emergent repair was performed in 22 patients (mean, 6 ± 1 month after CT) for rupture (n = 14) or acute severe pain. Significant differences were found for initial diameter (observation, 4.9 ±.1 cm; elective repair, 5.9 ±.1 cm; emergent repair, 6.1 ±.2 cm; P <.0001) and initial peak wall stress (38 ± 1 N/cm2, 42 ± 2 n/cm2, 58 ± 4 N/cm2, respectively; P <.0001), but peak wall stress appeared to better differentiate patients who later required emergent repair (elective vs emergent repair: diameter, 3% difference, P =.5; stress, 38% difference, P <.0001). Receiver operating characteristic (ROC) curves for predicting rupture were better for peak wall stress (sensitivity, 94%; specificity,81%; accuracy, 85% [with 44 N/cm2 threshold]) than for diameter (81%, 70%, 73%, respectively [with optimal 5.5 cm threshold). With proportional hazards analysis, peak wall stress (relative risk, 25×) and gender (relative risk, 3×) were the only significant independent predictors of rupture. Conclusions: For AAAs under observation, peak AAA wall stress seems superior to diameter in differentiating patients who will experience catastrophic outcome. Elevated wall stress associated with rupture is not simply an acute event near the time of rupture. (J Vasc Surg 2003;37:724-32.)</description><subject>Aged</subject><subject>Anatomy, Cross-Sectional - methods</subject><subject>Aorta, Abdominal - anatomy & histology</subject><subject>Aorta, Abdominal - physiopathology</subject><subject>Aortic Aneurysm, Abdominal - diagnostic imaging</subject><subject>Aortic Aneurysm, Abdominal - epidemiology</subject><subject>Aortic Aneurysm, Abdominal - physiopathology</subject><subject>Aortic Rupture - epidemiology</subject><subject>Aortic Rupture - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Body Weights and Measures</subject><subject>Cardiology. Vascular system</subject><subject>Computer Simulation</subject><subject>Diseases of the aorta</subject><subject>Female</subject><subject>Humans</subject><subject>Imaging, Three-Dimensional</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Observation</subject><subject>Predictive Value of Tests</subject><subject>Risk</subject><subject>Stress, Mechanical</subject><subject>Time Factors</subject><subject>Tomography, Spiral Computed</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0T2P1DAQgGELgbjloKNGbqAii504tkOHTnxJJ0EBorQm9uRkyMcyk6x0_x6vdqVrqNw8Mxq9FuKlVnutrHs3HWFfK9Xsa908EjutOldZr7rHYqec0VVba3MlnjH_Vkrr1run4krX1jad7Xbi7jthynHNyyyXQdJ2WDdCSZn_yDxL6NMy5RlGCQutOUqYcaN7nmTaKM93cukZ6Qin-ffyF4yj5JWQWR6ReGOZMky4Ij0XTwYYGV9c3mvx89PHHzdfqttvn7_efLitorF-rRIMQ1S2TaZuVDMk72CosfO-86pvHUJydetrE2urOsDUNcolZQYwfQ-tM821eHPee6Dl74a8hilzxHEshy8bB9foxlrvCnx7hpEWZsIhHChPQPdBq3AKG0rYcAobStjCX132bv2E6QFfShbw-gKAI4wDwRwzPzhjO6VNW5w9OywVjhkpcMw4x_ILhHENacn_v-AfP--VTA</recordid><startdate>20030401</startdate><enddate>20030401</enddate><creator>Fillinger, Mark F.</creator><creator>Marra, Steven P.</creator><creator>Raghavan, M.L.</creator><creator>Kennedy, Francis E.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20030401</creationdate><title>Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter</title><author>Fillinger, Mark F. ; Marra, Steven P. ; Raghavan, M.L. ; Kennedy, Francis E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-daffc065d42303fd87af2e988980b57ead725824c2609aed9307d04fa4bba5743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aged</topic><topic>Anatomy, Cross-Sectional - methods</topic><topic>Aorta, Abdominal - anatomy & histology</topic><topic>Aorta, Abdominal - physiopathology</topic><topic>Aortic Aneurysm, Abdominal - diagnostic imaging</topic><topic>Aortic Aneurysm, Abdominal - epidemiology</topic><topic>Aortic Aneurysm, Abdominal - physiopathology</topic><topic>Aortic Rupture - epidemiology</topic><topic>Aortic Rupture - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Body Weights and Measures</topic><topic>Cardiology. Vascular system</topic><topic>Computer Simulation</topic><topic>Diseases of the aorta</topic><topic>Female</topic><topic>Humans</topic><topic>Imaging, Three-Dimensional</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Observation</topic><topic>Predictive Value of Tests</topic><topic>Risk</topic><topic>Stress, Mechanical</topic><topic>Time Factors</topic><topic>Tomography, Spiral Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fillinger, Mark F.</creatorcontrib><creatorcontrib>Marra, Steven P.</creatorcontrib><creatorcontrib>Raghavan, M.L.</creatorcontrib><creatorcontrib>Kennedy, Francis E.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fillinger, Mark F.</au><au>Marra, Steven P.</au><au>Raghavan, M.L.</au><au>Kennedy, Francis E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2003-04-01</date><risdate>2003</risdate><volume>37</volume><issue>4</issue><spage>724</spage><epage>732</epage><pages>724-732</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Objectives: We previously showed that peak abdominal aortic aneurysm (AAA) wall stress calculated for aneurysms in vivo is higher at rupture than at elective repair. The purpose of this study was to analyze rupture risk over time in patients under observation. Methods: Computed tomography (CT) scans were analyzed for patients with AAA when observation was planned for at least 6 months. AAA wall stress distribution was computationally determined in vivo with CT data, three-dimensional computer modeling, finite element analysis (nonlinear hyperelastic model depicting aneurysm wall behavior), and blood pressure during observation. Results: Analysis included 103 patients and 159 CT scans (mean follow-up, 14 ± 2 months per CT). Forty-two patients were observed with no intervention for at least 1 year (mean follow-up, 28 ± 3 months). Elective repair was performed within 1 year in 39 patients, and emergent repair was performed in 22 patients (mean, 6 ± 1 month after CT) for rupture (n = 14) or acute severe pain. Significant differences were found for initial diameter (observation, 4.9 ±.1 cm; elective repair, 5.9 ±.1 cm; emergent repair, 6.1 ±.2 cm; P <.0001) and initial peak wall stress (38 ± 1 N/cm2, 42 ± 2 n/cm2, 58 ± 4 N/cm2, respectively; P <.0001), but peak wall stress appeared to better differentiate patients who later required emergent repair (elective vs emergent repair: diameter, 3% difference, P =.5; stress, 38% difference, P <.0001). Receiver operating characteristic (ROC) curves for predicting rupture were better for peak wall stress (sensitivity, 94%; specificity,81%; accuracy, 85% [with 44 N/cm2 threshold]) than for diameter (81%, 70%, 73%, respectively [with optimal 5.5 cm threshold). With proportional hazards analysis, peak wall stress (relative risk, 25×) and gender (relative risk, 3×) were the only significant independent predictors of rupture. Conclusions: For AAAs under observation, peak AAA wall stress seems superior to diameter in differentiating patients who will experience catastrophic outcome. Elevated wall stress associated with rupture is not simply an acute event near the time of rupture. (J Vasc Surg 2003;37:724-32.)</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>12663969</pmid><doi>10.1067/mva.2003.213</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Anatomy, Cross-Sectional - methods Aorta, Abdominal - anatomy & histology Aorta, Abdominal - physiopathology Aortic Aneurysm, Abdominal - diagnostic imaging Aortic Aneurysm, Abdominal - epidemiology Aortic Aneurysm, Abdominal - physiopathology Aortic Rupture - epidemiology Aortic Rupture - physiopathology Biological and medical sciences Blood and lymphatic vessels Body Weights and Measures Cardiology. Vascular system Computer Simulation Diseases of the aorta Female Humans Imaging, Three-Dimensional Male Medical sciences Observation Predictive Value of Tests Risk Stress, Mechanical Time Factors Tomography, Spiral Computed |
| title | Prediction of rupture risk in abdominal aortic aneurysm during observation: Wall stress versus diameter |
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