title: Impact of wall thickness and saccular geometry on the computational wall stress of descending thoracic aortic aneurysms.
abstract: BACKGROUND
  Wall stress calculated using finite element analysis has been used to predict rupture risk of aortic aneurysms. Prior models often assume uniform aortic wall thickness and fusiform geometry. We examined the effects of including local wall thickness, intraluminal thrombus, calcifications, and saccular geometry on peak wall stress (PWS) in finite element analysis of descending thoracic aortic aneurysms.
  
  
  RESULTS
  Computed tomographic angiography of descending thoracic aortic aneurysms (n=10 total, 5 fusiform and 5 saccular) underwent 3-dimensional reconstruction with custom algorithms. For each aneurysm, an initial model was constructed with uniform wall thickness. Experimental models explored the addition of variable wall thickness, calcifications, and intraluminal thrombus. Each model was loaded with 120 mm Hg pressure, and von Mises PWS was computed. The mean PWS of uniform wall thickness models was 410 ± 111 kPa. The imposition of variable wall thickness increased PWS (481 ± 126 kPa, P<0.001). Although the addition of calcifications was not statistically significant (506 ± 126 kPa, P=0.07), the addition of intraluminal thrombus to variable wall thickness (359 ± 86 kPa, P ≤ 0.001) reduced PWS. A final model incorporating all features also reduced PWS (368 ± 88 kPa, P<0.001). Saccular geometry did not increase diameter-normalized stress in the final model (77 ± 7 versus 67 ± 12 kPa/cm, P=0.22).
  
  
  CONCLUSIONS
  Incorporation of local wall thickness can significantly increase PWS in finite element analysis models of thoracic aortic aneurysms. Incorporating variable wall thickness, intraluminal thrombus, and calcifications significantly impacts computed PWS of thoracic aneurysms; sophisticated models may, therefore, be more accurate in assessing rupture risk. Saccular aneurysms did not demonstrate a significantly higher normalized PWS than fusiform aneurysms.
authors.affiliation: Department of Surgery (E.K.S., D.P.N., S.R.S., R.M.F., J.E.B., R.C.G., J.H.G., B.M.J.), Division of Cardiac Surgery (J.E.B., R.C.G., J.H.G.), and Division of Vascular Surgery and Endovascular Therapy (R.M.F., B.M.J.), University of Pennsylvania, Philadelphia, PA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shang
authors.forename: Derek P
authors.initials: DP
authors.lastname: Nathan
authors.forename: Shanna R
authors.initials: SR
authors.lastname: Sprinkle
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: aneurysm; finite element analysis; mechanical stress; modeling; risk stratification; rupture