## 5 Conclusions  
From this systematic review, the following remarks can be drawn:  
* Numerical models are feasible tools to recreate the complex conditions of the biomechanical system. These models can have the potential to provide insightful data toward clinical practice.
* Among the relevant data that numerical models can provide, we have highlighted: (i) the WSS and WS-based metrics, which were strongly correlated with aortic microstructure (mys) functioning and elevated propensity to rupture; (ii) PWV due to its ability to evaluate aortic stiffness by clinical guidelines; (iii) and wall strain.
* One-dimensional modelling and ML were the next most selected techniques. One-dimensional models proved to allow quick computations of PWV on a patient-specific basis. ML presented a wide range of applications that outperformed usual methods while reducing the computation time.
* There is no consensus on the gold standard technique to model the haemodynamics and structure dynamics of the aortic wall. From the review, FEM and FVM are the two preferred techniques to perform CSM and CFD patient-specific simulations, respectively. These techniques were collectively chosen in around 80% of the analysed works, are widely implemented in commercial and open-source computing platforms and allow the use of complex geometric models such as diseased aortas.
* Accuracy, computing time and lack of validation were the main identified contributors to the lack of application of numerical models in real-life medical applications. Accuracy issues are mostly correlated with poor selection of rheological, turbulence or wall constitutive models and difficulties in correctly assessing the in vivo patient-specific parameters for these models and patient-specific geometric models or BC. Excluding ROM, computing 3D haemodynamics or structural data can easily take days or even weeks, particularly in grid-based methods, which is not suitable for time-sensitive situations. Moreover, there is a lack of both numerical validations as assessed by the GRADE approach (only 12% of the total works presented numerical validation against in vivo patient-specific data) and extensive clinical trials.
* To date, there is still a lack of reports on the bibliography of studies on the impact of considering wall thickness and material properties' heterogeneity, surrounding aortic structures, the internal pressure of the human body, the calibration of impedance-based outlet conditions and aortic root motion on the numerical results.  
Conceptualisation, A.M., J.X., M.B., S.A. and J.F.; methodology, A.M., R.V., J.X., M.B., S.A., J.C.d.S., A.T. and J.F.; software, A.M., R.V., J.X., M.B., S.A. and J.C.d.S.; validation, A.M., R.V., J.X., M.B., S.A., A.T. and J.F.; formal analysis, A.M., R.V., J.X., M.B., S.A., A.T. and J.F.; investigation, A.M., R.V., J.X., M.B., S.A., J.C.d.S., A.T. and J.F.; resources, J.X., M.B., J.C.d.S., S.A., A.T. and J.F.; data curation, A.M., R.V., J.X., M.B., S.A., J.C.d.S., A.T. and J.F.; writing--original draft preparation, A.M., R.V., J.X. and M.B.; writing--review and editing, A.M., R.V., J.X., M.B., S.A., J.C.d.S., A.T. and J.F.; supervision, J.X., M.B., and A.T.; project administration, J.X., and J.F.; funding acquisition, J.X. and J.F. All authors have read and agreed to the published version of the manuscript.  
Funding by Portuguese Foundation for Science and Technology (FCT-MCTES) under the following projects: PTDC/EMD-EMD/1230/2021--_Fluid-structure interaction for functional assessment of ascending aortic aneurysms: a biomechanical-based approach toward clinical practice_; UNIDEMI UIDB/00667/2020; [PERSON] PhD grant UI/BD/151212/2021; [PERSON] PhD grant 2022.12223.BD.  
**Institutional Review Board Statement:** Not applicable.  
**Informed Consent Statement:** Not applicable.  
**Data Availability Statement:** Not applicable.  
**Conflicts of Interest:** The authors declare no conflict of interest.