Systematic Review and Meta‐Analysis of Peak Wall Stress and Peak Wall Rupture Index in Ruptured and Asymptomatic Intact Abdominal Aortic Aneurysms

Figures

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  Figure 1. Examples of 3‐dimensional segmentation produced using finite element analysis from computed tomography images of patients with AAA. The red areas indicate areas of high aortic wall stress. AAA indicates abdominal aortic aneurysm.

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  Figure 2. PRISMA diagram describing the literature search. AAA indicates abdominal aortic aneurysm; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses; PWRI, peak wall rupture index; and PWS, peak wall stress.

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  Figure 3. Strengths and weaknesses of studies included in this systematic review. The yellow and red colored cells represent criteria, which were and not met in each study respectively. For the sample size criterion, red colored cells represent studies that had a sample size <100 and yellow‐colored cells represent studies that had sample sizes >100. The green colored cells represent criteria that were partially met in each study. A blue colored cell was used if it was unclear whether a criterion was met by a study. AAA indicates abdominal aortic aneurysm; CT, computed tomography; PWRI, peak wall rupture index; and PWS, peak wall stress. *AAA rupture cases were identified using an International Classification; **cases and controls matched for age and sex; †reproducibility reported in an external publication; ††cases and controls matched for blood pressure; ‡cases and controls were not matched by study design although AAA diameter was similar between groups; ‡‡in this study blood pressure was omitted from biomechanical calculations; #PWS not assessed in this study.

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  Figure 4. Differences in peak wall stress in ruptured and asymptomatic intact AAAs. The SMD is the mean difference between both groups, standardized to 1 SD difference in PWS (kilopascal) within that study. The summary SMD is estimated from inverse variance‐weighted meta‐analysis. Box areas are inversely proportional to the variance of the SMD and horizontal lines illustrate 95%CIs. AAA indicates abdominal aortic aneurysm; PWS, peak wall stress; and SMD, standardized mean difference.

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  Figure 5. Differences in peak wall rupture index in ruptured and asymptomatic intact AAAs. The SMD is the mean difference between both groups, standardized to 1 SD difference in PWRI within that study. The summary SMD is estimated from inverse variance‐weighted meta‐analysis. Box areas are inversely proportional to the variance of the SMD and horizontal lines illustrate 95% CIs. AAA indicates abdominal aortic aneurysm; CT, computed tomography; PWRI, peak wall rupture index; and SMD, standardized mean difference.