{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:52:22Z","timestamp":1790311942339,"version":"4.1.0"},"reference-count":62,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Abdominal aortic aneurysm (AAA) is a complex vascular disease characterized by progressive and irreversible local dilatation of the aortic wall. Currently, the indication for repair is linked to the transverse diameter of the abdominal aorta, using computed tomography angiography imagery, which is one of the most used markers for aneurysmal growth. This study aims to verify the predictive role of imaging markers and underlying risk factors in AAA rupture. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included 220 patients over 18 years of age with a diagnosis of AAA, confirmed by computed tomography angiography (CTA), admitted to Vascular Surgery Clinic of Mures County Emergency Hospital in Targu Mures, Romania, between January 2018 and September 2022. Results: Patients with a ruptured AAA had higher incidences of AH (p = 0.006), IHD (p = 0.001), AF (p &lt; 0.0001), and MI (p &lt; 0.0001), and higher incidences of all risk factors (tobacco (p = 0.001), obesity (p = 0.02), and dyslipidemia (p &lt; 0.0001)). Multivariate analysis showed that a high baseline value of all imaging ratios markers was a strong independent predictor of AAA rupture (for all p &lt; 0.0001). Moreover, a higher baseline value of DAmax (OR:3.91; p = 0.001), SAmax (OR:7.21; p &lt; 0.001), and SLumenmax (OR:34.61; p &lt; 0.001), as well as lower baseline values of DArenal (OR:7.09; p &lt; 0.001), DACT (OR:12.71; p &lt; 0.001), DAfemoral (OR:2.56; p = 0.005), SArenal (OR:4.56; p &lt; 0.001), SACT (OR:3.81; p &lt; 0.001), and SThrombusmax (OR:5.27; p &lt; 0.001) were independent predictors of AAA rupture. In addition, AH (OR:3.33; p = 0.02), MI (OR:3.06; p = 0.002), and PAD (OR:2.71; p = 0.004) were all independent predictors of AAA rupture. In contrast, higher baseline values of SAmax\/Lumenmax (OR:0.13; p &lt; 0.001) and ezetimibe (OR:0.45; p = 0.03) were protective factors against AAA rupture. Conclusions: According to our findings, a higher baseline value of all imaging markers ratios at CTA strongly predicts AAA rupture and AH, MI, and PAD highly predicted the risk of rupture in AAA patients. Furthermore, the diameter of the abdominal aorta at different levels has better accuracy and a higher predictive role of rupture than the maximal diameter of AAA.<\/jats:p>","DOI":"10.3390\/ijerph192315961","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T03:49:13Z","timestamp":1669780153000},"page":"15961","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Computed Tomography Angiography Markers and Intraluminal Thrombus Morphology as Predictors of Abdominal Aortic Aneurysm Rupture"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1664-8130","authenticated-orcid":false,"given":"Emil Marian","family":"Arb\u0103na\u0219i","sequence":"first","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian Vasile","family":"Mure\u0219an","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania"},{"name":"Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103t\u0103lin Mircea","family":"Co\u0219arc\u0103","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1281-3749","authenticated-orcid":false,"given":"Eliza Mihaela","family":"Arb\u0103na\u0219i","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Niculescu","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Septimiu Toader","family":"Void\u0103zan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0638-1310","authenticated-orcid":false,"given":"Adrian Dumitru","family":"Iv\u0103nescu","sequence":"additional","affiliation":[{"name":"Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioana","family":"H\u0103lmaciu","sequence":"additional","affiliation":[{"name":"Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rare\u0219 Cristian","family":"Filep","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucian","family":"M\u0103rginean","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mures County Emergency Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuko","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Queensland Eye Institute, South Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6278-3168","authenticated-orcid":false,"given":"Traian V.","family":"Chiril\u0103","sequence":"additional","affiliation":[{"name":"Queensland Eye Institute, South Brisbane, QLD 4101, Australia"},{"name":"School of Chemistry & Physics, Queensland University of Technology, Brisbane, QLD 4001, Australia"},{"name":"Australian Institute of Bioengineering & Nanotechnology (AIBN), University of Queensland, St. Lucia, QLD 4072, Australia"},{"name":"Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia"},{"name":"School of Molecular Sciences, University of Western Australia, Crawley, WA 6009, Australia"},{"name":"Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9ka","family":"Kaller","sequence":"additional","affiliation":[{"name":"Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania"},{"name":"Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza","family":"Russu","sequence":"additional","affiliation":[{"name":"Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania"},{"name":"Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S191","DOI":"10.21037\/cdt.2017.10.01","article-title":"Current Status of the Treatment of Infrarenal Abdominal Aortic Aneurysms","volume":"8","author":"Wang","year":"2018","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.avsg.2012.02.005","article-title":"Opportunities in Abdominal Aortic Aneurysm Research: Epidemiology, Genetics, and Pathophysiology","volume":"26","author":"Kuivaniemi","year":"2012","journal-title":"Ann. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"84","DOI":"10.2478\/jce-2021-0012","article-title":"Late Rupture of a Thrombosed Aortic Abdominal Aneurysm\u2014A Case Report","volume":"7","author":"Russu","year":"2021","journal-title":"J. Cardiovasc. Emergencies"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"864846","DOI":"10.3389\/fsurg.2022.864846","article-title":"Innovative Technical Solution Using the Renal Artery Stump after Nephrectomy as an Inflow Artery for Lower Limb Revascularization\u2014A Case Report","volume":"9","author":"Russu","year":"2022","journal-title":"Front. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.2478\/jce-2021-0015","article-title":"Fatal Aortoduodenal Fistula Caused by a Ruptured Abdominal Aortic Aneurysm\u2014A Case Report","volume":"7","author":"Kaller","year":"2021","journal-title":"J. Cardiovasc. Emergencies"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/S0741-5214(97)70057-0","article-title":"Relationship of Age, Gender, Race, and Body Size to Infrarenal Aortic Diameter. The Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Investigators","volume":"26","author":"Lederle","year":"1997","journal-title":"J. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1067\/mva.2001.115275","article-title":"Abdominal Aortic Aneurysm in Women","volume":"34","author":"Lederle","year":"2001","journal-title":"J. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.jvs.2017.10.044","article-title":"The Society for Vascular Surgery Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm","volume":"67","author":"Chaikof","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1002\/bjs.8897","article-title":"Final Follow-up of the Multicentre Aneurysm Screening Study (MASS) Randomized Trial of Abdominal Aortic Aneurysm Screening","volume":"99","author":"Thompson","year":"2012","journal-title":"Br. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1067\/mva.2003.119","article-title":"The Risk of Rupture in Untreated Aneurysms: The Impact of Size, Gender, and Expansion Rate","volume":"37","author":"Brown","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1067\/mva.2001.111731","article-title":"Risk Factors for Rupture of Abdominal Aortic Aneurysm Based on Three-Dimensional Study","volume":"33","author":"Hatakeyama","year":"2001","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.1001\/jama.287.22.2968","article-title":"Rupture Rate of Large Abdominal Aortic Aneurysms in Patients Refusing or Unfit for Elective Repair","volume":"287","author":"Lederle","year":"2002","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e463","DOI":"10.1161\/CIRCULATIONAHA.106.174526","article-title":"ACC\/AHA 2005 Practice Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic)","volume":"113","author":"Hirsch","year":"2006","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1350","DOI":"10.1002\/bjs.9578","article-title":"Meta-Analysis of Peak Wall Stress in Ruptured, Symptomatic and Intact Abdominal Aortic Aneurysms","volume":"101","author":"Khosla","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.ejvs.2016.07.003","article-title":"Biomechanical Imaging Markers as Predictors of Abdominal Aortic Aneurysm Growth or Rupture: A Systematic Review","volume":"52","author":"Indrakusuma","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg. Off. J. Eur. Soc. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chung, T.K., Gueldner, P.H., Kickliter, T.M., Liang, N.L., and Vorp, D.A. (2022). An Objective and Repeatable Sac Isolation Technique for Comparing Biomechanical Metrics in Abdominal Aortic Aneurysms. Bioengineering, 9.","DOI":"10.3390\/bioengineering9110601"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Murali Krishna, S., Morton, S.K., Li, J., and Golledge, J. (2020). Risk Factors and Mouse Models of Abdominal Aortic Aneurysm Rupture. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21197250"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e019772","DOI":"10.1161\/JAHA.120.019772","article-title":"Systematic Review and Meta-Analysis of Peak Wall Stress and Peak Wall Rupture Index in Ruptured and Asymptomatic Intact Abdominal Aortic Aneurysms","volume":"10","author":"Singh","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1016\/j.avsg.2017.08.007","article-title":"Correlation of Intraluminal Thrombus Deposition, Biomechanics, and Hemodynamics with Surface Growth and Rupture in Abdominal Aortic Aneurysm\u2014Application in a Clinical Paradigm","volume":"46","author":"Metaxa","year":"2018","journal-title":"Ann. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1016\/j.avsg.2022.03.007","article-title":"Intraluminal Thrombus and Abdominal Aortic Aneurysm Complications","volume":"83","author":"Manenti","year":"2022","journal-title":"Ann. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.jvs.2019.03.051","article-title":"Biomechanical Indices Are More Sensitive than Diameter in Predicting Rupture of Asymptomatic Abdominal Aortic Aneurysms","volume":"71","author":"Polzer","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jusko, M., Kasprzak, P., Majos, A., and Kuczmik, W. (2022). The Ratio of the Size of the Abdominal Aortic Aneurysm to That of the Unchanged Aorta as a Risk Factor for Its Rupture. Biomedicines, 10.","DOI":"10.3390\/biomedicines10081997"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1016\/j.jacc.2008.09.004","article-title":"Standards for Measures Used for Public Reporting of Efficiency in Health Care: A Scientific Statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research and the American College of Cardiology Foundation","volume":"52","author":"Krumholz","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.avsg.2016.02.034","article-title":"Extending Abdominal Aortic Aneurysm Detection to Older Age Groups: Preliminary Results from the Li\u00e8ge Screening Programme","volume":"36","author":"Makrygiannis","year":"2016","journal-title":"Ann. Vasc. Surg."},{"key":"ref_25","unstructured":"(2022, November 04). Global Burden of Disease (GBD 2019). Available online: https:\/\/www.healthdata.org\/gbd\/2019."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1053\/ejvs.1999.0980","article-title":"Treatment of Ruptured Abdominal Aortic Aneurysm, a Permanent Challenge or a Waste of Resources? Prediction of Outcome Using a Multi-Organ-Dysfunction Score","volume":"19","author":"Kniemeyer","year":"2000","journal-title":"Eur. J. Vasc. Endovasc. Surg. Off. J. Eur. Soc. Vasc. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.ejvs.2018.01.008","article-title":"Project Investigators Prevalence of Abdominal Aortic Aneurysms in the General Population and in Subgroups at High Cardiovascular Risk in Italy. Results of the RoCAV Population Based Study","volume":"55","author":"Gianfagna","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg. Off. J. Eur. Soc. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ejvs.2014.04.010","article-title":"Change in Smoking Habits after Having Been Screened for Abdominal Aortic Aneurysm","volume":"48","author":"Bohlin","year":"2014","journal-title":"Eur. J. Vasc. Endovasc. Surg. Off. J. Eur. Soc. Vasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Li, K., Zhang, K., Li, T., and Zhai, S. (2018). Primary Results of Abdominal Aortic Aneurysm Screening in the At-Risk Residents in Middle China. BMC Cardiovasc. Disord., 18.","DOI":"10.1186\/s12872-018-0793-5"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1161\/CIRCULATIONAHA.111.030379","article-title":"Low Prevalence of Abdominal Aortic Aneurysm among 65-Year-Old Swedish Men Indicates a Change in the Epidemiology of the Disease","volume":"124","author":"Hellberg","year":"2011","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1002\/bjs.1800801117","article-title":"Ultrasonographic Screening for Abdominal Aortic Aneurysm in an Urban Community","volume":"80","author":"Smith","year":"1993","journal-title":"Br. J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1007\/BF00311434","article-title":"Screening for Abdominal Aortic Aneurysm and Occlusive Peripheral Vascular Disease in Japanese Residents","volume":"25","author":"Takei","year":"1995","journal-title":"Surg. Today"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/0967-2109(96)83791-4","article-title":"Screening for Abdominal Aortic Aneurysm in the Jeddah Area, Western Saudi Arabia","volume":"4","author":"Rawas","year":"1996","journal-title":"Cardiovasc. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Altobelli, E., Rapacchietta, L., Profeta, V.F., and Fagnano, R. (2018). Risk Factors for Abdominal Aortic Aneurysm in Population-Based Studies: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public. Health, 15.","DOI":"10.20944\/preprints201810.0636.v1"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1067\/mva.2002.126087","article-title":"Effect of Intraluminal Thrombus on Wall Stress in Patient-Specific Models of Abdominal Aortic Aneurysm","volume":"36","author":"Wang","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/S0950-821X(05)80714-5","article-title":"Biomechanical Factors in Abdominal Aortic Aneurysm Rupture","volume":"7","author":"Inzoli","year":"1993","journal-title":"Eur. J. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/S0741-5214(97)70058-2","article-title":"Effect of Intraluminal Thrombus on Abdominal Aortic Aneurysm Wall Stress","volume":"26","author":"Mower","year":"1997","journal-title":"J. Vasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/S1078-5884(98)80031-2","article-title":"Biomechanics of Abdominal Aortic Aneurysm in the Presence of Endoluminal Thrombus: Experimental Characterisation and Structural Static Computational Analysis","volume":"15","author":"Mantero","year":"1998","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1067\/mva.2001.114813","article-title":"Association of Intraluminal Thrombus in Abdominal Aortic Aneurysm with Local Hypoxia and Wall Weakening","volume":"34","author":"Vorp","year":"2001","journal-title":"J. Vasc. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/S0039-6109(16)44876-0","article-title":"Pathophysiology and Pathogenesis of Aortic Aneurysms: Current Concepts","volume":"69","author":"Dobrin","year":"1989","journal-title":"Surg. Clin. N. Am."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1067\/mva.2000.103693","article-title":"Thrombus within an Aortic Aneurysm Does Not Reduce Pressure on the Aneurysmal Wall","volume":"31","author":"Schurink","year":"2000","journal-title":"J. Vasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1148\/radiol.2020191723","article-title":"Intraluminal Thrombus Predicts Rapid Growth of Abdominal Aortic Aneurysms","volume":"294","author":"Zhu","year":"2020","journal-title":"Radiology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.avsg.2018.07.048","article-title":"Intraluminal Thrombus Deposition Is Reduced in Ruptured Compared to Diameter-Matched Intact Abdominal Aortic Aneurysms","volume":"55","author":"Kontopodis","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.avsg.2020.02.011","article-title":"Amount of Intraluminal Thrombus Correlates with Severe Adverse Events in Abdominal Aortic Aneurysms after Endovascular Aneurysm Repair","volume":"67","author":"Ding","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jvssci.2021.02.001","article-title":"Intraluminal Thrombus: Innocent Bystander or Factor in Abdominal Aortic Aneurysm Pathogenesis?","volume":"2","author":"Boyd","year":"2021","journal-title":"JVS Vasc. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1002\/bjs.5778","article-title":"Final 12-Year Follow-up of Surgery versus Surveillance in the UK Small Aneurysm Trial","volume":"94","author":"Powell","year":"2007","journal-title":"Br. J. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1056\/NEJMoa012573","article-title":"Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysms","volume":"346","author":"Lederle","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1016\/j.jvs.2014.10.023","article-title":"South East Wales Vascular Network Rupture Rates of Untreated Large Abdominal Aortic Aneurysms in Patients Unfit for Elective Repair","volume":"61","author":"Parkinson","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"431","DOI":"10.12659\/MSM.893639","article-title":"Influence of Selective Biochemical and Morphological Agents on Natural History of Aneurysm of Abdominal Aorta Development","volume":"22","author":"Kwasiborski","year":"2016","journal-title":"Med. Sci. Monit."},{"key":"ref_50","first-page":"221","article-title":"Magnetic Resonance Imaging of the Intraluminal Thrombus in Abdominal Aortic Aneurysms: A Quantitative and Qualitative Evaluation and Correlation with Growth Rate","volume":"60","author":"Gammelgaard","year":"2019","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.jacc.2017.11.053","article-title":"18F\u2013Sodium Fluoride Uptake in Abdominal Aortic Aneurysms: The SoFIA3 Study","volume":"71","author":"Forsythe","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_52","unstructured":"(2017). MA3RS Study Investigators Aortic Wall Inflammation Predicts Abdominal Aortic Aneurysm Expansion, Rupture, and Need for Surgical Repair. Circulation, 136, 787\u2013797."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1080\/14017431.2019.1707864","article-title":"Is the Aortic Size Index Relevant as a Predictor of Abdominal Aortic Aneurysm? A Population-Based Prospective Study: The Troms\u00f8 Study","volume":"54","author":"Skoog","year":"2020","journal-title":"Scand. Cardiovasc. J. SCJ"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.avsg.2018.12.071","article-title":"Spatial Distribution of Abdominal Aortic Aneurysm Surface Expansion and Correlation with Maximum Diameter and Volume Growth","volume":"58","author":"Tzirakis","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/RCT.0000000000000958","article-title":"Machine Learning to Predict the Rapid Growth of Small Abdominal Aortic Aneurysm","volume":"44","author":"Hirata","year":"2020","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ejvs.2018.09.020","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms","volume":"57","author":"Wanhainen","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_57","first-page":"27","article-title":"Ruptured Abdominal Aortic Aneurysm in the Huntingdon District: A 10-Year Experience","volume":"81","author":"Choksy","year":"1999","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s100169910027","article-title":"Aortic Wall Tension as a Predictive Factor for Abdominal Aortic Aneurysm Rupture: Improving the Selection of Patients for Abdominal Aortic Aneurysm Repair","volume":"14","author":"Hall","year":"2000","journal-title":"Ann. Vasc. Surg."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1177\/1526602818808292","article-title":"Aortic Lumen Area Is Increased in Ruptured Abdominal Aortic Aneurysms and Correlates to Biomechanical Rupture Risk","volume":"25","author":"Siika","year":"2018","journal-title":"J. Endovasc. Ther."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1067\/mva.2003.213","article-title":"Prediction of Rupture Risk in Abdominal Aortic Aneurysm during Observation: Wall Stress versus Diameter","volume":"37","author":"Fillinger","year":"2003","journal-title":"J. Vasc. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.jvs.2005.10.072","article-title":"Biomechanical Properties of Ruptured versus Electively Repaired Abdominal Aortic Aneurysm Wall Tissue","volume":"43","author":"Bohra","year":"2006","journal-title":"J. Vasc. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jvs.2018.04.035","article-title":"Geometric Analysis of Ruptured and Nonruptured Abdominal Aortic Aneurysms","volume":"69","author":"Kimura","year":"2019","journal-title":"J. Vasc. 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