The Obsolete Maximum Diameter Criterion, the Evident Role of Biomechanical (Pressure) Indices, the New Role of Hemodynamic (Flow) Indices, and the Multi-Modal Approach to the Rupture Risk Assessment of Abdominal Aortic Aneurysms

Although the therapeutic management of abdominal aortic aneurysms (AAAs) is currently based on the maximum diameter criterion, this has often proved inaccurate and misleading. Conversely, the biomechanical approach, which takes into account the pressure-induced wall stress exerted at every point throughout the aneurysmal surface, has been proven superior in predicting the rupture risk of AAAs, and its value is being increasingly recognized among physicians. More recently, hemodynamic indices, such as flow-induced wall shear stresses, have been indicated as potentially significant determinants of AAA natural history. Ultimately, a statistical model that takes into account all these factors may be relevant for making a sound prediction of the rupture risk of aneurysms and optimizing the management of these patients.