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Assessing the rupture risk of Abdominal Aortic Aneurysms (AAAs)
The rupture risk of AAAs is the most natural intervention indication, and currently minimal invasive (EVAR) or surgical interventions are available effectively treat such diseased portions of the aorta. The treatment itself is highly successful; however, these are major (expensive) interventions and naturally associated with diverse risks for the patients. According to different guidelines rupture risk is estimated from the AAA’s largest diameter and different trials came up with different threshold values (5.0cm , 5.5 cm,…).  The weakness of such an approach, however, is indicated by the fact that up to 30% of AAAs rupture although below such thresholds and it is known that the actual shape of the aneurysm matters most. The geometry of AAAs is highly diverse, and hence, a single diameter measure cannot reflect that. Already 10 years ago powerful hypothetical models (based on the Finite Element Method) demonstrated that one can do better! In details, patient specific computer models of the aneurysm are used to predict the mechanical loading in the wall, which in turn reflects its rupture risk. Different research groups all around the world demonstrated that this approach is superior to assessing the rupture risk from the aneurysm’s largest diameter.  However such approaches are not seen in clinical practice at all, although they cannot just avoid human tragedies but also save money.
So my question is why does no one apply this new method?



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