Journal
JOURNAL OF VASCULAR RESEARCH
Volume 58, Issue 3, Pages 172-179Publisher
KARGER
DOI: 10.1159/000514237
Keywords
Abdominal aortic aneurysm; Aortic rupture; Hemodynamics; Intraluminal thrombus
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Funding
- Thorlakson Foundation Fund, University of Manitoba
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Computational fluid dynamics were used to assess hemodynamic changes in an actively rupturing abdominal aortic aneurysm (AAA) over a 9-day period. The findings suggest that AAA may rupture at smaller sizes than those measured on day of rupture. Hemodynamic changes in the AAA flow lumen may occur in advance of any appreciable increase in aortic diameter or rupture.
Computational fluid dynamics were used to assess hemodynamic changes in an actively rupturing abdominal aortic aneurysm (AAA) over a 9-day period. Active migration of contrast from the lumen into the thickest region of intraluminal thrombus (ILT) was demonstrated until it ultimately breached the adventitial layer. Four days after symptom onset, there was a discrete disruption of adventitial calcium with bleb formation at the site of future rupture. Rupture occurred in a region of low wall shear stress and was associated with a marked increase in AAA diameter from 6.6 to 8.4 cm. The cross-sectional area of the flow lumen increased across all time points from 6.28 to 12.08 cm(2). The increase in luminal area preceded the increase in AAA diameter and was characterized by an overall deceleration in recirculation flow velocity with a coinciding increase in flow velocity penetrating the ILT. We show that there are significant hemodynamic and structural changes in the AAA flow lumen in advance of any appreciable increase in aortic diameter or rupture. The significant increase in AAA diameter with rupture suggests that AAA may actually rupture at smaller sizes than those measured on day of rupture. These findings have implications for algorithms the predict AAA rupture risk.
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