09:15
45 mins
|
INTEGRATING VASCULAR BIOMECHANICS SIMULATIONS INTO CLINICAL WORK FLOW OF THE ABDOMINAL AORTIC ANEURYSM PATIENT TREATMENT
Christian Gasser
Abstract: Currently, the clinical rupture risk assessment of an Abdominal Aortic Aneurysm (AAA) is based mainly on measuring, and following-up, its largest diameter. Clearly, such global parameters can only give very rough risk indications, and therefore are known to fail frequently in predicting individual risk for AAA rupture. AAA rupture is a local event in the aneurysm wall that often occurs away from location of the maximum diameter. This underlines the severe limitations of the purely diameter-bases risk assessment. In contrast, a biomechanics-based AAA rupture risk assessment inherently supports a local assessment of the wall’s risk of rupture. In addition, it quantitatively integrates many known rupture risk factors like female gender, large relative expansion, intra-luminal thrombus-related wall weakening and high blood pressure. The biomechanics-based AAA rupture risk method has progressed considerably in recent years and can enrich clinical decision making. The present talk aims at reviewing the current state-of-the-art in biomechanics-based AAA rupture risk assessment by summarizing its key underlying concepts: (i) geometry modelling, (ii) biomechanical simulation and (iii) result interpretation. Specifically, the validity of the underlying model assumptions is critically discussed, always in relation to the intended diagnostic objective. Subsequently, reported clinical biomechanics-based AAA rupture risk validation studies are summarized and their clinical relevance is reviewed. The biomechanics-based risk assessment follows a generic approach, which provides plenty of interfaces to incorporate information from different research disciplines. As an example, the final section of this talk suggests integrating growth aspects to (potentially) further improve the sensitivity and specificity of the biomechanics-based risk assessment. In conclusion, despite the fact that no prospective validation studies are reported, a significant and increasing body of validation evidence suggests integrating the biomechanics-based AAA rupture risk assessment into the clinical decision-making process to be beneficial for AAA patients.
|
