Advertisement

Intraluminal Thrombus and Abdominal Aortic Aneurysm Complications

Published:April 07, 2022DOI:https://doi.org/10.1016/j.avsg.2022.03.007
      The interesting article by Park et al. refers a new method to study blood flow in AAA, applying a CT digital subtraction angiography.
      • Park Y.J.
      • Mok S.K.
      • Park S.C.
      • et al.
      Real-time evaluation of blood flow patterns using AneurysmFlow for an in vivo abdominal aortic aneurysm model.
      It merits to be counted among the surgical diagnostic means, to predict an AAA-accelerated growth with an increased risk of rupture; this is better understood by deepening its pathophysiology. An aortic laminar blood flow, when getting inside a large and asymmetrical aneurysmal chamber, easily acquires a high Reynolds number and becomes turbulent. It also decreases its velocity and dissipates most of its kinetic power on the aortic walls, inelastic and unable to retrieve any recoiling energy through the “Windkessel” phenomenon. Besides, as per the Laplace's law, the parietal tension increases proportionally to the AAA diameter, being the mechanical protection offered by the ILT weak, given its organized/fibrous structure, inhomogeneous thickness, low cushioning capacity, and firm adhesion to the AAA walls.
      • Park Y.J.
      • Mok S.K.
      • Park S.C.
      • et al.
      Real-time evaluation of blood flow patterns using AneurysmFlow for an in vivo abdominal aortic aneurysm model.
      • Horvat N.
      • Virag L.
      • Karšaj I.
      Mechanical role of intraluminal thrombus in aneurysm growth: a computational study.
      • Qiu Y.
      • Wang Y.
      • Fan Y.
      • et al.
      Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: a hemodynamic point of view.
      • Boyd A.J.
      Intraluminal thrombus: innocent bystander or factor in abdominal aortic aneurysm pathogenesis?.
      • Lu H.
      • Daugherty A.
      Aortic aneurysms.
      All these mechanical elements cause an AAA greater risk of rupture, but paradoxically also favor the ILT growth through a blood flow decreased velocity and its peripheral stagnation, both correlated with the AAA frequent asymmetric shape. Only in case of regular fusiform AAA with a concentric ILT and an inner free lumen equivalent to a normal aortic diameter, an axial laminar blood flow can be maintained.
      • Lindquist Liljeqvist M.
      • Bogdanovic M.
      • Siika A.
      • et al.
      Geometric and biomechanical modeling aided by machine learning improves the prediction of growth and rupture of small abdominal aortic aneurysms.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Park Y.J.
        • Mok S.K.
        • Park S.C.
        • et al.
        Real-time evaluation of blood flow patterns using AneurysmFlow for an in vivo abdominal aortic aneurysm model.
        Ann Vasc Surg. 2022; 80: 256-263
        • Horvat N.
        • Virag L.
        • Karšaj I.
        Mechanical role of intraluminal thrombus in aneurysm growth: a computational study.
        Biomech Model Mechanobiol. 2021; 20: 1819-1832
        • Qiu Y.
        • Wang Y.
        • Fan Y.
        • et al.
        Role of intraluminal thrombus in abdominal aortic aneurysm ruptures: a hemodynamic point of view.
        Med Phys. 2019; 46: 4263-4275
        • Boyd A.J.
        Intraluminal thrombus: innocent bystander or factor in abdominal aortic aneurysm pathogenesis?.
        JVS Vasc Sci. 2021; 2: 159-169
        • Lu H.
        • Daugherty A.
        Aortic aneurysms.
        Arterioscler Thromb Vasc Biol. 2017; 37: e59-e65
        • Lindquist Liljeqvist M.
        • Bogdanovic M.
        • Siika A.
        • et al.
        Geometric and biomechanical modeling aided by machine learning improves the prediction of growth and rupture of small abdominal aortic aneurysms.
        Sci Rep. 2021; 11: 18040
        • Bruijn L.E.
        • van Stroe Gómez C.G.
        • Curci J.A.
        • et al.
        A histopathological classification scheme for abdominal aortic aneurysm disease.
        JVS Vasc Sci. 2021 7; 2: 260-273
        • Koole D.
        • Zandvoort H.J.
        • Schoneveld A.
        • et al.
        Intraluminal abdominal aortic aneurysm thrombus is associated with disruption of wall integrity.
        J Vasc Surg. 2013; 57: 77-83
        • Zhu C.
        • Leach J.R.
        • Wang Y.
        • et al.
        Intraluminal thrombus predicts rapid growth of abdominal aortic aneurysms.
        Radiology. 2020; 294: 707-713
        • Metaxa E.
        • Tzirakis K.
        • Kontopodis N.
        • et al.
        Correlation of intraluminal thrombus deposition, biomechanics, and hemodynamics with surface growth and rupture in abdominal aortic aneurysm-application in a clinical paradigm.
        Ann Vasc Surg. 2018; 46: 357-366
        • Kessler V.
        • Klopf J.
        • Eilenberg W.
        • et al.
        AAA Revisited: a comprehensive review of risk factors, management, and hallmarks of pathogenesis.
        Biomedicines. 2022; 10: 94
        • Sladojevic M.
        • Stanojevic Z.
        • Koncar I.
        • et al.
        Magnetic resonance imaging assessment of proteolytic enzyme concentrations and biologic properties of intraluminal thrombus in abdominal aortic aneurysms.
        J Vasc Surg. 2020; 72: 1025-1034
        • Haller S.J.
        • Crawford J.D.
        • Courchaine K.M.
        • et al.
        Intraluminal thrombus is associated with early rupture of abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67: 1051-1058
        • Cameron S.J.
        • Russell H.M.
        • Owens 3rd, A.P.
        Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental?.
        Blood. 2018; 132: 2619-2628
        • Wang Y.D.
        • Liu Z.J.
        • Ren J.
        • et al.
        Pharmacological therapy of abdominal aortic aneurysm: an update.
        Curr Vasc Pharmacol. 2018; 16: 114-124