title: Initial stress and nonlinear material behavior in patient-specific AAA wall stress analysis.
abstract: Rupture risk estimation of abdominal aortic aneurysms (AAA) is currently based on the maximum diameter of the AAA. A more critical approach is based on AAA wall stress analysis. For that, in most cases, the AAA geometry is obtained from CT-data and treated as a stress free geometry. However, during CT imaging, the AAA is subjected to a time-averaged blood pressure and is therefore not stress free. The aim of this study is to evaluate the effect of neglecting these initial stresses (IS) on the patient-specific AAA wall stress as computed by finite element analysis. Additionally, the contribution of the nonlinear material behavior of the AAA wall is evaluated. Thirty patients with maximum AAA diameters below the current surgery criterion were scanned with contrast-enhanced CT and the AAA's were segmented from the image data. The mean arterial blood pressure (MAP) was measured immediately after the CT-scan and used to compute the IS corresponding with the CT geometry and MAP. Comparisons were made between wall stress obtained with and without IS and with linear and nonlinear material properties. On average, AAA wall stresses as computed with IS were higher than without IS. This was also the case for the stresses computed with the nonlinear material model compared to the linear material model. However, omitting initial stress and material nonlinearity in AAA wall stress computations leads to different effects in the resulting wall stress for each AAA. Therefore, provided that other assumptions made are not predominant, IS cannot be discarded and a nonlinear material model should be used in future patient-specific AAA wall stress analyses.
authors.affiliation: Eindhoven University of Technology, Department of Biomedical Engineering, Eindhoven, The Netherlands. l.speelman@tue.nl
authors.forename: L
authors.initials: L
authors.lastname: Speelman
authors.forename: E M H
authors.initials: EM
authors.lastname: Bosboom
authors.forename: G W H
authors.initials: GW
authors.lastname: Schurink
authors.forename: J
authors.initials: J
authors.lastname: Buth
authors.forename: M
authors.initials: M
authors.lastname: Breeuwer
authors.forename: M J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: F N
authors.initials: FN
authors.lastname: van de Vosse
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001794:Blood Pressure; D003287:Contrast Media / Q000494:pharmacology; D004730:Endothelium, Vascular / Q000473:pathology; D020342:Finite Element Analysis; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D012044:Regression Analysis; D033081:Shear Strength; D013314:Stress, Mechanical; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media