Cellular content and permeability of intraluminal thrombus in abdominal aortic aneurysm

Adolph, Randall; Vorp, David A.; Steed, David L.; Webster, Marshall W.; Kameneva, Marina V.; Watkins, Simon C.

doi:10.1016/s0741-5214(97)70223-4

Cited by 202 publications

(213 citation statements)

References 20 publications

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“…Specifically, the ILT is stiffer at the luminal layer (c ¼ 2.62 kPa) and gradually softens towards its abluminal site (c ¼ 1.73 kPa) [40], which was accounted for in this study. Finally, it should be noted that although ITL tissue is highly porous [46], previous studies have demonstrated that a single-phase model predicts AAA wall stress with sufficient accuracy [25,26].…”

Section: Constitutive Abdominal Aortic Aneurysm Tissue Modellingmentioning

confidence: 97%

Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index

Polzer

Gasser

2015

J. R. Soc. Interface.

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A rupture risk assessment is critical to the clinical treatment of abdominal aortic aneurysm (AAA) patients. The biomechanical AAA rupture risk assessment quantitatively integrates many known AAA rupture risk factors but the variability of risk predictions due to model input uncertainties remains a challenging limitation. This study derives a probabilistic rupture risk index (PRRI). Specifically, the uncertainties in AAA wall thickness and wall strength were considered, and wall stress was predicted with a state-of-the-art deterministic biomechanical model. The discriminative power of PRRI was tested in a diameter-matched cohort of ruptured (n ¼ 7) and intact (n ¼ 7) AAAs and compared to alternative risk assessment methods. Computed PRRI at 1.5 mean arterial pressure was significantly ( p ¼ 0.041) higher in ruptured AAAs (20.21(s.d. 14.15%)) than in intact AAAs (3.71(s.d. 5.77)%). PRRI showed a high sensitivity and specificity (discriminative power of 0.837) to discriminate between ruptured and intact AAA cases. The underlying statistical representation of stochastic data of wall thickness, wall strength and peak wall stress had only negligible effects on PRRI computations. Uncertainties in AAA wall stress predictions, the wide range of reported wall strength and the stochastic nature of failure motivate a probabilistic rupture risk assessment. Advanced AAA biomechanical modelling paired with a probabilistic rupture index definition as known from engineering risk assessment seems to be superior to a purely deterministic approach.

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Section: Constitutive Abdominal Aortic Aneurysm Tissue Modellingmentioning

confidence: 97%

Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index

Polzer

Gasser

2015

J. R. Soc. Interface.

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“…Similarly, the observations of Lendon et al 83 that the mechanical strength of plaque caps is reduced with increased presence of macrophages may be caused by the stimulation of these cells by a local hypoxic environment, 95 causing them to release MMPs 82,93,94 or other proteolytic enzymes. Our laboratory has demonstrated that macrophages are present within the ILT 96 and are exposed to a hypoxic environment. 19,97 The observation by Jean-Claude et al that elevated levels of plasmin are present in the inner layers of the AAA wall near the interface with intraluminal thrombus is a possible consequence of this.…”

Section: Hypoxia-mediated Wall Weakeningmentioning

confidence: 99%

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

Vorp

Geest

2005

ATVB

Self Cite

231

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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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“…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. Fontaine et al 12 have indicated the enzymatic activity concentrated in mural thrombi as a likely relevant factor in the course of aneurisms.…”

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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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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Cellular content and permeability of intraluminal thrombus in abdominal aortic aneurysm

Abstract: These principally structural studies support the hypothesis that the thrombus is a self-sustaining entity that may have significance in the pathophysiologic mechanism of abdominal aortic aneurysms.

Cited by 202 publications

References 20 publications

Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index

Biomechanical rupture risk assessment of abdominal aortic aneurysms based on a novel probabilistic rupture risk index

Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture

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

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