Patient-specific biomechanical profiling in abdominal aortic aneurysm development and rupture

Introduction: It is difficult to reliably predict abdominal aortic aneurysm (AAA) expansion and rupture in individuals. There is increasing interest in the role of patient-specific biomechanical profiling of AAA development and rupture. This review examines evidence to support the use of biomechanical profiling in AAA. Methods: The literature was systematically reviewed to examine the evidence to support the role of patient-specific biomechanical profiles in the management of patients with AAA. A search of Medline, Medline in process and other nonindexed citations, and EMBASE was performed for articles published from January 1980 to December 2008. The search strategy retrieved 2410 titles. After exclusions, 83 articles were reviewed in full and form the basis of this review. Results: There is increasing evidence that patient-specific biomechanical factors may be more reliable in predicting AAA rupture than currently available clinical and biochemical parameters. Wall stress determination using finite element analysis is consistently higher in symptomatic and ruptured AAA. Recent improvements in computational methodology and advances in imaging and processing technology have increased the power of these biomechanical factors in predicting AAA expansion and rupture. Conclusions: Major progress has been made in the development of biomechanical profiles for AAA. Large population-based studies for validation of patient-specific biomechanical profiles with rupture risk assessment and tailored decision making are now indicated, particularly with the introduction of AAA screening programs. (J Vasc Surg 2010;52:480-8.)