Journal of Vascular Surgery
Volume 48, Issue 5 , Pages 1108-1113 , November 2008

Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture

  • Joy Roy, MD, PhD

      Affiliations

    • Department of Surgery, Capio St. Görans Hospital, Stockholm, Sweden
    • Department of Vascular Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
    • Corresponding Author InformationReprint requests: Joy Roy, MD, PhD, Vascular Surgery Laboratory, Department of Molecular Medicine and Surgery, CMM L8:03, Karolinska University Hospital Solna, 17176 Stockholm, Sweden
    • ,
  • Fausto Labruto, MD, PhD

      Affiliations

    • Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
    • ,
  • Mats O. Beckman, MD

      Affiliations

    • Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
    • ,
  • Jesper Danielson, MD

      Affiliations

    • Department of Radiology, Capio Diagnostik, Stockholm, Sweden
    • ,
  • Gunnar Johansson, MD, PhD

      Affiliations

    • Department of Surgery, Capio St. Görans Hospital, Stockholm, Sweden
    • ,
  • Jesper Swedenborg, MD, PhD

      Affiliations

    • Department of Vascular Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden

Received 2 April 2008 ,Accepted 30 June 2008.

References 

  1. Thompson RW, Geraghty PJ, Lee JK. Abdominal aortic aneurysms: basic mechanisms and clinical implications. Curr Probl Surg. 2002;39:110–230
  2. Filipovic M, Goldacre MJ, Roberts SE, Yeates D, Duncan ME, Cook-Mozaffari P. Trends in mortality and hospital admission rates for abdominal aortic aneurysm in England and Wales, 1979-1999. Br J Surg. 2005;92:968–975
  3. Acosta S, Ogren M, Bengtsson H, Bergqvist D, Lindblad B, Zdanowski Z. Increasing incidence of ruptured abdominal aortic aneurysm: a population-based study. J Vasc Surg. 2006;44:237–243
  4. Choke E, Cockerill G, Wilson WR, Sayed S, Dawson J, Loftus I, et al. A review of biological factors implicated in abdominal aortic aneurysm rupture. Eur J Vasc Endovasc Surg. 2005;30:227–244
  5. Hans SS, Jareunpoon O, Balasubramaniam M, Zelenock GB. Size and location of thrombus in intact and ruptured abdominal aortic aneurysms. J Vasc Surg. 2005;41:584–588
  6. Wolf YG, Thomas WS, Brennan FJ, Goff WG, Sise MJ, Bernstein EF. Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms. J Vasc Surg. 1994;20:529–535; discussion 535-28.
  7. Satta J, Laara E, Juvonen T. Intraluminal thrombus predicts rupture of an abdominal aortic aneurysm. J Vasc Surg. 1996;23:737–739
  8. Stenbaek J, Kalin B, Swedenborg J. Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2000;20:466–469
  9. Kazi M, Thyberg J, Religa P, Roy J, Eriksson P, Hedin U, et al. Influence of intraluminal thrombus on structural and cellular composition of abdominal aortic aneurysm wall. J Vasc Surg. 2003;38:1283–1292
  10. Vorp DA, Lee PC, Wang DH, Makaroun MS, Nemoto EM, Ogawa S, et al. Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening. J Vasc Surg. 2001;34:291–299
  11. Kazi M, Zhu C, Roy J, Paulsson-Berne G, Hamsten A, Swedenborg J, et al. Difference in matrix-degrading protease expression and activity between thrombus-free and thrombus-covered wall of abdominal aortic aneurysm. Arterioscler Thromb Vasc Biol. 2005;25:1341–1346
  12. Arita T, Matsunaga N, Takano K, Nagaoka S, Nakamura H, Katayama S, et al. Abdominal aortic aneurysm: rupture associated with the high-attenuating crescent sign. Radiology. 1997;204:765–768
  13. Mehard WB, Heiken JP, Sicard GA. High-attenuating crescent in abdominal aortic aneurysm wall at CT: a sign of acute or impending rupture. Radiology. 1994;192:359–362
  14. Rakita D, Newatia A, Hines JJ, Siegel DN, Friedman B. Spectrum of CT findings in rupture and impending rupture of abdominal aortic aneurysms. Radiographics. 2007;27:497–507
  15. Schwartz SA, Taljanovic MS, Smyth S, O'Brien MJ, Rogers LF. CT findings of rupture, impending rupture, and contained rupture of abdominal aortic aneurysms. AJR Am J Roentgenol. 2007;188:W57–W62
  16. Thammaroj J, Vungtal S, Srinakarin J. Predictive CT features in ruptured abdominal aortic aneurysm. J Med Assoc Thai. 2006;89:434–440
  17. Simao da Silva E, Rodrigues AJ, Magalhaes Castro de Tolosa E, Rodrigues CJ, Villas Boas do Prado G, Nakamoto JC. Morphology and diameter of infrarenal aortic aneurysms: a prospective autopsy study. Cardiovasc Surg. 2000;8:526–532
  18. Fontaine V, Jacob MP, Houard X, Rossignol P, Plissonnier D, Angles-Cano E, et al. Involvement of the mural thrombus as a site of protease release and activation in human aortic aneurysms. Am J Pathol. 2002;161:1701–1710
  19. Carrell TW, Burnand KG, Booth NA, Humphries J, Smith A. Intraluminal thrombus enhances proteolysis in abdominal aortic aneurysms. Vascular. 2006;14:9–16
  20. Hinnen JW, Koning OH, Visser MJ, Van Bockel HJ. Effect of intraluminal thrombus on pressure transmission in the abdominal aortic aneurysm. J Vasc Surg. 2005;42:1176–1182
  21. Mower WR, Quinones WJ, Gambhir SS. Effect of intraluminal thrombus on abdominal aortic aneurysm wall stress. J Vasc Surg. 1997;26:602–608
  22. Di Martino E, Mantero S, Inzoli F, Melissano G, Astore D, Chiesa R, et al. Biomechanics of abdominal aortic aneurysm in the presence of endoluminal thrombus: experimental characterization and structural static computational analysis. Eur J Vasc Endovasc Surg. 1998;15:290–299
  23. Schurink GW, van Baalen JM, Visser MJ, van Bockel JH. Thrombus within an aortic aneurysm does not reduce pressure on the aneurysmal wall. J Vasc Surg. 2000;31:501–506
  24. Gasser TC, Görgülü G, Folkesson M, Swedenborg J. Failure properties of intra-luminal thrombus in abdominal aortic aneurysm under static and pulsating mechanical loads. J Vasc Surg. 2008;(in press).
  25. Veith FJ, Gargiulo NJ, Ohki T. Endovascular treatment of ruptured infrarenal aortic and iliac aneurysms. Acta Chir Belg. 2003;103:555–562

 Competition of interest: none.

PII: S0741-5214(08)01103-8

doi: 10.1016/j.jvs.2008.06.063

Journal of Vascular Surgery
Volume 48, Issue 5 , Pages 1108-1113 , November 2008

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