Effect of intraluminal thrombus on wall stress in patient-specific models of abdominal aortic aneurysm

Wang, David H. J.; Makaroun, Michel S.; Webster, Marshall W.; Vorp, David A.

doi:10.1067/mva.2002.126087

Cited by 340 publications

(358 citation statements)

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“…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. However, these authors did not associate a role of protection to the thrombus, since it was present in 80% (62) of the cases, at the site of rupture.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9] An intraluminal thrombus (ILT) is present in approximately 75% of all cases of AAA. 10 Recent studies suggest that the ILT is an active pathogenic factor for AAA. [11][12] Adolph et al, 11 have demonstrated the biological activity of the thrombus by the presence of activated cells and by the relative permeability of the aneurismatic wall to formed elements of the blood.…”

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: Introductionmentioning

confidence: 99%

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

et al. 2008

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“…The ratio of the vessel stress to vessel strength is regarded as an alternative tool to conventional diameter criteria, which may be insufficient in small aneurysms. In computational simulations, vessel stress is calculated as a function of the vessel diameter [7,34], wall thickness [36,37], asymmetry [14,18,34,36], tortuosity [21], material property [17,24,29,38], calcification [15,22], intraluminal thrombus (ILT) [5,15,16,33], and blood flow [4, 9, 13, 14, 17, 20, 25, 26, 28-30, 32, 35-41]. Blood vessel strength is measured by ex vivo studies [11,12,23,31,44] or estimated by effective features such as ILT existence, sex, and genetic vulnerability [10].…”

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confidence: 99%

Investigation of material modeling in fluid–structure interaction analysis of an idealized three-layered abdominal aorta: aneurysm initiation and fully developed aneurysms

Şimşek

Kwon

2015

J Biol Phys

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Different material models for an idealized three-layered abdominal aorta are compared using computational techniques to study aneurysm initiation and fully developed aneurysms. The computational model includes fluid-structure interaction (FSI) between the blood vessel and the blood. In order to model aneurysm initiation, the medial region was degenerated to mimic the medial loss occurring in the inception of an aneurysm. Various cases are considered in order to understand their effects on the initiation of an abdominal aortic aneurysm. The layers of the blood vessel were modeled using either linear elastic materials or Mooney-Rivlin (otherwise known as hyperelastic) type materials. The degenerated medial region was also modeled in either linear elastic or hyperelastic-type materials and assumed to be in the shape of an arc with a thin width or a circular ring with different widths. The blood viscosity effect was also considered in the initiation mechanism. In addition, dynamic analysis of the blood vessel was performed without interaction with the blood flow by applying time-dependent pressure inside the lumen in a three-layered abdominal aorta. The stresses, strains, and displacements were compared for a healthy aorta, an initiated aneurysm and a fully developed aneurysm. The study shows that the material modeling of the vessel has a sizable effect on aneurysm initiation and fully developed aneurysms. Different material modeling of degeneration regions also affects the stressstrain response of aneurysm initiation. Additionally, the structural analysis without considering FSI (called noFSI) overestimates the peak von Mises stress by 52% at the interfaces of the layers.

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“…However, very recently [7] and [3] reported extensive studies on the material properties of thrombus. The mean thrombus shear modulus that they found (1.7 ± 1.3 kPa) is much lower than the values assumed in [9,48], the role of thrombus in wall-stress analysis may therefore be overestimated. The elasticity of thrombus is several orders higher than that of the vessel wall [6], which may mean that thrombus could be neglected during the wall-stress simulations.…”

Section: Wall-stress Modelingmentioning

confidence: 56%

“…Intraluminal thrombus has been incorporated in the finite-element models in several other studies [9,21,48]. In [48] and [9] a significant influence was reported of thrombus on the outcome of the stress calculations. However, very recently [7] and [3] reported extensive studies on the material properties of thrombus.…”

Section: Wall-stress Modelingmentioning

confidence: 99%

Towards patient-specific risk assessment of abdominal aortic aneurysm

Breeuwer

Putter

Kose

et al. 2008

Med Biol Eng Comput

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Document VersionPublisher's PDF, also known as Version of Record (includes final page, issue and volume numbers)Please check the document version of this publication:• A submitted manuscript is the author's version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication Citation for published version (APA):Breeuwer, M., Putter, de, S., Kose, U., Speelman, L., Visser, K., Gerritsen, F. A., ... Vosse, van de, F. N. (2008). Towards patient-specific risk assessment of abdominal aortic aneurysm. Medical and Biological Engineering and Computing, 46(11), 1085-1095. DOI: 10.1007/s11517-008-0393-0 General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Diagnosis of vascular disease and selection and planning of therapy are to a large extent based on the geometry of the diseased vessel. Treatment of a particular vascular disease is usually considered if the geometrical parameter that characterizes the severity of the disease, e.g. % vessel narrowing, exceeds a threshold. The thresholds that are used in clinical practice are based on epidemiological knowledge, which has been obtained by clinical studies including large numbers of patients. They may apply ''on average'', but they can be sub-optimal for individual patients. To realize more patient-specific treatment decision criteria, more detailed knowledge may be required about the vascular hemodynamics, i.e. the blood flow and pressure in the diseased vessel and the biomechanical reaction of the vessel wall to this flow and pressure. Over the last decade, a substantial number of publications have appeared on hemodynamic modeling. Some studies have provided first evidence that this modeling may indeed be used to support therapeutic decisions. The goal of the research reported in this paper is to go one step further, namely to investigate the feasibilit...

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Effect of intraluminal thrombus on wall stress in patient-specific models of abdominal aortic aneurysm

Abstract: The presence of ILT alters the wall stress distribution and reduces the peak wall stress in AAA. For this reason, ILT should be included in all patient-specific models of AAA for evaluation of AAA wall stresses.

Cited by 340 publications

References 0 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

Investigation of material modeling in fluid–structure interaction analysis of an idealized three-layered abdominal aorta: aneurysm initiation and fully developed aneurysms

Towards patient-specific risk assessment of abdominal aortic aneurysm

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