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Morphology and hemodynamics in isolated common iliac artery aneurysms impacts proximal aortic remodeling

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Title: Morphology and hemodynamics in isolated common iliac artery aneurysms impacts proximal aortic remodeling
Authors: Parker, LP
Powell, JT
Kelsey, LJ
Lim, B
Ashleigh, R
Venermo, M
Koncar, I
Norman, PE
Doyle, BJ
Item Type: Journal Article
Abstract: Objective- Isolated common iliac artery aneurysms (CIAA) are rare. Their prognosis and influence on aortoiliac blood flow and remodeling are unclear. We evaluated the hypotheses that morphology at and distal to the aortic bifurcation, together with the associated hemodynamic changes, influence both the natural history of CIAA and proximal aortic remodeling. Approach and Results- Twenty-five isolated CIAAs (15 intact, 10 ruptured), in 23 patients were reconstructed and analyzed with computational fluid dynamics: all showed abnormal flow. Then we studied a series of 24 hypothetical aortoiliac geometries in silico with varying abdominal aortic deflection and aortic bifurcation angles: key findings were assessed in an independent validation cohort of 162 patients. Wall shear stress in isolated unilateral CIAAs was lower than the contralateral common iliac artery, 0.38±0.33 Pa versus 0.61±0.24 Pa, inversely associated with CIAA diameter ( P<0.001) and morphology (high shear stress in variants distal to a sharp kink). Rupture usually occurred in regions of elevated low and oscillatory shear with a wide aortic bifurcation angle. Abdominal aortas deflected towards the CIAA for most unilateral isolated CIAAs (14/21). In silico, wider bifurcation angles created high focal regions of low and oscillatory shear in the common iliac artery. The associations of unilateral CIAA with aortic deflection and common iliac artery diameter with bifurcation angle were confirmed in the validation cohort. Conclusions- Decreasing wall shear stress is strongly associated with CIAA progression (larger aneurysms and rupture), whereas abnormal blood flow in the CIAA seems to promote proximal aortic remodeling, with adaptive lateral deflection of the abdominal aorta towards the aneurysmal side.
Issue Date: 1-Jun-2019
Date of Acceptance: 5-Apr-2019
URI: http://hdl.handle.net/10044/1/70063
DOI: https://dx.doi.org/10.1161/ATVBAHA.119.312687
ISSN: 1079-5642
Publisher: American Heart Association
Start Page: 1125
End Page: 1136
Journal / Book Title: Arteriosclerosis, Thrombosis, and Vascular Biology
Volume: 39
Issue: 6
Copyright Statement: © 2019 American Heart Association, Inc.
Sponsor/Funder: Department of Health
National Institute for Health Research Health Technology Assessment Programme
Funder's Grant Number: 07/37/64
HTA project 07/37/64
Keywords: aneurysm
aorta
hemodynamics
iliac artery
prognosis
aneurysm
aorta
hemodynamics
iliac artery
prognosis
1103 Clinical Sciences
1102 Cardiorespiratory Medicine and Haematology
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: United States
Embargo Date: 2019-10-25
Online Publication Date: 2019-04-25
Appears in Collections:Division of Surgery
Faculty of Medicine



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