Stress-strain analysis of aortic aneurysms

Tato práce se zabývá problematikou aneurysmat břišní aorty a možností využít konečnoprvkovou deformačně-napěťovou analýzu těchto aneurysmat ke stanovení rizika ruptury. První část práce je věnována úvodu do problematiky, popisu kardiovaskulární soustavy člověka s důrazem na abdominální aortu, anatomii, fyziologii a patologii stěny tepny s důrazem na procesy vedoucí ke vzniku aneurysmatu. Dále se práce věnuje rizikovým faktorům přispívajících ke vzniku aneurysmat spolu s analýzou současných klinických postupů ke stanovení rizika ruptury spolu se srovnáním navrhovaného kritéria maximálního napětí. Dominantní část této disertace je věnována identifikaci faktorů ovlivňujících napjatost a deformaci stěny aneurysmatu spolu s návrhem nových postupů, prezentací vlastních poznatků vedoucích ke zpřesnění určení rizika ruptury pomocí deformačně- napěťové analýzy a metody konečných prvků. Nejprve je analyzován vliv geometrie, vedoucí k závěru, že je nezbytné používání individuálních geometrií pacienta. Dále je pozornost zaměřena na odbočující tepny, které ve stěně působí jako koncentrátor napětí a mohou tedy ovlivňovat napjatost v ní. Jako další podstatný faktor byl identifikován vliv nezatížené geometrie a bylo napsáno makro pro její nalezení, které bylo opět zahrnuto jako standardní součást do výpočtového modelu. Mechanické vlastnosti jak stěny aneurysmatu, tak intraluminálního trombu jsou experimentálně testovány pomocí dvouosých zkoušek. Také je zde analyzován vliv modelu materiálu, kde je ukázáno, že srovnávání maximálních napětí u jednotlivých modelů materiálu není vhodné díky zcela rozdílným gradientům napětí ve stěně aneurysmatu. Dále je zdůrazněna potřeba znalosti distribuce kolagenních vláken ve stěně a navržen program k jejímu získání. Intraluminální trombus je analyzován ve dvou souvislostech. Jednak je ukázán vliv jeho ruptury na napětí ve stěně a jednak je analyzován vliv jeho poroelastické struktury na totéž. Posledním identifikovaným podstatným faktorem je zbytková napjatost ve stěně. Její významnost je demonstrována na několika aneurysmatech a i tato je zahrnuta jako integrální součást do našeho výpočtového modelu.Na závěr jsou pak navrženy další možné směry výzkumu.This thesis deals with abdominal aortic aneurysms and the possibility of using finite element method in assessment of their rupture risk. First part of the thesis is dedicated to an introduction into the problem, description of human cardiovascular system where the abdominal aorta, its anatomy, physiology and pathology is emphasized. There Processes leading to formationing of abdominal aortic aneurysms are also discussed. Risk factors contributing to creation of aneurysms are discussed next. Finally, an analysis of current clinical criteria which determine rupture risk of an abdominal aortic aneurysm is presented and compared with the new maximum stress criterion being currently in development. Main part of the thesis deals with the identification of relevant factors which affect stress and deformation of aneurysmal wall. This is connected with proposals of new approaches leading to predicting the rupture risk more accurately by using finite element stress-strain analysis. The impact of geometry is analyzed first with the conclusion that patient-specific geometry is a crucial input in the computational model. Therefore its routine reconstruction has been managed. Attention is then paid to the branching arteries which were neglected so far although they cause a stress concentration in arterial wall. The necessity of knowing the unloaded geometry of aneurysm is then emphasized. Therefore a macro has been written in order to be able to find the unloaded geometry for any patient-specific geometry of aneurysm. Mechanical properties of both aneurysmal wall and intraluminal thrombus were also experimentally tested and their results were fitted by an isotropic material model. The effect of the material model itself has been also investigated by comparing whole stress fields of several aneurysms. It has been shown that different models predict completely different stresses due to different stress gradients in the aneurysmal wall. The necessity of known collagen fiber distribution in arterial wall is also emphasized. A special program is then presented enabling us to obtain this information. Effect of intraluminal thrombus on the computed wall stress is analyzed in two perspectives. First the effect of its failure on wall stress is shown and also the impact of its poroelastic structure is analyzed. Finally the residual stresses were identified as an important factor influencing the computed wall stress in aneurysmal wall and they were included into patient-specific finite element analysis of aneurysms. Further possible regions of investigation are mentioned as the last part of the thesis.

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