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

Abstract

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). 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<3mm), and a thick-layered ILT group. The hemodynamic features of the RAAAs were assessed using computational fluid dynamics simulation. 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. 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.