Heterogeneous Finite Element Stress Analysis of Abdominal Aortic Aneurysms: Comparison Between Ruptured and Unruptured Lesions

Abdominal Aortic Aneurysm (AAA) rupture remains a leading cause of death in westernized countries. Much remains to be understood on the biomechanics of rupture. It is not clear whether rupture is predominantly a phenomenon at the material level (aneurysm wall weakening) or due to abnormally elevated tissue wall tension (stress resultant). A computational study involving 4 ruptured and 9 unruptured abdominal aortic aneurysms (AAA) was conducted to test if ruptured aneurysms were subject to a higher pressure induced wall tension than unruptured aneurysms. The unique aspect of this study is that, regional variations in material properties (thickness, stiffness, failure strength) were documented in all the aneurysms in the study population. In addition, AAA geometry was documented using photographs from multiple rotational angles. Novel methods were developed for 3D reconstruction from photographs using voxel carving, for precise spatial mapping of measured properties onto the reconstructed 3D models and for scattered data interpolation of sparsely measured parameters to the entire finite element model. Heterogeneous, variable wall thickness models of patient-specific AAA were developed and the tension distribution under normal systolic pressure computed. Peak wall tension was the primary metric studied. Other indices found in literature (peak wall stress, peak regional tension to failure tension ratio and peak regional stress to failure stress ratio) were also compared. The peak wall tension in the ruptured aneurysm group was not higher than the unruptured aneurysms with statistical significance, but with a trend toward it (p = 0.053). Among the other metrics, the peak regional tension and stress ratios (with their respective failure counterparts) were higher in the ruptured group (p = 0.038 for both) but not so for peak wall stress (p = 0.099). Although rigorously studied, the small study population does not warrant definitive conclusions. The study methods developed however will permit larger studies of this nature to better investigate mechanisms in AAA rupture.