On growth, buckling, and rupture of aneurysms: Cylindrical tube analogy.

Aneurysms are localized bulges of arteries; and they can rupture with fatal consequences. Complex mechanobiological factors preclude in vivo testing to assess the rupture risk of an aneurysm, and size based criteria are often used in clinical practice to guide surgical interventions. It is often found that tortuous and buckled aneurysms can exceed the size recommended for surgical intervention, and yet do not rupture. This study addresses why buckled aneurysms exhibit this intriguing behavior by combining in vitro inflation experiments on hyperelastic cylindrical tubes with finite element calculations. Using a biologically relevant material model for an arterial wall, we show that buckled aneurysms can grow in size without rupture under favorable arterial pre-tensions. Stretch reversal phenomenon exhibited by arteries governs whether buckling or bulging occurs first. Exponential stiffening favors the axial propagation of an aneurysm instead of radial growth or size. The choice of failure criteria based on Ogden's strain energy function, Gent's first stretch invariant, and Cauchy stress are discussed. Failure maps incorporating post-bifurcation (bulging and buckling) response are constructed to delineate the regimes of growth, buckling and rupture of an aneurysm.

Evaluation of aortic tortuosity as a negative predictor of abdominal aortic aneurysm rupture.

OBJECTIVE: The maximal aortic diameter has been used as a key indication for whether to repair abdominal aortic aneurysms (AAAs). Aortic tortuosity has been proposed as another factor to consider. In the present study, we compared the degree of aortic tortuosity in ruptured AAAs with that of unruptured AAAs using computed tomography. METHODS: We performed a retrospective review of a prospectively maintained database of patients who had undergone AAA repair from December 2014 to December 2019. Patients with a ruptured aneurysm (rAAA) were matched with patients with a nonruptured AAA (nrAAA) with the same maximal aneurysm diameter and age. The degree of aortic tortuosity, defined as the maximum lateral deviation from the aortic centerline, was measured on preoperative coronal computed tomography scans. RESULTS: During a 5-year period, 572 AAA cases were identified. The aortic tortuosity of the 25 rAAA cases was compared with that of a matched control group of 31 nrAAAs, selected by the same mean maximum diameter of 8.4 cm and similar patient age. In the rAAA group, the mean age was 74.8 years (84% men). In the nrAAA group, the mean age was 76.3 years (88% men). The mean aortic tortuosity for the rAAA and nrAAA groups was 9.3 ± 7.9 mm and 18.0 ± 11.2 mm, respectively (P < .01). CONCLUSIONS: Greater aortic tortuosity was seen in the nrAAA cases compared with the rAAA cases at the same matched aneurysm size. Thus, aortic tortuosity might confer a reduced rupture risk. Further studies with larger cohorts are needed to verify this observation.

Deformation mechanics of self-expanding venous stents: Modelling and experiments.

Deformation properties of venous stents based on braided design, chevron design, Z design, and diamond design are compared using in vitro experiments coupled with analytical and finite element modelling. Their suitability for deployment in different clinical contexts is assessed based on their deformation characteristics. Self-expanding stainless steel stents possess superior collapse resistance compared to Nitinol stents. Consequently, they may be more reliable to treat diseases like May-Thurner syndrome in which resistance against a concentrated (pinching) force applied on the stent is needed to prevent collapse. Braided design applies a larger radial pressure particularly for vessels of diameter smaller than 75% of its nominal diameter, making it suitable for a long lesion with high recoil. Z design has the least foreshortening, which aids in accurate deployment. Nitinol stents are more compliant than their stainless steel counterparts, which indicates their suitability in veins. The semi-analytical method presented can aid in rapid assessment of topology governed deformation characteristics of stents and their design optimization.