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Characterizing saccular aortic arch aneurysms from the geometry-flow dynamics relationship.

Kayoko Natsume¹, Norihiko Shiiya¹, Yasuo Takehara²

¹First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.

The Journal of Thoracic and Cardiovascular Surgery

|December 29, 2016

Summary

Low wall shear stress (WSS) is linked to aneurysm progression. Saccular aneurysms, particularly those with a high sac depth/neck width ratio (>0.8), exhibit consistently low WSS, potentially explaining their aggressive nature.

Keywords:

4D-Flow MRI hemodynamics saccular aneurysm thoracic aorta aneurysm

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Area of Science:

Cardiovascular imaging
Biomedical engineering
Medical physics

Background:

Low wall shear stress (WSS) is implicated in atherosclerosis and aneurysm development.
Understanding the geometric factors influencing WSS in aortic arch aneurysms is crucial for predicting clinical behavior.

Purpose of the Study:

To evaluate the geometric characteristics of saccular and fusiform aortic arch aneurysms.
To investigate the relationship between aneurysm geometry, wall shear stress (WSS), and vortex flow using 4D flow MRI.

Main Methods:

Computed tomography (CT) was used to analyze aneurysm geometry in 100 patients.
4D flow magnetic resonance imaging (MRI) assessed WSS and vortex flow in 16 patients, compared to 8 controls and 8 young volunteers.

Main Results:

Saccular aneurysms (82%) showed higher and more variable geometric ratios (diameter/length, sac depth/neck width) than fusiform aneurysms (18%).
Vortex flow was consistently observed in aneurysms, leading to low WSS.
A sac depth/neck width ratio >0.8 in saccular aneurysms resulted in low WSS irrespective of diameter.

Conclusions:

Fusiform aneurysms elongate with dilation, showing decreased WSS with larger diameters.
Saccular aneurysms dilate without proportionate elongation, often having high sac depth/neck width ratios.
High sac depth/neck width ratios in saccular aneurysms correlate with low WSS and may indicate malignant behavior.