Abdominal aortic aneurysm volume and relative intraluminal thrombus volume might be auxiliary predictors of rupture-an observational cross-sectional study

I Koncar; D Nikolic; Z Milosevic; N Bogavac-Stanojevic; N Ilic; M Dragas; M Sladojevic; M Markovic; A Vujcic; N Filipovic; L Davidovic

doi:10.3389/fsurg.2023.1095224

Abdominal aortic aneurysm volume and relative intraluminal thrombus volume might be auxiliary predictors of rupture-an observational cross-sectional study

Front Surg. 2023 May 5:10:1095224. doi: 10.3389/fsurg.2023.1095224. eCollection 2023.

Authors

I Koncar^{1

2}, D Nikolic^{3

4}, Z Milosevic³, N Bogavac-Stanojevic⁵, N Ilic^{1

2}, M Dragas^{1

2}, M Sladojevic², M Markovic^{1

2}, A Vujcic², N Filipovic^{3

4}, L Davidovic^{1

2}

Affiliations

¹ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
² Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
³ Research and Development Center for Bioengineering BioIRC, Kragujevac, Serbia.
⁴ Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia.
⁵ Belgrade-Faculty of Pharmacy, Department of Medical Biochemistry, Belgrade, Serbia.

Abstract

Objectives: The study aimed to identify differences and compare anatomical and biomechanical features between elective and ruptured abdominal aortic aneurysms (AAAs).

Methods: Data (clinical, anatomical, and biomechanical) of 98 patients with AAA, 75 (76.53%) asymptomatic (Group aAAA) and 23 (23.46%) ruptured AAA (Group rAAA), were prospectively collected and analyzed. Anatomical, morphological, and biomechanical imaging markers like peak wall stress (PWS) and rupture risk equivalent diameter (RRED), comorbid conditions, and demographics were compared between the groups. Biomechanical features were assessed by analysis of Digital Imaging and Communication in Medicine images by A4clinics (Vascops), and anatomical features were assessed by 3Surgery (Trimensio). Binary and multiple logistic regression analysis were used and adjusted for confounders. Accuracy was assessed using receiving operative characteristic (ROC) curve analysis.

Results: In a multivariable model, including gender and age as confounder variables, maximal aneurysm diameter [MAD, odds ratio (OR) = 1.063], relative intraluminal thrombus (rILT, OR = 1.039), and total aneurysm volume (TAV, OR = 1.006) continued to be significant predictors of AAA rupture with PWS (OR = 1.010) and RRED (OR = 1.031). Area under the ROC curve values and correct classification (cc) for the same parameters and the model that combines MAD, TAV, and rILT were measured: MAD (0.790, cc = 75%), PWS (0.713, cc = 73%), RRED (0.717, cc = 55%), TAV (0.756, cc = 79%), rILT (0.656, cc = 60%), and MAD + TAV + rILT (0.797, cc = 82%).

Conclusion: Based on our results, in addition to MAD, other important predictors of rupture that might be used during aneurysm surveillance are TAV and rILT. Biomechanical parameters (PWS, RRED) as valuable predictors should be assessed in prospective clinical trials. Similar studies on AAA smaller than 55 mm in diameter, even difficult to organize, would be of even greater clinical value.

Keywords: AAA; ILT; PWS; RRED; risk prediction; volume.

Grants and funding

The presented study is part of scientific research projects supported by the Ministry of Education and Science of the Republic of Serbia (Nos. 175008 and III41007).