Growth of Thrombus may be a Better Predictor of Rupture than Diameter in Patients with Abdominal Aortic Aneurysms

Stenbaek, J; Kalin, Bo; Swedenborg, Jesper

doi:10.1053/ejvs.2000.1217

Cited by 189 publications

(158 citation statements)

References 16 publications

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“…It was discovered, that inflammation and new vessels proliferation within the wall of abdominal aortic aneurysms and within the thrombus might be confirmed by medical imaging technique [23][24][25][26]. Our present results show straight correlation between B cells inflammatory infiltration and contrast enhancement in CT.…”

Section: Discussionsupporting

confidence: 74%

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Assessment of inflammatory infiltration and angiogenesis in the thrombus and the wall of abdominal aortic aneurysms on the basis of histological parameters and computed tomography angiography study

Łukasiewicz¹,

Reszeć²,

Kowalewski³

et al. 2012

Folia Histochem Cytobiol.

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Abstract:The proliferation of vessels within the aneurysm's wall and the intraluminal thrombus of abdominal aortic aneurysm (AAA) may be the main factor responsible for progression and rupture of AAA. The aim of this study was to compare the parameters of the thrombus (size, density, contrast enhancement) measured by computed tomography (CT) with histological assessment of thrombi removed during surgery. 29 patients with AAA were examined with angio-CT. Post-surgery histopathological evaluation of AAA was performed. Slides were stained with markers of B-(CD20) and T-lymphocytes (CD3), and markers of endothelial cells (CD34). Thrombi were enhanced after contrast media administration in angio-CT (p = 0.002). There was a statistically significant correlation between contrast enhancement and the presence of B lymphocytes. Intensity of endothelial cell marker expression significantly correlated with the presence of inflammatory T-and B-cells. No statistical significant correlation was found between contrast enhancement of the thrombus and markers of endothelial cells. The accumulation of inflammatory cells in the wall of AAA thrombus results in the formation of new vessels which participates to the instability of the thrombus and AAA wall. Assessment of the inflammation and neovascularization in the wall and thrombus of the AAA might be an important factor in monitoring the progression and the risk of aneurysm's rupture.

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Section: Discussionsupporting

confidence: 74%

“…The growing thrombus impairs the wall nourishing, causing decreased oxygenetion and ill-distribution of nutrients from blood to the vessel's wall. The local hypoxia activates neutrophils and lymphocytes chemotaxis and stimulates angiogenesis by activating growth factors, like Vascular Endothelial Growth Factor (VEGF) [23,24].…”

Section: Discussionmentioning

confidence: 99%

Assessment of inflammatory infiltration and angiogenesis in the thrombus and the wall of abdominal aortic aneurysms on the basis of histological parameters and computed tomography angiography study

Łukasiewicz¹,

Reszeć²,

Kowalewski³

et al. 2012

Folia Histochem Cytobiol.

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show abstract

“…Though most physicians do not use this 5.5-cm cutoff as an "end all" for determining when a patient should have surgery, this method can be improved as it has resulted in a rupture rate of 1% per year for patients under observation. [11][12][13] Other parameters that have also been proposed as potential predictors of AAA rupture include the AAA wall stiffness, 29 increase in intraluminal thrombus thickness, 99 wall tension, 15 and peak AAA wall stress. 20 -22 All of these approaches have their own limitations and may lead to errors in decisions pertaining to clinical management of AAA.…”

Section: Biomechanics-based Aaa Rupture Predictionmentioning

confidence: 99%

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Vorp

Geest

2005

ATVB

228

172

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Abstract-Rupture of abdominal aortic aneurysm (AAA) represents a significant clinical event, having a mortality rate of 90% and being currently ranked as the 13th leading cause of death in the US. The ability to reliably evaluate the susceptibility of a particular AAA to rupture on a case-specific basis could vastly improve the clinical management of these patients. Because AAA rupture represents a mechanical failure of the degenerated aortic wall, biomechanical considerations are important to understand this process and to improve our predictions of its occurrence. Presented here is an overview of research to date related to the biomechanics of AAA rupture. This includes a summary of results related to ex vivo and in vivo mechanical testing, noninvasive AAA wall stress estimations, and potential mechanisms of AAA wall weakening. We conclude with a demonstration of a biomechanics-based approach to predicting AAA rupture on a patient-specific basis, which may ultimately prove to be superior to the widely and currently used maximum diameter criterion. Key Words: abdominal aortic aneurysm Ⅲ biomechanics Ⅲ rupture Ⅲ strength Ⅲ stress A bdominal aortic aneurysm (AAA) is a focal enlargement of the infrarenal aorta, which occurs over a time course of several years. This condition is present in Ϸ2% of the elderly population, with Ϸ150 000 new cases diagnosed each year, and the incidence is increasing. 1,2 If left untreated, AAA will gradually expand until rupture; it is an event that carries a mortality rate of 90% and that is ranked as the 13th most common cause of death in the US. 3 Current AAA repair procedures are expensive and carry significant morbidity and mortality risks.Open repair of AAA is a major surgical procedure that requires patients to be hospitalized typically for 1 week and to recuperate at home for several more weeks. The mean postoperative mortality for elective repair is Ϸ5% and for emergency operations 47% (range 27% to 69%). 4 The major drawback of open repair is the compromised quality of life after surgery because of postoperative pain, the prolonged recovery period, and the high costs associated with both the surgery and the recovery.An alternative approach that avoids the extensive tissue dissection associated with open repair is the minimally invasive endovascular repair procedure. The potential advantages of endovascular AAA repair include reductions in mortality, morbidity, blood loss, hospital stay, intensive careOriginal

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“…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]. From the clinical point of view, rapid growth and volume of ILT is correlated with the high risk of rupture [31]. This observation confirms that the presence of the thick thrombus at leasthas negative impact on AAA wall strength.…”

Section: Presence Of Intraluminal Thrombus and Calcifications In Aaa mentioning

confidence: 63%

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

et al. 2017

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Growth of Thrombus may be a Better Predictor of Rupture than Diameter in Patients with Abdominal Aortic Aneurysms

Abstract: a rapid increase of thrombus area may be a better predictor of AAA rupture than increase in maximal diameter.

Cited by 189 publications

References 16 publications

Assessment of inflammatory infiltration and angiogenesis in the thrombus and the wall of abdominal aortic aneurysms on the basis of histological parameters and computed tomography angiography study

Assessment of inflammatory infiltration and angiogenesis in the thrombus and the wall of abdominal aortic aneurysms on the basis of histological parameters and computed tomography angiography study

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Biomechanical factors in Finite Element Analysis of abdominal aortic aneurysms

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