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THE JOURNAL OF CARDIOVASCULAR SURGERY
A Journal on Cardiac, Vascular and Thoracic Surgery
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632
The Journal of Cardiovascular Surgery 2015 Jul 16
Grading abdominal aortic aneurysm rupture risk
Chisci E. 1, Alamanni N. 2, Iacoponi F. 3, Michelagnoli S. 1, Procacci T. 2, Colombo G. 4, Setacci C. 5 ✉
1 Department of Surgery, Vascular and Endovascular Surgery Unit, “San Giovanni di Dio” Hospital, Florence, Italy;
2 Configuratori.it, Florence, Italy;
3 Osservatorio Epidemiologico, Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana “M. Aleandri”, Rome , Italy;
4 Department for Mechanical Engineering, Polytechnic of Milan, Milan, Italy;
5 Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
OBJECTIVE: To develope a scoring system to grade the risk of rupture of an abdominal aortic aneurysm (AAA) in individual patients.
METHODS: Computed tomography angiography of an AAA were coupled with computational fluid dynamics (CFD) evaluation performed using open source software (ElmerSolver, Institute of Technology, Finland). CFD criteria studied were: oscillatory shear index (OSI), time averaged wall shear stress (TAWSS) and residence relative time (RRT) on both two-dimensional (2D) and three-dimensional (3D) models. AAA rupture predictors were analysed and a scoring system was generated using Arabic numerals for all significant variables in order to grade the individual patient risk of rupture.
RESULTS: There were 143 patients examined. 91 AAAs (18 ruptured AAAs), and 52 had a non-aneurysmal aorta. The 2D OSI index was the best CFD criterion following multivariate analysis and ROC curves evaluation. An AAA was deemed at low, moderate, or high risk of rupture, respectively, according to whether the risk score was defined as AAA I (total score<2.3), AAA II (2.3-6.5) or AAA III (>6.5). The only protective factor was found in diabetes (OR=0.775; CI:0.665-0.902).
CONCLUSIONS: The Florence risk score for AAA rupture based on this report may be a useful tool to predict AAA rupture. A prospective multicentre registry will need to confirm its validity.