Full Text:   <2008>

Summary:  <945>

CLC number: O351.2; R732.21

On-line Access: 2021-12-15

Received: 2021-07-03

Revision Accepted: 2021-09-17

Crosschecked: 2021-11-18

Cited: 0

Clicked: 2955

Citations:  Bibtex RefMan EndNote GB/T7714


Maria Antonietta Boniforti


-   Go to

Article info.
Open peer comments

Journal of Zhejiang University SCIENCE A 2021 Vol.22 No.12 P.957-978


On the role of hemodynamics in predicting rupture of the abdominal aortic aneurysm

Author(s):  Maria Antonietta Boniforti, Lorenzo Di Bella, Roberto Magini

Affiliation(s):  Department of Civil, Building, and Environmental Engineering, Sapienza University, Rome 00184, Italy

Corresponding email(s):   antonietta.boniforti@uniroma1.it

Key Words:  Hemodynamics, Computational fluid dynamics, Wall shear stress, Vortex dynamics, Abdominal aortic aneurysm (AAA), Patient-specific modelling

Maria Antonietta Boniforti, Lorenzo Di Bella, Roberto Magini. On the role of hemodynamics in predicting rupture of the abdominal aortic aneurysm[J]. Journal of Zhejiang University Science A, 2021, 22(12): 957-978.

@article{title="On the role of hemodynamics in predicting rupture of the abdominal aortic aneurysm",
author="Maria Antonietta Boniforti, Lorenzo Di Bella, Roberto Magini",
journal="Journal of Zhejiang University Science A",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T On the role of hemodynamics in predicting rupture of the abdominal aortic aneurysm
%A Maria Antonietta Boniforti
%A Lorenzo Di Bella
%A Roberto Magini
%J Journal of Zhejiang University SCIENCE A
%V 22
%N 12
%P 957-978
%@ 1673-565X
%D 2021
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.A2100308

T1 - On the role of hemodynamics in predicting rupture of the abdominal aortic aneurysm
A1 - Maria Antonietta Boniforti
A1 - Lorenzo Di Bella
A1 - Roberto Magini
J0 - Journal of Zhejiang University Science A
VL - 22
IS - 12
SP - 957
EP - 978
%@ 1673-565X
Y1 - 2021
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.A2100308

hemodynamics plays a crucial role in the growth of an abdominal aortic aneurysm (AAA) and its possible rupture. Due to the serious consequences that arise from the aneurysm rupture, the ability to predict its evolution and the need for surgery are of primary importance in the medical field. Furthermore, the presence of intraluminal thrombus (ILT) strongly affects the evolution of the pathology. In this study, we analyzed the influence of hemodynamics on the growth and possible rupture of AAAs. Numerical investigations of pulsatile non-Newtonian blood flow were performed in six patient-specific AAAs reconstructed from diagnostic images, having different sizes and shapes, and with or without ILT. wall shear stress and vorticity distribution in the bulge and their evolution during the cardiac cycle were analyzed. The results indicate that blood flow dynamics acts synergistically with atherosclerotic degeneration in the development of the disease. The high surface complexity and tortuosity of the aneurysms significantly affect the blood motion, and the presence of inflection in the aneurysm centerline has a noticeable effect on the vortex dynamics. Links between regions of slow recirculating flows, low values of time-averaged wall shear stress, high values of oscillatory shear index, and zones of ILT deposition were found. In the absence of ILT, possible thrombus accumulation areas and consequent aneurysm growth were identified. The findings of this study highlight the importance of hemodynamics in assessing the vulnerability of the aortic wall and underline the crucial role of patient-specific investigations in predicting the rupture of individual aneurysms.


创新点:1. 研究在主动脉疾病的发展过程中,血流动力学与动脉粥样硬化变性协同作用;2. 分析动脉瘤中心线的拐点、颈部角度和凸起的不对称性对血流动力学的影响.
方法:1. 对6例不同大小和形状、有无腔内血栓的患者特异性腹主动脉瘤进行脉动非牛顿血流的数值研究;2. 根据诊断图像准确地重建患者特定的几何结构;3. 通过分析二维和三维流线演变以及瞬时壁剪应力等值线,描述病变动脉中血流的不稳定性质;4. 计算时间平均血流动力学指标,包括时间平均壁剪切应力和振荡剪切指数.
结论:1. 研究结果表明流动停滞区、低壁面切应力和振荡壁面切应力与腔内血栓的出现存在空间相关性;2. 血管曲率和动脉瘤中心线拐点有利于形成涡流,从而可能导致腔内血栓积聚;3. 血液动力学对主动脉壁脆弱性的评估具有重要作用;此外,患者特异性研究在预测单个动脉瘤破裂时具有关键作用.


Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Bai ZD, Zhu LD, 2019. Simulation of blood flow past a distal arteriovenous-graft anastomosis at low Reynolds numbers. Physics of Fluids, 31(9):091902.

[2]Bhagavan D, di Achille P, Humphrey JD, 2018. Strongly coupled morphological features of aortic aneurysms drive intraluminal thrombus. Scientific Reports, 8(1):13273.

[3]Biasetti J, Gasser TC, Auer M, et al., 2010. Hemodynamics of the normal aorta compared to fusiform and saccular abdominal aortic aneurysms with emphasis on a potential thrombus formation mechanism. Annals of Biomedical Engineering, 38(2):380-390.

[4]Biasetti J, Hussain F, Gasser TC, 2011. Blood flow and coherent vortices in the normal and aneurysmatic aortas: a fluid dynamical approach to intra-luminal thrombus formation. Journal of the Royal Society Interface, 8(63):1449-1461.

[5]Biasetti J, Spazzini PG, Swedenborg J, et al., 2012. An integrated fluid-chemical model toward modeling the formation of intra-luminal thrombus in abdominal aortic aneurysms. Frontiers in Physiology, 3:266.

[6]Bluestein D, Niu L, Schoephoerster RT, et al., 1996. Steady flow in an aneurysm model: correlation between fluid dynamics and blood platelet deposition. Journal of Biomechanical Engineering, 118(3):280-286.

[7]Boyd AJ, Kuhn DCS, Lozowy RJ, et al., 2016. Low wall shear stress predominates at sites of abdominal aortic aneurysm rupture. Journal of Vascular Surgery, 63(6):1613-1619.

[8]Canchi T, Kumar SD, Ng EYK, et al., 2015. A review of computational methods to predict the risk of rupture of abdominal aortic aneurysms. BioMed Research International, 2015:861627.

[9]Cecchi E, Giglioli C, Valente S, et al., 2011. Role of hemodynamic shear stress in cardiovascular disease. Atherosclerosis, 214(2):249-256.

[10]Chatzizisis YS, Coskun AU, Jonas M, et al., 2007. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. Journal of the American College of Cardiology, 49(25):2379-2393.

[11]da Silva ES, Rodrigues AJ, de Tolosa EMC, et al., 2000. Morphology and diameter of infrarenal aortic aneurysms: a prospective autopsy study. Cardiovascular Surgery, 8(7):526-532.

[12]Darling RC, Messina CR, Brewster DC, et al., 1977. Autopsy study of unoperated abdominal aortic aneurysms. The case for early resection. Circulation, 56(S3):II161-4.

[13]Decorato I, Kharboutly Z, Legallais C, et al., 2011. Numerical study of the influence of wall compliance on the haemodynamics in a patient-specific arteriovenous fistula. Computer Methods in Biomechanics and Biomedical Engineering, 14(S1):121-123.

[14]di Achille P, Tellides G, Figueroa CA, et al., 2014. A haemodynamic predictor of intraluminal thrombus formation in abdominal aortic aneurysms. Proceedings of the Royal Society A: Mathematical, Physical and Engineering Sciences, 470(2172):20140163.

[15]di Martino ES, Bohra A, Vande Geest JP, et al., 2006. Biomechanical properties of ruptured versus electively repaired abdominal aortic aneurysm wall tissue. Journal of Vascular Surgery, 43(3):570-576.

[16]Doyle BJ, McGloughlin TM, Kavanagh EG, et al., 2014. From detection to rupture: a serial computational fluid dynamics case study of a rapidly expanding, patient-specific, ruptured abdominal aortic aneurysm. In: Doyle B, Miller K, Wittek A, et al. (Eds.), Computational Biomechanics for Medicine: Fundamental Science and Patient-specific Applications. Springer, New York, USA, p.53-68.

[17]Forneris A, Marotti FB, Satriano A, et al., 2020. A novel combined fluid dynamic and strain analysis approach identified abdominal aortic aneurysm rupture. Journal of Vascular Surgery Cases, Innovations and Techniques, 6(2):172-176.

[18]Gasser TC, Auer M, Labruto F, 2010. Biomechanical rupture risk assessment of abdominal aortic aneurysms: model complexity versus predictability of finite element simulations. European Journal of Vascular and Endovascular Surgery, 40(2):176-185.

[19]Georgakarakos E, Ioannou CV, Volanis S, et al., 2009. The influence of intraluminal thrombus on abdominal aortic aneurysm wall stress. International Angiology, 28(4):325-333.

[20]Gijsen F, Katagiri Y, Barlis P, et al., 2019. Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications. European Heart Journal, 40(41):3421-3433.

[21]Gopalakrishnan SS, Pier B, Biesheuvel A, 2014. Dynamics of pulsatile flow through model abdominal aortic aneurysms. Journal of Fluid Mechanics, 758:150-179.

[22]Haller SJ, Crawford JD, Courchaine KM, et al., 2018. Intraluminal thrombus is associated with early rupture of abdominal aortic aneurysm. Journal of Vascular Surgery, 67(4):1051-1058.

[23]Hans SS, Jareunpoon O, Balasubramaniam M, et al., 2005. Size and location of thrombus in intact and ruptured abdominal aortic aneurysms. Journal of Vascular Surgery, 41(4):584-588.

[24]Hinds MT, Park YJ, Jones SA, et al., 2001. Local hemodynamics affect monocytic cell adhesion to a three-dimensional flow model coated with E-selectin. Journal of Biomechanics, 34(1):95-103.

[25]Huang Y, Teng ZZ, Elkhawad M, et al., 2016. High structural stress and presence of intraluminal thrombus predict abdominal aortic aneurysm 18F-FDG uptake. Circulation: Cardiovascular Imaging, 9(11):004656.

[26]Hunt JCR, Wray AA, Moin P, 1988. Eddies, streams, and convergence zones in turbulent flows. Proceedings of the Summer Program.

[27]Kazi M, Thyberg J, Religa P, et al., 2003. Influence of intraluminal thrombus on structural and cellular composition of abdominal aortic aneurysm wall. Journal of Vascular Surgery, 38(6):1283-1292.

[28]Kelsey LJ, Powell JT, Norman PE, et al., 2017. A comparison of hemodynamic metrics and intraluminal thrombus burden in a common iliac artery aneurysm. International Journal for Numerical Methods in Biomedical Engineering, 33(5):e2821.

[29]Kent KC, 2014. Clinical practice. Abdominal aortic aneurysms. The New England Journal of Medicine, 371(22):2101-2108.

[30]Kolipaka A, Illapani VSP, Kenyhercz W, et al., 2016. Quantification of abdominal aortic aneurysm stiffness using magnetic resonance elastography and its comparison to aneurysm diameter. Journal of Vascular Surgery, 64(4):966-974.

[31]Koole D, Zandvoort HJA, Schoneveld A, et al., 2013. Intraluminal abdominal aortic aneurysm thrombus is associated with disruption of wall integrity. Journal of Vascular Surgery, 57(1):77-83.

[32]Ku DN, 1997. Blood flow in arteries. Annual Review of Fluid Mechanics, 29:399-434.

[33]Ku DN, Giddens DP, Zarins CK, et al., 1985. Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis, 5(3):293-302.

[34]Laine MT, Vänttinen T, Kantonen I, et al., 2016. Rupture of abdominal aortic aneurysms in patients under screening age and elective repair threshold. European Journal of Vascular and Endovascular Surgery, 51(4):511-516.

[35]Lasheras JC, 2007. The biomechanics of arterial aneurysms. Annual Review of Fluid Mechanics, 39:293-319.

[36]Li ZH, Kleinstreuer C, 2007. A comparison between different asymmetric abdominal aortic aneurysm morphologies employing computational fluid-structure interaction analysis. European Journal of Mechanics-B/Fluids, 26(5):615-631.

[37]Li ZY, U-King-Im J, Tang TY, et al., 2008. Impact of calcification and intraluminal thrombus on the computed wall stresses of abdominal aortic aneurysm. Journal of Vascular Surgery, 47(5):928-935.

[38]Lozowy RJ, Kuhn DCS, Ducas AA, et al., 2017. The relationship between pulsatile flow impingement and intraluminal thrombus deposition in abdominal aortic aneurysms. Cardiovascular Engineering and Technology, 8(1):57-69.

[39]Nicholls SC, Gardner JB, Meissner MH, et al., 1998. Rupture in small abdominal aortic aneurysms. Journal of Vascular Surgery, 28(5):884-888.

[40]Parr A, McCann M, Bradshaw B, et al., 2011. Thrombus volume is associated with cardiovascular events and aneurysm growth in patients who have abdominal aortic aneurysms. Journal of Vascular Surgery, 53(1):28-35.

[41]Pasta S, Gentile G, Raffa GM, et al., 2017. Three-dimensional parametric modeling of bicuspid aortopathy and comparison with computational flow predictions. Artificial Organs, 41(9):E92-E102.

[42]Patel S, Usmani AY, Muralidhar K, et al., 2017. Effect of aorto-iliac bifurcation and iliac stenosis on flow dynamics in an abdominal aortic aneurysm. Fluid Dynamics Research, 49(3):035513.

[43]Qiu Y, Wang Y, Fan YB, et al., 2019. Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: a hemodynamic point of view. Medical Physics, 46(9):4263-4275.

[44]Scardulla F, Pasta S, D’Acquisto L, et al., 2017. Shear stress alterations in the celiac trunk of patients with a continuous-flow left ventricular assist device as shown by in-silico and in-vitro flow analyses. The Journal of Heart and Lung Transplantation, 36(8):906-913.

[45]Shibeshi SS, Collins WE, 2005. The rheology of blood flow in a branched arterial system. Applied Rheology, 15(6):398-405.

[46]Sorescu GP, Song HN, Tressel SL, et al., 2004. Bone morphogenic protein 4 produced in endothelial cells by oscillatory shear stress induces monocyte adhesion by stimulating reactive oxygen species production from a nox1-based NADPH oxidase. Circulation Research, 95(8):773-779.

[47]Soudah E, Ng EYK, Loong TH, et al., 2013. CFD modelling of abdominal aortic aneurysm on hemodynamic loads using a realistic geometry with CT. Computational and Mathematical Methods in Medicine, 2013:472564.

[48]Speelman L, Schurink GWH, Bosboom EMH, et al., 2010. The mechanical role of thrombus on the growth rate of an abdominal aortic aneurysm. Journal of Vascular Surgery, 51(1):19-26.

[49]Stenbaek J, Kalin B, Swedenborg J, 2000. Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms. European Journal of Vascular and Endovascular Surgery, 20(5):466-469.

[50]Swedenborg J, Eriksson P, 2006. The intraluminal thrombus as a source of proteolytic activity. Annals of the New York Academy of Sciences, 1085(1):133-138.

[51]Takehara Y, Isoda H, Takahashi M, et al., 2020. Abnormal flow dynamics result in low wall shear stress and high oscillatory shear index in abdominal aortic dilatation: initial in vivo assessment with 4D-flow MRI. Magnetic Resonance in Medical Sciences, 19(3):235-246.

[52]Tarbell JM, Shi ZD, Dunn J, et al., 2014. Fluid mechanics, arterial disease, and gene expression. Annual Review of Fluid Mechanics, 46:591-614.

[53]Thubrikar MJ, Labrosse M, Robicsek F, et al., 2001. Mechanical properties of abdominal aortic aneurysm wall. Journal of Medical Engineering & Technology, 25(4):133-142.

[54]Tong J, Cohnert T, Holzapfel GA, 2015. Diameter-related variations of geometrical, mechanical, and mass fraction data in the anterior portion of abdominal aortic aneurysms. European Journal of Vascular & Endovascular Surgery, 49(3):262-270.

[55]Tzirakis K, Kamarianakis Y, Metaxa E, et al., 2017. A robust approach for exploring hemodynamics and thrombus growth associations in abdominal aortic aneurysms. Medical & Biological Engineering & Computing, 55(8):1493-1506.

[56]Vande Geest JP, Sacks MS, Vorp DA, 2006. The effects of aneurysm on the biaxial mechanical behavior of human abdominal aorta. Journal of Biomechanics, 39(7):1324-1334.

[57]Vorp DA, 2007. Biomechanics of abdominal aortic aneurysm. Journal of Biomechanics, 40(9):1887-1902.

[58]Vorp DA, Lee PC, Wang DHJ, et al., 2001. Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening. Journal of Vascular Surgery, 34(2):291-299.

[59]Wang DHJ, Makaroun MS, Webster MW, et al., 2002. Effect of intraluminal thrombus on wall stress in patient-specific models of abdominal aortic aneurysm. Journal of Vascular Surgery, 36(3):598-604.

[60]Wolf YG, Thomas WS, Brennan FJ, et al., 1994. Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms. Journal of Vascular Surgery, 20(4):529-538.

[61]Xenos M, Rambhia SH, Alemu Y, et al., 2010. Patient-based abdominal aortic aneurysm rupture risk prediction with fluid structure interaction modeling. Annals of Biomedical Engineering, 38(11):3323-3337.

[62]Zambrano BA, Gharahi H, Lim CY, et al., 2016. Association of intraluminal thrombus, hemodynamic forces, and abdominal aortic aneurysm expansion using longitudinal CT images. Annals of Biomedical Engineering, 44(5):1502-1514.

[63]Zhu CC, Leach JR, Wang YT, et al., 2020. Intraluminal thrombus predicts rapid growth of abdominal aortic aneurysms. Radiology, 294(3):707-713.

Open peer comments: Debate/Discuss/Question/Opinion


Please provide your name, email address and a comment

Journal of Zhejiang University-SCIENCE, 38 Zheda Road, Hangzhou 310027, China
Tel: +86-571-87952783; E-mail: cjzhang@zju.edu.cn
Copyright © 2000 - 2024 Journal of Zhejiang University-SCIENCE