Imperial College London

ProfessorJanetPowell

Faculty of MedicineDepartment of Surgery & Cancer

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 8846 7312j.powell

 
 
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Location

 

4N17Charing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Parker:2019:10.1161/ATVBAHA.119.312687,
author = {Parker, LP and Powell, JT and Kelsey, LJ and Lim, B and Ashleigh, R and Venermo, M and Koncar, I and Norman, PE and Doyle, BJ},
doi = {10.1161/ATVBAHA.119.312687},
journal = {Arteriosclerosis, Thrombosis, and Vascular Biology},
pages = {1125--1136},
title = {Morphology and hemodynamics in isolated common iliac artery aneurysms impacts proximal aortic remodeling},
url = {http://dx.doi.org/10.1161/ATVBAHA.119.312687},
volume = {39},
year = {2019}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - Objective- Isolated common iliac artery aneurysms (CIAA) are rare. Their prognosis and influence on aortoiliac blood flow and remodeling are unclear. We evaluated the hypotheses that morphology at and distal to the aortic bifurcation, together with the associated hemodynamic changes, influence both the natural history of CIAA and proximal aortic remodeling. Approach and Results- Twenty-five isolated CIAAs (15 intact, 10 ruptured), in 23 patients were reconstructed and analyzed with computational fluid dynamics: all showed abnormal flow. Then we studied a series of 24 hypothetical aortoiliac geometries in silico with varying abdominal aortic deflection and aortic bifurcation angles: key findings were assessed in an independent validation cohort of 162 patients. Wall shear stress in isolated unilateral CIAAs was lower than the contralateral common iliac artery, 0.38±0.33 Pa versus 0.61±0.24 Pa, inversely associated with CIAA diameter ( P<0.001) and morphology (high shear stress in variants distal to a sharp kink). Rupture usually occurred in regions of elevated low and oscillatory shear with a wide aortic bifurcation angle. Abdominal aortas deflected towards the CIAA for most unilateral isolated CIAAs (14/21). In silico, wider bifurcation angles created high focal regions of low and oscillatory shear in the common iliac artery. The associations of unilateral CIAA with aortic deflection and common iliac artery diameter with bifurcation angle were confirmed in the validation cohort. Conclusions- Decreasing wall shear stress is strongly associated with CIAA progression (larger aneurysms and rupture), whereas abnormal blood flow in the CIAA seems to promote proximal aortic remodeling, with adaptive lateral deflection of the abdominal aorta towards the aneurysmal side.
AU - Parker,LP
AU - Powell,JT
AU - Kelsey,LJ
AU - Lim,B
AU - Ashleigh,R
AU - Venermo,M
AU - Koncar,I
AU - Norman,PE
AU - Doyle,BJ
DO - 10.1161/ATVBAHA.119.312687
EP - 1136
PY - 2019///
SN - 1079-5642
SP - 1125
TI - Morphology and hemodynamics in isolated common iliac artery aneurysms impacts proximal aortic remodeling
T2 - Arteriosclerosis, Thrombosis, and Vascular Biology
UR - http://dx.doi.org/10.1161/ATVBAHA.119.312687
UR - https://www.ncbi.nlm.nih.gov/pubmed/31018660
UR - http://hdl.handle.net/10044/1/70063
VL - 39
ER -