Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening

Vorp, David A.; Lee, Paul C.; Wang, David H. J.; Makaroun, Michel S.; Nemoto, Edwin M.; Ogawa, Satoshi; Webster, Marshall W.

doi:10.1067/mva.2001.114813

Cited by 433 publications

(387 citation statements)

References 45 publications

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“…15 Despite the relative oxygen perfusion of the thrombus, it may function as a barrier to oxygen transport, leading to hypoxia. 14 Other authors suggest the mural thrombus could be a protecting factor, reducing the hemodynamic stress on the AAA wall, such reduction being more marked in large and well organized thrombi, whereas it could also be found in small ones. 10 A study of 78 autopsies reported that 62% (49) of the aneurisms suffered rupture on the posterior wall.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have focused on investigating the role of mural thrombi in the rupture of aneurisms, 14 since such thrombi may be associated with the weakening of the aortic wall. The wall beneath the thrombus is thinner, has less and more fragmented elastic fibers, and contains higher concentrations of inflammatory cells and lower concentrations of cells regulating production of matrix components (SMC).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have suggested that the thrombus would function as a protecting factor for the aneurismatic wall against the hemodynamic stress; 10 others report the thrombus as a factor predisposing to rupture 13 and associate it with the weakening of the aneurismatic wall. [14][15] …”

Section: Introductionmentioning

confidence: 99%

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Morphological aspects of mural thrombi deposition residual lumen route in infrarenal abdominal aorta aneurisms

et al. 2008

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Purpose: To assess the most frequent deposition site of mural thrombi in infrarenal abdominal aorta aneurisms, as well as the route of the residual lumen. Methods: Assessment of CT scan images from 100 patients presenting asymptomatic abdominal aorta aneurism, and followed at HC-FMRP-USP. Results: In 53% of the cases the mural thrombus was deposited on the anterior wall; from these, in 22%, the residual lumen described a predominantly right sided route; in 22%, a left sided route; on the mid line in 5%; and crossing over the mid line in 1%. In 23%, the deposition of thrombi was concentric. In 11% it occured on the posterior wall; from these, in 5%, the route of the residual anterior lumen was predominantly right sided; in 5%, left sided; and crossed over the mid line in 1%. In 13% complex morfological deposition patterns were found. Conclusion: Mural thrombi formation was predominantly found on the anterior wall of the aneurismatic mass, with the route of the residual lumen projecting towards the posterior wall. Key-words:Abdominal Aorta Aneurisms. Thrombi and CT Scan. RESUMOObjetivos: Avaliar o local mais freqüente de deposição do trombo mural em aneurismas de aorta abdominal infrarenal, bem como o trajeto da luz residual. Métodos: Avaliação de tomografias de 100 pacientes do HC-FMRP-USP apresentando aneurisma de aorta abdominal assintomático. Resultados: O trombo mural se deposita na parede anterior em 53% dos casos, sendo que a luz residual posterior descreveu um trajeto predominantemente à direita em 22% dos casos, à esquerda em 22%, na linha mediana em 5% e cruzando da direita para a esquerda em 4%. 23% dos casos apresentaram deposição concêntrica do trombo e 11% apresentaram deposição na parede posterior, sendo o trajeto da luz residual anterior predominante a direita em 5% dos casos, a esquerda em 5% e cruzando a linha mediana em 1%. Padrões morfológicos complexos de deposição do trombo foram encontrados em 13% dos casos. Conclusão: A formação do trombo mural predominou na parede anterior da massa aneurismática, com o trajeto da luz residual se projetando para a parede posterior.Descritores: Aneurisma de Aorta Abdominal. Trombo e Tomografia Computadorizada por Raios X. Guimarães TAS et al 152

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Morphological aspects of mural thrombi deposition residual lumen route in infrarenal abdominal aorta aneurisms

et al. 2008

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“…A local dilatation of the abdominal aorta may be expected to promote instability of the blood flow, and it is not unlikely that flashes of turbulence may occur during part of the cardiac cycle even during rest conditions (Yip & Yu 2001). This is believed to be beneficial, on the grounds that the presence of turbulence reduces the size of regions of flow stasis and the existence of a correlation between the presence of such regions and thrombus formation (Reininger et al 1994;Vorp et al 2001;Salsac et al 2004). Although we have no support for this, we believe that the repeated occurrence of a vessel wall loading with random small-scale fluctuations in time and space, due to the fact that during part of the cardiac cycle the flow becomes turbulent, may have a detrimental effect on the structure of the vessel wall, and thereby enhance the growth and rupture of aneurysms.…”

mentioning

confidence: 99%

Dynamics of pulsatile flow through model abdominal aortic aneurysms

2014

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To contribute to the understanding of flow phenomena in abdominal aortic aneurysms, numerical computations of pulsatile flows through aneurysm models and a stability analysis of these flows were carried out. The volume flow rate waveforms into the aneurysms were based on measurements of these waveforms, under rest and exercise conditions, of patients suffering abdominal aortic aneurysms. The Reynolds number and Womersley number, the dimensionless quantities that characterize the flow, were varied within the physiologically relevant range, and the two geometric quantities that characterize the model aneurysm were varied to assess the influence of the length and maximal diameter of an aneurysm on the details of the flow. The computed flow phenomena and the induced wall shear stress distributions agree well with what was found in PIV measurements by Salsac et al. (J. Fluid Mech., vol. 560, 2006, pp. 19-51). The results suggest that long aneurysms are less pathological than short ones, and that patients with an abdominal aortic aneurysm are better to avoid physical exercise. The pulsatile flows were found to be unstable to three-dimensional disturbances if the aneurysm was sufficiently localized or had a sufficiently large maximal diameter, even for flow conditions during rest. The abdominal aortic aneurysm can be viewed as acting like a 'wavemaker' that induces disturbed flow conditions in healthy segments of the arterial system far downstream of the aneurysm; this may be related to the fact that one-fifth of the larger abdominal aortic aneurysms are found to extend into the common iliac arteries. Finally, we report a remarkable sensitivity of the wall shear stress distribution and the growth rate of three-dimensional disturbances to small details of the aneurysm geometry near the proximal end. These findings suggest that a sensitivity analysis is appropriate when a patient-specific computational study is carried out to obtain a quantitative description of the wall shear stress distribution.

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“…Others underline the degeneration process that occurs in wall due to hypoxia, and ultimately weakens of the tissue [23,24].This biochemical approach is based on in vivo experiments and tries to capture the micro-changes in wall formation, which could locally affect its strength. Aforementioned transformation includes: the inflammation and neovascularization [25], proteolytic activity [26] -especially increase in elastase production [27], decrease in collagen synthesis [28][29][30] and production of abnormal collagen [29].…”

Section: Presence Of Intraluminal Thrombus and Calcifications In Aaamentioning

confidence: 99%

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

et al. 2017

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Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening

Cited by 433 publications

References 45 publications

Morphological aspects of mural thrombi deposition residual lumen route in infrarenal abdominal aorta aneurisms

Morphological aspects of mural thrombi deposition residual lumen route in infrarenal abdominal aorta aneurisms

Dynamics of pulsatile flow through model abdominal aortic aneurysms

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

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