Exploring the trinity of risks in abdominal aortic aneurysms

This thesis explores the three main risks that are relevant in the management of patients with an abdominal aortic aneurysm (AAA). These risks are the risk of rupture, procedural risks and competing risks and will need to be weighed against each other to tailor the treatment decision to the individual patient. However, making this decision can sometimes be a challenge because it is often difficult to accurately estimate either of these risks. Therefore, any improvement in estimating these risks may help both the vascular surgeon and the patient in making this decision. The first part of this thesis is focused on evaluating biomechanical imaging markers that could potentially be used to estimate rupture risk. The existing literature was critically reviewed in order to determine potentially useful biomechanical imaging markers and a magnetic resonance imaging (MRI) study was undertaken to assess the reproducibility of 4D flow MRI. Part two of this thesis primarily consists out of retrospective cohort studies that evaluated whether certain determinants for procedural and competing risks could be relevant for clinical practice. The final part considers AAA research and the challenges regarding the three risks. It presents the design and protocol of the biobank ‘Pearl AAA’ which was initiated in order to address some of these challenges. Specifically, it is aimed to recruit patients with a small asymptomatic AAA of whom clinical data, imaging data and biomaterials are collected for future study.