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The aim of this thesis is the problematic of abdominal aortic aneurysm wall stress in relation to a different material behavior of intraluminal thrombus, which is in most cases present in the aneurysmal volume. In this thesis, the influence of neglecting the patient-specific material properties of the intraluminal thrombus, on the aneurysmal wall stress, obtained from finite element stress-strain analysis, is investigated. In terms of solution method selection, a system approach was applied so that the solution method was selected in order to respect a system of essential variables as much as possible. The first part of this thesis is focused on a description of the problematic and the human cardiovascular system with important aspects contributing to development and growth of the abdominal aortic aneurysm. Next, this part of the thesis includes chapters devoted to the intraluminal thrombus in terms of its basic characteristics (anatomy, physiology, pathology), structure and its influence on processes within the abdominal aneurysm. The second part of this work is devoted to the accomplishment of the first and second goal of this thesis, which is analyzing the available literature to obtain mean population stiffness values of the intraluminal thrombus and conducting biaxial experimental tests of provided samples of intraluminal thrombus. The experimental testing was conducted in order to obtain the patient-specific mechanical properties, which are used as the inputs in the finite element analysis. The experimental testing confirmed the stiffness negligibility of the intraluminal thrombus’s outer layer, which is mentioned is several studies, however, the influence of this layer on resulting aneurysmal wall stress has been to this date not tested. The dominant part of this thesis is focused on the third goal of this work, which is a comparison of aneurysmal wall stress obtained from the finite element computation that included mechanical properties of intraluminal thrombus obtained either from the literature analysis of experimental testing. This part includes discerption of idealized geometry model development, which was used to analyze the sensibility of computed stresses on a number of ILT layers representing different material properties. In order to obtain this analysis, a macro was created prescribing each element of the intraluminal thrombus finite element mesh with material properties derived from its distance from the lumen. Next, this chapter contains description of patient-specific geometry models development, material models, and boundary conditions selection. In the end of this part, results of the finite element computations are presented together with their statistical analysis. Within the last part of this thesis, discussion of results and conclusions of this thesis is included. Also, an overview of important aspects entering computational modeling of abdominal aortic aneurysms is presented.

This thesis deals with stress strain analysis of an aortic abdominal aneurysm (AAA) and the influence of its contact with the spine on the extreme wall stress. The influence was tested on the idealized geometry, as well as on ten patient specific geometries obtained from computer tomography (CT-A) scans. Hyperelastic constitutive models were used for the AAA wall and intraluminal thrombus (ILT) tissue description. The prestress algorithm was used for reconstruction of the unloaded geometry to get more trustworthy results against the geometry from CT which was obtained under the blood pressure. Statistical analysis was used for the results evaluation. The maximal increase of peak wall stress was as high as 81 %.

This paper deals with the problem of abdominal aortic aneurysms (AAA), taking into account the possibility of using mechanical tests of aortic tissues for improvement of level of their constitutive models. First part of thesis deals with the introduction into the problem, description of the structure of the wall of the healthy aorta, its main components and the degenerative changes which lead to formation of AAA. This is followed by a brief excursion into constitutive modeling, which focuses closely on the description of the models used to describe the mechanical behavior of soft tissues. The theoretical part is then supplemented by a narrower selection of constitutive models used for modeling aortic wall and intraluminal thrombus, together with published results, which are reviewed and discussed at the end of this section. The main part of this thesis is devoted to tests of mechanical properties of arterial tissues. First, the methodology is presented together with the description of the customizations of the laboratory equipments together with the test rig. In addition, attention is focused on the results of mechanical tests of intraluminal thrombus, where the results of both uniaxial tensile tests and equbiaxial testing are presented. Also the influence of distance ILT from the lumen on the mechanical properties of the thrombus is examined. Another area of interest is the investigation of the effect of elastase on the chnage of mechanical properties of pig aorta. In this case, porcine aortas are experimentally tested only by biaxial testing, and the time of elastase action to alter the mechanical properties is analyzed so that the resulting tissue has a similar stress-strain response as aneurysmal tissue. Finally, the results of experimental measurements, limitations and other possible ways of research are summarized.

The diploma thesis is focused on the creation of the aneurysm finite element model and the making of the aneurysm wall stess-strain analysis using ANSYS software. The model of abdominal aortic aneurysm geometry starts from the CT scan of the particular patient. In the thesis there are compared two chosen constitutive models, each of them appears from different mechanical tests done on human arterial fibre samples. Furthermore, a limiting condition for aneurysm wall structure damage is expressed. On the basis of the results of stress calculation in the aneurysm wall and the limiting condition, the safety coefficient and rupture factors risk are worked out.

This master thesis is focused on stress-strain analysis abdominal aortic aneurysm using ANSYS software. The model of abdominal aortic aneurysm are based on CT scans of five specific patients. The branching arteries are included to the model and one goal of this thesis is decision about their influence of the wall stress. In this thesis was used a hyperelastic materiál model, which is based on mechanical tests done on human arterial samples.

Background: Scoring models are widely established in the intensive care unit (ICU). However, the importance in patients with ruptured abdominal aortic aneurysm (RAAA) remains unclear. Our aim was to analyze scoring systems as predictors of survival in patients undergoing open surgical repair (OSR) for RAAA. Methods: This is a retrospective study in critically ill patients in a surgical ICU at a university hospital. Sixty-eight patients with RAAA were treated between February 2005 and June 2013. Serial measurements of Sequential Organ Failure Assessment score (SOFA), Simplified Acute Physiology Score II (SAPS II) and Simplified Therapeutic Intervention Scoring System-28 (TISS-28) were evaluated with respect to in-hospital mortality. Eleven patients had to be excluded from this study because 6 underwent endovascular repair and 5 died before they could be admitted to the ICU. Results: All patients underwent OSR. The initial, highest, and mean of SOFA and SAPS II scores correlated significant with in-hospital mortality. In contrast, TISS-28 was inferior and showed a smaller area under the receiver operating curve. The cut-off point for SOFA showed the best performance in terms of sensitivity and specificity. An initial SOFA score below 9 predicted an in-hospital mortality of 16.2% (95% CI, 4.3–28.1) and a score above 9 predicted an in-hospital mortality of 73.7% (95% CI, 53.8–93.5, p < 0.01). Trend analysis showed the largest effect on SAPS II. When the score increased or was unchanged within the first 48 h (score >45), the in-hospital mortality rate was 85.7% (95% CI, 67.4–100, p < 0.01) versus 31.6% (95% CI, 10.7–52.5, p = 0.01) when it decreased. On multiple regression analysis, only the mean of the SOFA score showed a significant predictive capacity with regards to mortality (odds ratio 1.77; 95% CI, 1.19–2.64; p < 0.01). Conclusion: SOFA and SAPS II scores were able to predict in-hospital mortality in RAAA within 48 h after OSR. According to cut-off points, an increase or decrease in SOFA and SAPS II scores improved sensitivity and specificity.

Bakgrund: Tidig upptäckt av Abdominellt aortaaneurysm (AAA) minskar dödlighet bland äldre män och kvinnor. AAA är till stor del asymtomatisk så många blir överraskade när de får en diagnos. Diagnosen medför vetskap att något inom dem växer, något som kan brista med risk för dödlig utgång. Det orsakar rädsla och osäkerhet hos patienter som plötsligt försöker förstå sin nya sjukdom. Operationen är inte riskfri från komplikationer och medför en ökad risk för mortalitet. Syftet: Syftet var att med en allmän litteraturöversikt beskriva hur upplevelsen av dagligt liv påverkas hos patienter som lever med abdominellt aortaaneurysm. Frågeställning: Hur upplever patienter som har opererats för abdominellt aortaaneurysm att det påverkar deras dagliga liv? Metod: En allmän litteraturöversikt av tolv studier med kvalitativ metod genomfördes. PubMed, Cinahl, Psychinfo och även manuell sökning användes för litteratursökning. Studierna granskades med SBU:s granskningsmall (2014) för kvalitativa studier. Studierna analyserades med inspiration av Fribergs fyra steg analysmetod, där resultat från analysen presenterades under lämpliga kategorier och subkategorier. Resultat: Resultatet gav tre teman: Upplevelser av diagnostisering, Upplevelser av konservativ behandling och Upplevelser före och efter kirurgiska behandlingar. Att diagnostisera med AAA påverkades patientens dagliga liv och livskvalitet. Patienter upplevde nedsatt förmåga att ta emot information vilket orsakade ytterligare rädslan och osäkerhet i deras liv. Konklusion: Alla patienter påverkades av diagnosen AAA och utvecklades negativa känslor, tankar samt orealistiska hanteringsstrategier. Efter kirurgiska behandling hade patienten ofta ouppfyllda förväntningar. / Background: Early detection of Abdominal Aortic Aneurysm (AAA) reduces mortality among older men and women. AAA is largely asymptomatic so many people are surprised when they are diagnosed. The diagnosis leads to the knowledge that something within them is growing, something that can break with the risk of fatal outcome. It causes fear and insecurity in patients who are suddenly trying to understand their new disease. The operation is not risk-free from complications and entails an increased risk of mortality. Purpose: The purpose was to describe with a general literature review how the experience of daily life is affected in patients living with abdominal aortic aneurysm. Question: How do patients who have had surgery for an abdominal aortic aneurysm feel that it affects their daily lives? Method: A literature review of twelve studies with a qualitative method was conducted. PubMed, Cinahl, Psychinfo and manual search were used for the literature search. The studies were reviewed with SBU's review template (2014) for qualitative studies. This were analyzed with inspiration from Friberg's four step analysis method, where results from analysis were presented under appropriate categories and subcategories. Results: The result produced three themes: Experiences of diagnosis, Experiences of conservative treatment and Experiences before and after surgical treatments. Being diagnosed with AAA affected the patient's daily life and quality of life. Patients experienced impaired their ability to receive information which caused further fear and insecurity in their lives. Conclusion: All patients were affected by the diagnosis AAA and developed negative emotions, thoughts, and unrealistic coping strategies. After surgical treatment, the patient often had unfulfilled expectations.

Mise en contexte : La réparation endovasculaire des anévrismes de l’aorte abdominale est limitée par le développement des endofuites, qui nécessite un suivi à long terme par imagerie. L’élastographie sonore de déformation a été proposée comme méthode complémentaire pour aider à la détection des endofuites et la caractérisation des propriétés mécaniques des anévrismes. On s’intéresse ici également à la possibilité de suivre l’embolisation des endofuites, qui est indiquée dans certains cas mais dont le succès est variable. Un nouvel agent d’embolisation a été récemment créé en combinant un hydrogel de chitosane radio-opaque (CH) et le sclérosant tetradecyl sulfate de sodium (STS), qui s’appelle CH-STS. Le CH-STS démontre des propriétés mécaniques in vitro favorables, mais son comportement in vivo et son effet sur l’évolution du sac par rapport à un agent non-sclérosant pourraient être mieux caractérisés. L’objectif de cette étude était la caractérisation des propriétés mécaniques des composantes des endofuites embolisées avec CH-STS et CH avec élastographie sonore de déformation. Méthodologie : Des anévrismes bilatéraux avec endofuites de type I ont été créés au niveau des artères iliaques communes chez neuf chiens. Chez chaque sujet, une endofuite a été embolisée avec CH, et l’autre, avec CH-STS, d’une façon aléatoire et aveugle. Des images d’échographie duplex et des cinéloops pour élastographie sonore de déformation ont été acquis à 1 semaine, 1 mois, 3 mois et (chez 3 sujets) 6 mois post-embolisation. La tomodensitométrie a été faite à 3 mois et (si pertinente) 6 mois post-embolisation. L’histopathologie a été faite au sacrifice. Les études radiologiques et les données d’histopathologie ont été co-enregistrées pour définir trois régions d’intérêt sur les cinéloops : l’agent d’embolisation (au sacrifice), le thrombus intraluminal (au sacrifice) et le sac anévrismal (pendant chaque suivi). L’élastographie sonore de déformation a été faite avec les segmentations par deux observateurs indépendants. La déformation axiale maximale (DAM) a été le critère d’évaluation principal. Les analyses statistiques ont été faites avec des modèles mixtes linéaires généralisés et des coefficients de corrélations intraclasses (ICCs). Résultats : Des endofuites résiduelles ont été trouvées dans 7/9 (77.8%) et 4/9 (44.4%) des anévrismes embolisés avec CH et CH-STS, respectivement. Le CH-STS a eu une DAM 66 % plus basse (p < 0.001) que le CH. Le thrombus a eu une DAM 37% plus basse (p = 0.010) que le CH et 77% plus élevée (p = 0.079) que le CH-STS. Il n’y avait aucune différence entre les thrombi associés avec les deux traitements. Les sacs anévrismaux embolisés avec CH-STS ont eu une DAM 29% plus basse (p < 0.001) que ceux embolisés avec CH. Des endofuites résiduelles ont été associées avec une DAM du sac anévrismal 53% plus élevée (p < 0.001). Le ICC pour la DAM a été de 0.807 entre les deux segmentations. Conclusion : Le CH-STS confère des valeurs de déformations plus basses aux anévrismes embolisés. Les endofuites persistantes sont associées avec des déformations plus élevées du sac anévrismal. / Background: Endovascular aneurysm repair (EVAR) is the modality of choice for the treatment of abdominal aortic aneurysms (AAAs). EVAR is limited by the development of endoleaks, which necessitate long-term imaging follow-up. Conventional follow-up modalities suffer from unique limitations. Strain ultrasound elastography (SUE) has been recently proposed as an imaging adjunct to detect endoleaks and to characterize aneurysm mechanical properties. Once detected, certain endoleaks may be treated with embolization; however, success is limited. In this context, the embolic agent CH-STS—containing a chitosan hydrogel and the sclerosant sodium tetradecyl sulphate (STS)—was created. CH-STS demonstrates favorable mechanical properties in vitro; however, its behavior in vivo and impact on sac evolution compared to a non-sclerosing chitosan-based embolic agent (CH) merit further characterization. Purpose: To compare the mechanical properties of the constituents of endoleaks embolized with CH and CH-STS—including the agent, the intraluminal thrombus (ILT), and the overall sac—via SUE. Methods: Bilateral common iliac artery aneurysms with type I endoleaks were created in nine dogs. In each animal, one endoleak was randomly embolized with CH, and the other with CH-STS. Duplex ultrasound (DUS) and radiofrequency cine loops were acquired at 1 week, 1 month, 3 months, and—in 3 subjects—6 months post-embolization. Contrast-enhanced CT was performed at 3 months and—where applicable—6 months post-embolization. Histopathological analysis was performed at time of sacrifice. Radiological studies and histopathological slides were co-registered to identify three regions of interest (ROIs) on the cine loops: embolic agent (at sacrifice), ILT (at sacrifice), and aneurysm sac (at all follow-up times). SUE was performed using segmentations from two independent observers on the cine loops. Maximum axial deformation (MAD) was the main outcome. Statistical analysis was performed using general linear mixed models and intraclass correlation coefficients (ICCs). Results: Residual endoleaks were identified in 7/9 (77.8%) and 4/9 (44.4%) aneurysms embolized with CH and CH-STS, respectively. CH-STS had a 66 % lower MAD (p < 0.001) than CH. The ILT had a 37% lower MAD (p = 0.010) than CH and a 77% greater MAD (p = 0.079; trending towards significance) than CH-STS. There was no difference in the ILT between treatment groups. Aneurysm sacs embolized with CH-STS had a 29% lower MAD (p < 0.001) than those with CH. Residual endoleak increased MAD of the aneurysm sac by 53% (p < 0.001), regardless of the agent used. The ICC for MAD was 0.807 between readers’ segmentations. Conclusion: CH-STS confers lower strain values to embolized aneurysms. Persistent endoleaks result are associated with increased sac strain, which may be useful for clinical follow-up.

Tato práce je zaměřena na problematiku výpočtového a experimentálního modelování deformačně napjatostních stavů měkkých tkání se zaměřením na riziko ruptury u výdutě břišní aorty (AAA). V první části (kap. 1) je stručně nastíněn současný stav dané problematiky. Tato část shrnuje důležité poznatky publikované v dostupné literatuře. Pozornost je věnována zejména klíčovým faktorům pro stanovení rizika ruptury AAA. V další kapitole (kap. 2) je stručně popsána histologie cévní stěny a její výsledné mechanické chování, jakož i její patologie, především AAA. Druhá část práce (kap.3) je věnována experimentálnímu vyhodnocování deformačně napjatostního chování měkkých tkání, které je nutným předpokladem k věrohodnému výpočtovému modelování tohoto chování. V této kapitole je stručně popsáno experimentální zařízení speciálně vyvinuté pro testování měkkých tkání a typy zkoušek, které lze na tomto zařízení provádět. Dále jsou shrnuty klíčové faktory ovlivňující deformačně napjatostní chování měkkých tkání a experimentální ověření těchto faktorů na vzorcích z prasečích hrudních aort. V závěru této kapitoly jsou shrnuty nové poznatky vyplývající z experimentálního testování. Třetí část disertační práce (kap.4) je zaměřena na matematický popis deformačně napjatostního chování měkkých tkání, stručný popis používaných konstitutivních vztahu a postup při identifikaci parametrů pro tyto konstitutivní modely určované na základě provedených experimentálních zkoušek. Poslední část disertační práce (kap.5) je věnována výpočtovému modelování deformačně napjatostního chování AAA. V této kapitole jsou nejdříve shrnuty klíčové faktory a předpoklady pro vytváření modelů a pro vyhodnocování výsledku a dále jsou uvedeny materiálové parametry pro konstitutivní modely implementované do programu ANSYS. Byly provedeny testovací výpočty při použití hypotetické zjednodušené geometrie AAA, na kterých byly vyhodnoceny vlivy změny geometrie a vliv změny konsitutivního modelu na extrémní napětí ve stěně AAA. U reálné geometrie AAA byla navržena a otestována metoda výpočtu nezatížené geometrie z reálných CT snímků. Dále byl testován vliv zvýšení vnitřního tlaku jako rizika ruptury AAA. V závěru práce jsou shrnuty poznatky a možnosti výpočtového modelování a návrhy na další práce.