Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall

Schurink, Geert Willem H.; Baalen, Jary M. van; Visser, M.J.T.; Bockel, J.H. van

doi:10.1016/s0741-5214(00)90311-2

Cited by 109 publications

(114 citation statements)

References 19 publications

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“…While the earliest models did not include ILT, their incorporation into models of AAAs has developed over the past two decades from axisymmetric [111,112] to 2D eccentric [40] and finally to fully 3D patient-specific geometries [113][114][115][116]. The majority of these computational studies, as well as an in vitro experimental study using a synthetic AAA model with thrombus [117], support the initial work by Inzoli et al [111] that an ILT may provide a mechanically protective effect (i.e., a "cushioning" or "shielding") by reducing the stress on the aneurysmal wall; yet, others question the ability of the porous thrombus to reduce wall stress consistently, as assessed computationally [118] or by direct intraoperative pressure measurements in vivo [119]. Clearly, controversy remains.…”

Section: Implications Of Spatial Distribution-the Shoulder and Neck Rsupporting

confidence: 55%

Biochemomechanics of Intraluminal Thrombus in Abdominal Aortic Aneurysms

Wilson

Virag

Achille

et al. 2013

Journal of Biomechanical Engineering

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Most computational models of abdominal aortic aneurysms address either the hemodynamics within the lesion or the mechanics of the wall. More recently, however, some models have appropriately begun to account for the evolving mechanics of the wall in response to the changing hemodynamic loads. Collectively, this large body of work has provided tremendous insight into this life-threatening condition and has provided important guidance for current research. Nevertheless, there has yet to be a comprehensive model that addresses the mechanobiology, biochemistry, and biomechanics of thrombus-laden abdominal aortic aneurysms. That is, there is a pressing need to include effects of the hemodynamics on both the development of the nearly ubiquitous intraluminal thrombus and the evolving mechanics of the wall, which depends in part on biochemical effects of the adjacent thrombus. Indeed, there is increasing evidence that intraluminal thrombus in abdominal aortic aneurysms is biologically active and should not be treated as homogeneous inert material. In this review paper, we bring together diverse findings from the literature to encourage next generation models that account for the biochemomechanics of growth and remodeling in patient-specific, thrombus-laden abdominal aortic aneurysms.

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Section: Implications Of Spatial Distribution-the Shoulder and Neck Rsupporting

confidence: 55%

Biochemomechanics of Intraluminal Thrombus in Abdominal Aortic Aneurysms

Wilson

Virag

Achille

et al. 2013

Journal of Biomechanical Engineering

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“…Xenos et al showed an uneven pressure distribution in the case of a type I endoleak [22], Pacanowski et al detected a higher pressure close to the stent graft compared to the one close to the aneurysm wall [23], which might be dependent upon the microstructure of the thrombus [24]. In contrast, Dias et al and Schurink et al found an almost even distribution inside the thrombus [7,25]. We are aware that in our model the thrombus represents a gelatinous, non-wall-adhesive state of the organisation process and is not comparable to organised thrombi after 6 months [26].…”

Section: Discussionmentioning

confidence: 98%

Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study

et al. 2007

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A feasibility study on a completely digital telemetric pressure sensor (TPS) to detect endoleaks was performed in an in vitro model of an abdominal aortic aneurysm (AAA). An endovascular-stented AAA silicone model with different types (I-III) and sizes (3-11 French) of endoleaks was created and pulsatile pressure was applied with physiological flow and pressure rates [mean intraaortic pressure (IAP): 95-130 mmHg] and different degrees of thrombosis of the aneurysm sac. Aneurysm sac pressure (ASP) was measured with the TPS and with wired pressure sensors (WPS) as a reference. Statistical analysis included paired t-test, Pearson's correlation analysis and Bland-Altman plots. After opening an endoleak, the mean ASP increased significantly (P < 0.0001) from 15 to almost 95% of the mean IAP depending on endoleak type and size. ASP could be measured accurately with the TPS and the WPS. The telemetric and wired ASP increase showed a high Pearson's correlation coefficient (r) for a non-thrombosed (r = 0.97) and a thrombosed (r = 0.96) aneurysm sac. In an in vitro silicone model, the newly designed telemetric pressure sensor was able to detect the occurrence of an endoleak in a non-invasive way and might be a valuable device for follow-up of endovascular AAA repair.

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“…The mechanical role of the ILT on AAA wall stress distributions is controversial. Early experimental studies 15,59 suggest that the presence of ILT does not reduce the pressure acting on the aneurysmal wall. However, early computational studies 14,34,48 based on both simplified material models and idealized AAA geometry suggest that the ILT reduces the wall stress level.…”

Section: Computational Analysismentioning

confidence: 99%

“…At least of similar importance, Schurink et al 59 substantiated that a thrombus within an aneurysm does not reduce both the mean and the pulse pressure near the aneurysm wall, and thus would not reduce the risk of AAA rupture from the loading point of view. The role of ILT within the structural stability of AAA, specifically in relation to the risk of rupture, is not yet well understood.…”

Section: Introductionmentioning

confidence: 99%

Structure, Mechanics, and Histology of Intraluminal Thrombi in Abdominal Aortic Aneurysms

Tong

Holzapfel

2015

Ann Biomed Eng

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It has been recognized that the intraluminal thrombus (ILT) is a biologically active material contributing in the progression and rupture of abdominal aortic aneurysms (AAAs). To advance our understanding of the potential role of ILT in the natural history of AAAs, the structural, mechanical, and histological characteristics of ILTs have been studied with great interest over the past decade. Given that the ILT is evolving and changing its composition during AAA progression, attention has been paid to exploring the chemomechanical effects of ILT on the underlying wall properties. Various biomechanical and chemomechanical data, and related models have provided advanced insights into AAA pathogenesis which have served as a basis for clinical diagnosis. The goal of this review is to describe and summarize recent advances in the research of ILT found in the aorta in terms of structure, mechanics, and histology on a patient-specific basis. We point to some possible future studies which hopefully stimulate multidisciplinary research to address open problems.

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Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall

Abstract: We conclude that thrombus within the aneurysm does not reduce both the mean and the pulse pressure near the aneurysmal wall and thus will not reduce the risk of rupture of the aneurysm.

Cited by 109 publications

References 19 publications

Biochemomechanics of Intraluminal Thrombus in Abdominal Aortic Aneurysms

Biochemomechanics of Intraluminal Thrombus in Abdominal Aortic Aneurysms

Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study

Structure, Mechanics, and Histology of Intraluminal Thrombi in Abdominal Aortic Aneurysms

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