Research progress on risk factors of abdominal aortic aneurysm rupture_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Ru ,  WANG Haiyang

Department of Vascular Interventional Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding author：

WANG Haiyang, Email: wanghaiyangguan@163.com

Keywords：

abdominal aortic aneurysm; risk factor; biomechanic; imaging

DOI：

10.7507/1007-9424.202101113

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand risk factors of abdominal aortic aneurysm (AAA) rupture and the latest progress.Method The domestic and foreign related literatures on risk factors affecting AAA rupture were retrieved and reviewed.Results Besides some definite risk factors of AAA rupture, including age, gender, hypertension, smoking, family history, complications (such as diabetes mellitus, hypertension, dyslipidemia, etc.), the biomechanical factor was the crucial factor of AAA rupture, including the aortic compliance, aortic wall peak value of pressure, aortic wall calcification, and hemodynamics. The latest imaging methods such as the high resolution ultrasound, function and molecular imaging, and phase contrast magnetic resonance imaging could provide technical supports for the prediction of AAA rupture.Conclusions There are many risk factors affecting AAA rupture. Clinicians might prevent and make individualize treatment for AAA rupture according to its risk factors, and risks of AAA rupture could be more accurately assessed with help of new medical imaging examination.

Citation： CHEN Ru, WANG Haiyang. Research progress on risk factors of abdominal aortic aneurysm rupture. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(12): 1676-1680. doi: 10.7507/1007-9424.202101113 Copy

1.	Ahmed R, Ghoorah K, Kunadian V. Abdominal aortic aneurysms and risk factors for adverse events. Cardiol Rev, 2016, 24(2): 88-93.
2.	Dobrucki LW, Sinusas AJ. Targeted imaging of abdominal aortic aneurysm: biology over structure. Circ Cardiovasc Imaging, 2020, 13(3): e010495.
3.	Golledge J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol, 2019, 16(4): 225-242.
4.	Meyrignac O, Bal L, Zadro C, et al. Combining volumetric and wall shear stress analysis from CT to assess risk of abdominal aortic aneurysm progression. Radiology, 2020, 295(3): 722-729.
5.	Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
6.	Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
7.	Morioka C, Meng F, Taira R, et al. Automatic classification of ultrasound screening examinations of the abdominal aorta. J Digit Imaging, 2016, 29(6): 742-748.
8.	Sherifova S, Holzapfel GA. Biomechanics of aortic wall failure with a focus on dissection and aneurysm: a review. Acta Biomater, 2019, 99: 1-17.
9.	Golledge J, Norman PE, Murphy MP, et al. Challenges and opportunities in limiting abdominal aortic aneurysm growth. J Vasc Surg, 2017, 65(1): 225-233.
10.	O’Leary SA, Mulvihill JJ, Barrett HE, et al. Determining the influence of calcification on the failure properties of abdominal aortic aneurysm (AAA) tissue. J Mech Behav Biomed Mater, 2015, 42: 154-167.
11.	Boyd AJ. Biomechanical prediction of abdominal aortic aneurysm rupture potential. J Vasc Surg, 2020, 71(2): 627.
12.	Martyn CN, Greenwald SE. Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension. Lancet, 1997, 350(9082): 953-955.
13.	van’t Veer M, Buth J, Merkx M, et al. Biomechanical properties of abdominal aortic aneurysms assessed by simultaneously measured pressure and volume changes in humans. J Vasc Surg, 2008, 48(6): 1401-1407.
14.	Wilson KA, Lee AJ, Lee AJ, et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg, 2003, 37(1): 112-117.
15.	Niestrawska JA, Regitnig P, Viertler C, et al. The role of tissue remodeling in mechanics and pathogenesis of abdominal aortic aneurysms. Acta Biomater, 2019, 88: 149-161.
16.	Khosla S, Morris DR, Moxon JV, et al. Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms. Br J Surg, 2014, 101(11): 1350-1357.
17.	Lindquist Liljeqvist M, Hultgren R, Siika A, et al. Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis. J Vasc Surg, 2017, 65(4): 1014-1021.
18.	Indrakusuma R, Jalalzadeh H, Planken RN, et al. Biomechanical imaging markers as predictors of abdominal aortic aneurysm growth or rupture: a systematic review. Eur J Vasc Endovasc Surg, 2016, 52(4): 475-486.
19.	Buijs RV, Willems TP, Tio RA, et al. Calcification as a risk factor for rupture of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg, 2013, 46(5): 542-548.
20.	Joshi NV, Vesey AT, Williams MC, et al. ¹⁸F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet, 2014, 383(9918): 705-713.
21.	Li Z, Zhao Z, Cai Z, et al. Runx2 (runt-related transcription factor 2)-mediated microcalcification is a novel pathological characteristic and potential mediator of abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol, 2020, 40(5): 1352-1369.
22.	Qiu Y, Wang Y, Fan Y, et al. Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: a hemodynamic point of view. Med Phys, 2019, 46(9): 4263-4275.
23.	Villard C, Hultgren R. Abdominal aortic aneurysm: sex differences. Maturitas, 2018, 109: 63-69.
24.	Kimura M, Hoshina K, Miyahara K, et al. Geometric analysis of ruptured and nonruptured abdominal aortic aneurysms. J Vasc Surg, 2019, 69(1): 86-91.
25.	Hay O, Dar G, Abbas J, et al. The lumbar lordosis in males and females, revisited. PLoS One, 2015, 10(8): e0133685.
26.	Gallo D, Steinman DA, Bijari PB, et al. Helical flow in carotid bifurcation as surrogate marker of exposure to disturbed shear. J Biomech, 2012, 45(14): 2398-2404.
27.	van Noort K, Schuurmann RC, Wermelink B, et al. Fluid displacement from intraluminal thrombus of abdominal aortic aneurysm as a result of uniform compression. Vascular, 2017, 25(5): 542-548.
28.	Gao Z, Xiong J, Chen Z, et al. Gender differences of morphological and hemodynamic characteristics of abdominal aortic aneurysm. Biol Sex Differ, 2020, 11(1): 41.
29.	van Disseldorp EMJ, Petterson NJ, van de Vosse FN, et al. Quantification of aortic stiffness and wall stress in healthy volunteers and abdominal aortic aneurysm patients using time-resolved 3D ultrasound: a comparison study. Eur Heart J Cardiovasc Imaging, 2019, 20(2): 185-191.
30.	Brangsch J, Reimann C, Kaufmann JO, et al. Concurrent molecular magnetic resonance imaging of inflammatory activity and extracellular matrix degradation for the prediction of aneurysm rupture. Circ Cardiovasc Imaging, 2019, 12(3): e008707.
31.	MA3RS Study Investigators. Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture, and need for surgical repair. Circulation, 2017, 136(9): 787-797.
32.	Hag AM, Pedersen SF, Christoffersen C, et al. ¹⁸F-FDG PET imaging of murine atherosclerosis: association with gene expression of key molecular markers. PLoS One, 2012, 7(11): e50908.
33.	Jalalzadeh H, Indrakusuma R, Planken RN, et al. Inflammation as a predictor of abdominal aortic aneurysm growth and rupture: a systematic review of imaging biomarkers. Eur J Vasc Endovasc Surg, 2016, 52(3): 333-342.
34.	Forsythe RO, Dweck MR, McBride OMB, et al. ¹⁸F-sodium fluoride uptake in abdominal aortic aneurysms: The SoFIA3 study. J Am Coll Cardiol, 2018, 71(5): 513-523.
35.	Ramaswamy AK, Hamilton M 2nd, Joshi RV, et al. Molecular imaging of experimental abdominal aortic aneurysms. Sci World J, 2013, 2013: 973150.
36.	Liu D, Fan Z, Li Y, et al. Quantitative study of abdominal blood flow patterns in patients with aortic dissection by 4-dimensional flow MRI. Sci Rep, 2018, 8(1): 9111.
37.	Ziegler M, Welander M, Lantz J, et al. Visualizing and quantifying flow stasis in abdominal aortic aneurysms in men using 4D flow MRI. Magn Reson Imaging, 2019, 57: 103-110.
38.	Kolipaka A, Illapani VS, Kalra P, et al. Quantification and comparison of 4D-flow MRI-derived wall shear stress and MRE-derived wall stiffness of the abdominal aorta. J Magn Reson Imaging, 2017, 45(3): 771-778.
39.	Singh P, Almarzooq Z, Salata B, et al. Role of molecular imaging with positron emission tomographic in aortic aneurysms. J Thorac Dis, 2017, 9(Suppl 4): S333-S342.
40.	Majmudar MD, Keliher EJ, Heidt T, et al. Monocyte-directed RNAi targeting CCR2 improves infarct healing in atherosclerosis-prone mice. Circulation, 2013, 127(20): 2038-2046.

1. Ahmed R, Ghoorah K, Kunadian V. Abdominal aortic aneurysms and risk factors for adverse events. Cardiol Rev, 2016, 24(2): 88-93.
2. Dobrucki LW, Sinusas AJ. Targeted imaging of abdominal aortic aneurysm: biology over structure. Circ Cardiovasc Imaging, 2020, 13(3): e010495.
3. Golledge J. Abdominal aortic aneurysm: update on pathogenesis and medical treatments. Nat Rev Cardiol, 2019, 16(4): 225-242.
4. Meyrignac O, Bal L, Zadro C, et al. Combining volumetric and wall shear stress analysis from CT to assess risk of abdominal aortic aneurysm progression. Radiology, 2020, 295(3): 722-729.
5. Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg, 2019, 57(1): 8-93.
6. Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg, 2018, 67(1): 2-77.
7. Morioka C, Meng F, Taira R, et al. Automatic classification of ultrasound screening examinations of the abdominal aorta. J Digit Imaging, 2016, 29(6): 742-748.
8. Sherifova S, Holzapfel GA. Biomechanics of aortic wall failure with a focus on dissection and aneurysm: a review. Acta Biomater, 2019, 99: 1-17.
9. Golledge J, Norman PE, Murphy MP, et al. Challenges and opportunities in limiting abdominal aortic aneurysm growth. J Vasc Surg, 2017, 65(1): 225-233.
10. O’Leary SA, Mulvihill JJ, Barrett HE, et al. Determining the influence of calcification on the failure properties of abdominal aortic aneurysm (AAA) tissue. J Mech Behav Biomed Mater, 2015, 42: 154-167.
11. Boyd AJ. Biomechanical prediction of abdominal aortic aneurysm rupture potential. J Vasc Surg, 2020, 71(2): 627.
12. Martyn CN, Greenwald SE. Impaired synthesis of elastin in walls of aorta and large conduit arteries during early development as an initiating event in pathogenesis of systemic hypertension. Lancet, 1997, 350(9082): 953-955.
13. van’t Veer M, Buth J, Merkx M, et al. Biomechanical properties of abdominal aortic aneurysms assessed by simultaneously measured pressure and volume changes in humans. J Vasc Surg, 2008, 48(6): 1401-1407.
14. Wilson KA, Lee AJ, Lee AJ, et al. The relationship between aortic wall distensibility and rupture of infrarenal abdominal aortic aneurysm. J Vasc Surg, 2003, 37(1): 112-117.
15. Niestrawska JA, Regitnig P, Viertler C, et al. The role of tissue remodeling in mechanics and pathogenesis of abdominal aortic aneurysms. Acta Biomater, 2019, 88: 149-161.
16. Khosla S, Morris DR, Moxon JV, et al. Meta-analysis of peak wall stress in ruptured, symptomatic and intact abdominal aortic aneurysms. Br J Surg, 2014, 101(11): 1350-1357.
17. Lindquist Liljeqvist M, Hultgren R, Siika A, et al. Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis. J Vasc Surg, 2017, 65(4): 1014-1021.
18. Indrakusuma R, Jalalzadeh H, Planken RN, et al. Biomechanical imaging markers as predictors of abdominal aortic aneurysm growth or rupture: a systematic review. Eur J Vasc Endovasc Surg, 2016, 52(4): 475-486.
19. Buijs RV, Willems TP, Tio RA, et al. Calcification as a risk factor for rupture of abdominal aortic aneurysm. Eur J Vasc Endovasc Surg, 2013, 46(5): 542-548.
20. Joshi NV, Vesey AT, Williams MC, et al. ¹⁸F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet, 2014, 383(9918): 705-713.
21. Li Z, Zhao Z, Cai Z, et al. Runx2 (runt-related transcription factor 2)-mediated microcalcification is a novel pathological characteristic and potential mediator of abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol, 2020, 40(5): 1352-1369.
22. Qiu Y, Wang Y, Fan Y, et al. Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: a hemodynamic point of view. Med Phys, 2019, 46(9): 4263-4275.
23. Villard C, Hultgren R. Abdominal aortic aneurysm: sex differences. Maturitas, 2018, 109: 63-69.
24. Kimura M, Hoshina K, Miyahara K, et al. Geometric analysis of ruptured and nonruptured abdominal aortic aneurysms. J Vasc Surg, 2019, 69(1): 86-91.
25. Hay O, Dar G, Abbas J, et al. The lumbar lordosis in males and females, revisited. PLoS One, 2015, 10(8): e0133685.
26. Gallo D, Steinman DA, Bijari PB, et al. Helical flow in carotid bifurcation as surrogate marker of exposure to disturbed shear. J Biomech, 2012, 45(14): 2398-2404.
27. van Noort K, Schuurmann RC, Wermelink B, et al. Fluid displacement from intraluminal thrombus of abdominal aortic aneurysm as a result of uniform compression. Vascular, 2017, 25(5): 542-548.
28. Gao Z, Xiong J, Chen Z, et al. Gender differences of morphological and hemodynamic characteristics of abdominal aortic aneurysm. Biol Sex Differ, 2020, 11(1): 41.
29. van Disseldorp EMJ, Petterson NJ, van de Vosse FN, et al. Quantification of aortic stiffness and wall stress in healthy volunteers and abdominal aortic aneurysm patients using time-resolved 3D ultrasound: a comparison study. Eur Heart J Cardiovasc Imaging, 2019, 20(2): 185-191.
30. Brangsch J, Reimann C, Kaufmann JO, et al. Concurrent molecular magnetic resonance imaging of inflammatory activity and extracellular matrix degradation for the prediction of aneurysm rupture. Circ Cardiovasc Imaging, 2019, 12(3): e008707.
31. MA3RS Study Investigators. Aortic wall inflammation predicts abdominal aortic aneurysm expansion, rupture, and need for surgical repair. Circulation, 2017, 136(9): 787-797.
32. Hag AM, Pedersen SF, Christoffersen C, et al. ¹⁸F-FDG PET imaging of murine atherosclerosis: association with gene expression of key molecular markers. PLoS One, 2012, 7(11): e50908.
33. Jalalzadeh H, Indrakusuma R, Planken RN, et al. Inflammation as a predictor of abdominal aortic aneurysm growth and rupture: a systematic review of imaging biomarkers. Eur J Vasc Endovasc Surg, 2016, 52(3): 333-342.
34. Forsythe RO, Dweck MR, McBride OMB, et al. ¹⁸F-sodium fluoride uptake in abdominal aortic aneurysms: The SoFIA3 study. J Am Coll Cardiol, 2018, 71(5): 513-523.
35. Ramaswamy AK, Hamilton M 2nd, Joshi RV, et al. Molecular imaging of experimental abdominal aortic aneurysms. Sci World J, 2013, 2013: 973150.
36. Liu D, Fan Z, Li Y, et al. Quantitative study of abdominal blood flow patterns in patients with aortic dissection by 4-dimensional flow MRI. Sci Rep, 2018, 8(1): 9111.
37. Ziegler M, Welander M, Lantz J, et al. Visualizing and quantifying flow stasis in abdominal aortic aneurysms in men using 4D flow MRI. Magn Reson Imaging, 2019, 57: 103-110.
38. Kolipaka A, Illapani VS, Kalra P, et al. Quantification and comparison of 4D-flow MRI-derived wall shear stress and MRE-derived wall stiffness of the abdominal aorta. J Magn Reson Imaging, 2017, 45(3): 771-778.
39. Singh P, Almarzooq Z, Salata B, et al. Role of molecular imaging with positron emission tomographic in aortic aneurysms. J Thorac Dis, 2017, 9(Suppl 4): S333-S342.
40. Majmudar MD, Keliher EJ, Heidt T, et al. Monocyte-directed RNAi targeting CCR2 improves infarct healing in atherosclerosis-prone mice. Circulation, 2013, 127(20): 2038-2046.

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