{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:02:55Z","timestamp":1790787775011,"version":"4.1.0"},"reference-count":19,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T00:00:00Z","timestamp":1644537600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The current stratification model of aneurysm rupture seems to be insufficient in some clinical cases. In our study, we determined the differences in wall structure between ruptured and unruptured aneurysms. We obtained computed tomography angiograms and categorized them into the following three groups, consisting of 49 patients each: the group with ruptured abdominal aortic aneurysms (rAAA), symptomatic (sAAA), and asymptomatic (aAAA). The three-dimensional AAA anatomy was digitally reconstructed for each patient through semi-automatically obtained segmentation, and each aneurysm was distinguished by the following three parameters: AFL (aneurysm flow lumen), ILT (intraluminal thrombus), and calcifications. The AFL volume was greater in rAAA compared with aAAA (p = 0.004), the ILT volume was greater in aAAA than in rAAA (p = 0.013), and the AFL\/ILT surface ratio was bigger in rAAA than in aAAA (p &lt; 0.001), sAAA than in aAAA (p = 0.033), and rAAA than in sAAA (p = 0.016). AFL\/ILT surface*100 was defined as an independent predictive factor of rAAA to aAAA (OR 1.187; 95% CI 1.099\u20131.281), to sAAA (OR 1.045; 95% CI 1.004\u20131.087), and in sAAA vs. aAAA (OR 1.067; 95% CI 1.017\u20131.119). Consequently, the wall of rAAA differs significantly from unruptured aneurysms. The AFL\/ILT surface ratio might indicate an increased risk of aneurysm rupture and the occurrence of symptoms in AAA.<\/jats:p>","DOI":"10.3390\/jcm11040933","type":"journal-article","created":{"date-parts":[[2022,2,13]],"date-time":"2022-02-13T21:08:43Z","timestamp":1644786523000},"page":"933","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Abdominal Aortic Aneurysm Morphology as an Essential Criterion for Stratifying the Risk of Aneurysm Rupture"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6031-2757","authenticated-orcid":false,"given":"Natalia","family":"Niklas","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Gutowski","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6670-927X","authenticated-orcid":false,"given":"Arkadiusz","family":"Kazimierczak","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3365-1822","authenticated-orcid":false,"given":"Pawe\u0142","family":"Rynio","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Al. Powsta\u0144c\u00f3w Wielkopolskich 72, 70-111 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,11]]},"reference":[{"key":"ref_1","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_2","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1001\/jama.2013.950","article-title":"Surveillance intervals for small abdominal aortic aneurysms: A meta-analysis","volume":"309","author":"Bown","year":"2013","journal-title":"JAMA-J. Am. Med. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.avsg.2016.06.023","article-title":"Mortality Risk for Ruptured Abdominal Aortic Aneurysm in Women","volume":"39","author":"Simonte","year":"2017","journal-title":"Ann. Vasc. Surg."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1053\/ejvs.2002.1850","article-title":"A myth exposed: Fast growth in diameter does not justify precocious abdominal aortic aneurysms repair","volume":"25","author":"Sharp","year":"2003","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1016\/S0741-5214(98)70065-5","article-title":"Rupture in small abdominal aortic aneurysms","volume":"28","author":"Nicholls","year":"1998","journal-title":"J. Vasc. Surg."},{"key":"ref_7","first-page":"67","article-title":"Effect of thrombus on abdominal aortic aneurysm wall dilation and stress","volume":"44","author":"Thubrikar","year":"2003","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_8","first-page":"325","article-title":"The influence of intraluminal thrombus on abdominal aortic aneurysm wall stress","volume":"28","author":"Georgakarakos","year":"2009","journal-title":"Int. Angiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jvs.2012.07.003","article-title":"Intraluminal abdominal aortic aneurysm thrombus is associated with disruption of wall integrity","volume":"57","author":"Koole","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jmbbm.2015.11.012","article-title":"Aneurysm strength can decrease under calcification","volume":"57","author":"Volokh","year":"2016","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_11","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_12","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.ejvs.2010.09.011","article-title":"Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery","volume":"41","author":"Moll","year":"2011","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jvs.2013.08.036","article-title":"Thrombus volume is similar in patients with ruptured and intact abdominal aortic aneurysms","volume":"59","author":"Golledge","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1007\/s00330-008-0956-3","article-title":"Measurement and determinants of infrarenal aortic thrombus volume","volume":"18","author":"Golledge","year":"2008","journal-title":"Eur. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.jvs.2004.02.025","article-title":"Anatomic characteristics of ruptured abdominal aortic aneurysm on conventional CT scans: Implications for rupture risk","volume":"39","author":"Fillinger","year":"2004","journal-title":"J. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.jvs.2005.01.004","article-title":"Size and location of thrombus in intact and ruptured abdominal aortic aneurysms","volume":"41","author":"Hans","year":"2005","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.1016\/j.jvs.2019.03.057","article-title":"Systematic review and meta-analysis of the association between intraluminal thrombus volume and abdominal aortic aneurysm rupture","volume":"70","author":"Singh","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.ejvs.2013.09.006","article-title":"Calcification as a risk factor for rupture of abdominal aortic aneurysm","volume":"46","author":"Buijs","year":"2013","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.jocd.2006.05.007","article-title":"Detection of Abdominal Aortic Calcification With Lateral Spine Imaging Using DXA","volume":"9","author":"Schousboe","year":"2006","journal-title":"J. Clin. Densitom."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/933\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:17:56Z","timestamp":1760134676000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/4\/933"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,11]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11040933"],"URL":"https:\/\/doi.org\/10.3390\/jcm11040933","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,11]]}}}