Morphology and computational fluid dynamics support a novel classification of common iliac aneurysms
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives: Isolated common iliac artery aneurysms (CIAAs) are uncommon and evidence concerning their development, progression and management is weak. Our objective was to describe the morphology and haemodynamics of isolated CIAAs in a retrospective study.
Methods: Initially a series of 25 isolated CIAAs (15 intact, 10 ruptured) in 23 patients were gathered from multiple centres, reconstructed from computed tomography (CT), then morphologically classified and analysed with computational fluid dynamics. The morphological classification was applied in a separate, consecutive cohort of 162 patients assessed for elective aorto-iliac intervention, in which 45 patients had intact CIAAs.
Results: In the isolated CIAA cohort, three distinct morphologies were identified: complex, fusiform and kinked (distal to a sharp bend in the CIA), with mean diameters 90.3, 48.3 and 31.7 mm, and mean time-averaged wall shear stress of 0.16, 0.31 and 0.71 Pa, respectively (both ANOVA p<.001). Kinked cases, compared to fusiform cases, had less thrombus and favourable haemodynamics similar to the non-aneurysmal contralateral CIA. Ruptured isolated CIAA were large (mean diameter 87.5mm, range 55.5-138.0mm) and predominantly complex. Mean CIA length for aneurysmal arteries was greatest in kinked cases followed by complex and fusiform (100.8mm, 91.1mm and 80.6mm respectively). The morphological classification was readily applicable to a separate elective patient cohort.
Conclusions: A new morphological categorization of CIAAs is proposed. This is potentially associated with both haemodynamics and clinical course. Further research is required to determine whether the kinked CIAA is haemodynamically protected from aneurysm progression and establish the wider applicability of the categorization presented.
Methods: Initially a series of 25 isolated CIAAs (15 intact, 10 ruptured) in 23 patients were gathered from multiple centres, reconstructed from computed tomography (CT), then morphologically classified and analysed with computational fluid dynamics. The morphological classification was applied in a separate, consecutive cohort of 162 patients assessed for elective aorto-iliac intervention, in which 45 patients had intact CIAAs.
Results: In the isolated CIAA cohort, three distinct morphologies were identified: complex, fusiform and kinked (distal to a sharp bend in the CIA), with mean diameters 90.3, 48.3 and 31.7 mm, and mean time-averaged wall shear stress of 0.16, 0.31 and 0.71 Pa, respectively (both ANOVA p<.001). Kinked cases, compared to fusiform cases, had less thrombus and favourable haemodynamics similar to the non-aneurysmal contralateral CIA. Ruptured isolated CIAA were large (mean diameter 87.5mm, range 55.5-138.0mm) and predominantly complex. Mean CIA length for aneurysmal arteries was greatest in kinked cases followed by complex and fusiform (100.8mm, 91.1mm and 80.6mm respectively). The morphological classification was readily applicable to a separate elective patient cohort.
Conclusions: A new morphological categorization of CIAAs is proposed. This is potentially associated with both haemodynamics and clinical course. Further research is required to determine whether the kinked CIAA is haemodynamically protected from aneurysm progression and establish the wider applicability of the categorization presented.
Date Issued
2020-05
Date Acceptance
2019-11-21
Citation
European Journal of Vascular and Endovascular Surgery, 2020, 59 (5), pp.786-793
ISSN
1078-5884
Publisher
Elsevier
Start Page
786
End Page
793
Journal / Book Title
European Journal of Vascular and Endovascular Surgery
Volume
59
Issue
5
Copyright Statement
© 2020 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
Department of Health
National Institute for Health Research Health Technology Assessment Programme
Identifier
https://www.sciencedirect.com/science/article/pii/S1078588419326322?via%3Dihub
Grant Number
07/37/64
HTA project 07/37/64
Subjects
Aneurysm
Aorta
Haemodynamics
Iliac aneurysm
Iliac artery
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Cardiovascular System & Hematology
Publication Status
Published
Date Publish Online
2020-01-22