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Letter to the Editor| Volume 61, ISSUE 1, P163-164, January 2021

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Re “Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm”

Open ArchivePublished:July 20, 2020DOI:https://doi.org/10.1016/j.ejvs.2020.05.017
Re “Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm”
Previous ArticleComment and Questions on “European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections”∗
Next ArticleResponse to “Re Biomechanical Assessment Predicts Aneurysm Related Events in Patients with Abdominal Aortic Aneurysm”
      We are very pleased that methodology developed at our Intelligent Systems for Medicine Laboratory has been used in an extensive study of abdominal aortic aneurysm (AAA) biomechanics published in the European Journal of Vascular and Endovascular Surgery.
      • Doyle B.J.
      • Bappoo N.
      • Syed M.B.J.
      • Forsythe R.O.
      • Powell J.T.
      • Conlisk N.
      • et al.
      Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
      Eur J Vasc Endovasc Surg. 2020; 60: 365-373
      However, we feel obliged to point out a few limitations of our methodology, the understanding of which is necessary to interpret the results of Doyle et al.
      • Doyle B.J.
      • Bappoo N.
      • Syed M.B.J.
      • Forsythe R.O.
      • Powell J.T.
      • Conlisk N.
      • et al.
      Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
      Eur J Vasc Endovasc Surg. 2020; 60: 365-373
      properly.
      The software for the biomechanical analysis of AAA (BioPARR) does not have any special functionality for AAA wall segmentation and thickness measurement. As our parametric studies showed an approximately linear relationship between measured/assumed wall thickness and computed maximum principal stress,
      • Miller K.
      • Joldes G.
      • Qian J.
      • Patel A.P.
      • Jung M.S.
      • Tavner A.
      • et al.
      Maximum principal AAA wall stress is proportional to wall thickness.
      in: Computational Biomechanics for Medicine. Springer Nature, New York2018: 43-53
      the inaccuracies in wall thickness measurements directly translate to imprecision in principal wall stress computation. Based on information about magnetic resonance image resolution,
      • Doyle B.J.
      • Bappoo N.
      • Syed M.B.J.
      • Forsythe R.O.
      • Powell J.T.
      • Conlisk N.
      • et al.
      Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
      Eur J Vasc Endovasc Surg. 2020; 60: 365-373
      we estimate a principal stress inaccuracy of ±30%.
      The version of BioPARR used in the study by Doyle et al.
      • Doyle B.J.
      • Bappoo N.
      • Syed M.B.J.
      • Forsythe R.O.
      • Powell J.T.
      • Conlisk N.
      • et al.
      Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
      Eur J Vasc Endovasc Surg. 2020; 60: 365-373
      does not account for the presence of residual stress. Using the current, freely available version of BioPARR (https://bioparr.mech.uwa.edu.au/), accounting for the presence of residual stress, we showed that its inclusion changes stress distributions significantly.
      • Joldes G.R.
      • Noble C.
      • Polzer S.
      • Taylor Z.A.
      • Wittek A.
      • Miller K.
      A simple method of incorporating the effect of the Uniform Stress Hypothesis in arterial wall stress computations.
      Acta Bioeng Biomech. 2018; 20: 59-67
      The evaluation of the results published by Doyle et al.
      • Doyle B.J.
      • Bappoo N.
      • Syed M.B.J.
      • Forsythe R.O.
      • Powell J.T.
      • Conlisk N.
      • et al.
      Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
      Eur J Vasc Endovasc Surg. 2020; 60: 365-373
      is not truly patient specific as it uses population based statistics for estimation of the wall strength.

      References

        • Doyle B.J.
        • Bappoo N.
        • Syed M.B.J.
        • Forsythe R.O.
        • Powell J.T.
        • Conlisk N.
        • et al.
        Biomechanical assessment predicts aneurysm related events in patients with abdominal aortic aneurysm.
        Eur J Vasc Endovasc Surg. 2020; 60: 365-373
        View in Article
        • Miller K.
        • Joldes G.
        • Qian J.
        • Patel A.P.
        • Jung M.S.
        • Tavner A.
        • et al.
        Maximum principal AAA wall stress is proportional to wall thickness.
        in: Computational Biomechanics for Medicine. Springer Nature, New York2018: 43-53
        View in Article
        • Joldes G.R.
        • Noble C.
        • Polzer S.
        • Taylor Z.A.
        • Wittek A.
        • Miller K.
        A simple method of incorporating the effect of the Uniform Stress Hypothesis in arterial wall stress computations.
        Acta Bioeng Biomech. 2018; 20: 59-67
        View in Article

      Article info

      Publication history

      Published online: July 20, 2020
      Accepted: May 4, 2020
      Received in revised form: April 22, 2020
      Received: April 17, 2020

      Identification

      DOI: https://doi.org/10.1016/j.ejvs.2020.05.017

      Copyright

      © 2020 European Society for Vascular Surgery. Published by Elsevier B.V.

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