Intraluminal thrombus is associated with early rupture of abdominal aortic aneurysm

Haller, Stephen J.; Crawford, Jeffrey D.; Courchaine, Katherine; Bohannan, Colin J.; Landry, Gregory J.; Moneta, Gregory L.; Azarbal, Amir F.; Rugonyi, Sandra

doi:10.1016/j.jvs.2017.08.069

Cited by 90 publications

(87 citation statements)

References 23 publications

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“…Actually, the rupture of AAAs with thick‐layered ILTs generally occurred at the borders where both the flow features and ILT thickness significantly changed. Therefore, the protective biomechanical advantage that ILTs provide by lowering wall stress is outweighed by the weakening of the AAA wall, that is, thick‐layered ILTs increased the rupture risk of particular AAAs, especially small ones …”

Section: Resultsmentioning

confidence: 99%

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Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

et al. 2019

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Purpose Intraluminal thrombus (ILTs) are found in most abdominal aortic aneurysms (AAAs) of clinically relevant size; however, the role of ILTs in AAA ruptures remains unclear. This study investigated the role of the presence and thickness of ILTs in AAA ruptures by analyzing the hemodynamic environment in ruptured AAAs (RAAAs). Methods Three‐dimensional reconstructions from computed tomography scans were performed, and 13 RAAA cases were categorized into a no‐ILT group, a thin‐layered ILT group (thickness < 3 mm), and a thick‐layered ILT group. The hemodynamic features of the RAAAs were assessed using computational fluid dynamics simulation. Results The thin‐ and thick‐layered ILT groups showed significant differences in aneurysm diameters (P < 0.05). The three types of AAAs ruptured at different flow regions, with different hemodynamic features: (a) the no‐ILT AAAs ruptured at regions of flow recirculation where velocity and wall shear stresses (WSSs) were close to zero; (b) the thin‐layered ILT AAAs ruptured at sites at which the dominant flow impinged the wall; and (c) the thick‐layered ILT AAAs ruptured at the border of the dominant flow channel and recirculation zone where the flow velocity and pressure changed dramatically. Conclusions Hemodynamic characteristics influence the rupture mechanisms of particular AAAs differently on the basis of the presence and thickness of ILTs. Recirculation flows and low WSSs may have negative effects by inducing local rupture or positive effects by promoting the formation of thin‐layered ILTs. However, eccentrically located thick‐layered ILTs may increase the rupture risk of small AAAs because of their location in the sac lumen, which results in chaotic flow patterns and rapid increases in flow resistance.

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Section: Resultsmentioning

confidence: 99%

“…Therefore, the protective biomechanical advantage that ILTs provide by lowering wall stress is outweighed by the weakening of the AAA wall, that is, thick-layered ILTs increased the rupture risk of particular AAAs, especially small ones. 52…”

Section: Resultsmentioning

confidence: 99%

Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

et al. 2019

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“…2 Thick ILT can induce localized hypoxia and inflammation and weaken the underlying arterial wall, 6 and could play a role in the rupture of smaller aneurysms. 7 Additionally, ILT growth has been associated with rupture. 8 Magnetic resonance imaging (MRI) can show not only the size and location of ILT, but also its unique signal characteristics.…”

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confidence: 99%

Evaluation of the distribution and progression of intraluminal thrombus in abdominal aortic aneurysms using high‐resolution MRI

Zhu¹,

Leach²,

Tian

et al. 2019

Magnetic Resonance Imaging

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Background Intraluminal thrombus (ILT) signal intensity on MRI has been studied as a potential marker of abdominal aortic aneurysm (AAA) progression. Purpose 1) To characterize the relationship between ILT signal intensity and AAA diameter; 2) to evaluate ILT change over time; and 3) to assess the relationship between ILT features and AAA growth. Study Type Prospective. Subjects Eighty AAA patients were imaged, and a subset (n = 41) were followed with repeated MRI for 16 ± 9 months. Field Strength/Sequence 3D black‐blood fast‐spin‐echo sequence at 3 T. Assessment ILT was designated as "bright" if the signal was greater than 1.2 times that of adjacent psoas muscle. AAAs were divided into three groups based on ILT: Type 1: bright ILT; Type 2: isointense ILT; Type 3: no ILT. During follow‐up, an active ILT change was defined as new ILT formation or an increase in ILT signal intensity to bright; stable ILT was defined as no change in ILT type or ILT became isointense from bright previously. Statistical Tests Shapiro–Wilk test; Mann–Whitney U‐test; Fisher's exact test; Kruskal‐Wallis test; Spearman's r; intraclass correlation coefficient (ICC), Cohen's kappa. Results AAAs with Type 1 ILT were larger than those with Types 2 and 3 ILT (5.1 ± 1.1 cm, 4.4 ± 0.9 cm, 4.2 ± 0.8 cm, P = 0.008). The growth rate of AAAs with Type 1 ILT was significantly greater than that of AAAs with Types 2 and 3 ILT (2.6 ± 2.5, 0.6 ± 1.3, 1.5 ± 0.6 mm/year, P = 0.01). During follow‐up, AAAs with active ILT changes had a 3‐fold increased growth rate compared with AAAs with stable ILT (3.6 ± 3.0 mm/year vs. 1.2 ± 1.5 mm/year, P = 0.008). Data Conclusion AAAs with bright ILT are larger in diameter and grow faster. Active ILT change is associated with faster AAA growth. Black‐blood MRI can characterize ILT features and monitor their change over time, which may provide new insights into AAA risk assessment. Level of Evidence: 2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:994–1001.

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“…Aortic aneurysm can be detected with physical examination but needs to be confirmed with a series of medical imaging tests such as ultrasound or computerized tomography (CT) scans . When diagnosed, the best way to reduce the risk of rupture is with prompt surgical intervention, although in some cases complications associated with surgical treatment may be deemed greater than the risk of rupture itself . To decide on the appropriate treatment strategy for each individual patient, it is necessary to obtain a reliable predictor to estimate the state of aneurysm and monitor growth.…”

Section: Introductionmentioning

confidence: 99%

Computational prediction of hemodynamical and biomechanical alterations induced by aneurysm dilatation in patient‐specific ascending thoracic aortas

Jayendiran

Condemi

Campisi

et al. 2020

Numer Methods Biomed Eng

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The aim of the present work is to propose a robust computational framework combining computational fluid dynamics (CFD) and 4D flow MRI to predict the progressive changes in hemodynamics and wall rupture index (RPI) induced by aortic morphological evolutions in patients harboring ascending thoracic aortic aneurysms (ATAAs). An analytical equation has been proposed to predict the aneurysm progression based on age, sex, and body surface area. Parameters such as helicity, wall shear stress (WSS), time‐averaged WSS, oscillatory shear index, relative residence time, and viscosity were evaluated for two patients at different stages of aneurysm growth, and compared with age‐sex‐matched healthy subjects. The study shows that evolution of hemodynamics and RPI, despite being very slow in ATAAs, is strongly affected by morphological alterations and, in turn could impact biomechanical factors and aortic mechanobiology. An aspect of the current work is that the patient‐specific 4D MRI data sets were obtained with a follow‐up of 1 year and the measured time‐averaged velocity maps and flow eccentricity were compared with the CFD simulation for validation. The computational framework presented here is capable of capturing the blood flow patterns and the hemodynamic descriptors during the various stages of aneurysm growth. Further investigations will be conducted in order to verify these results on a larger cohort of patients and with long follow‐up times to finally elucidate the link between deranged hemodynamics, AA geometry, and wall mechanical properties in ATAAs.

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Intraluminal thrombus is associated with early rupture of abdominal aortic aneurysm

Cited by 90 publications

References 23 publications

Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: A hemodynamic point of view

Evaluation of the distribution and progression of intraluminal thrombus in abdominal aortic aneurysms using high‐resolution MRI

Computational prediction of hemodynamical and biomechanical alterations induced by aneurysm dilatation in patient‐specific ascending thoracic aortas

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