Abstract
Intra-luminal thrombus has been suggested to play a role in the progression of abdominal aortic aneurysm (AAA). The aims of this study were twofold. Firstly, to assess the reproducibility of a computer tomography (CT)-based technique for measurement of aortic thrombus volume. Secondly, to examine the determinants of infrarenal aortic thrombus volume in a cohort of patients with aortic dilatation. A consecutive series of 75 patients assessed by CT angiography with maximum aortic diameter ≥25 mm were recruited. Intra-luminal thrombus volume was measured by a semi-automated workstation protocol based on a previously defined technique to quantitate aortic calcification. Intra- and inter-observer reproducibility were assessed using correlation coefficients, coefficient of variation and Bland-Altman plots. Infrarenal aortic thrombus volume percentage was related to clinical, anatomical and blood characteristics of the patients using univariate and multivariate tests. Infrarenal aortic thrombus volume was related to the severity of aortic dilatation assessed by total aortic volume (r = 0.87, P < 0.0001) or maximum aortic diameter (r = 0.74, P < 0.0001). We therefore examined the clinical determinates of aortic thrombus expressed as a percentage of total aortic volume. Aortic thrombus percentage was negatively correlated with serum high density lipoprotein (HDL, r = -0.31). By ordinal multiple logistic regression analysis serum HDL below median (≤1.2 mM) was associated with aortic thrombus percentage in the upper quartile adjusting for other risk factors (odds ratio 5.3, 95% CI 1.1–25.0). Infrarenal aortic thrombus volume can be measured reproducibly on CT. Serum HDL, which can be therapeutically raised, may play a role in discouraging aortic thrombus accumulation with implications in terms of delaying progression of AAA.
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References
Golledge J, Muller J, Daugherty A, Norman P (2006) Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol 26:2605–2613
Powell JT, Brady AR (2004) Detection, management, and prospects for the medical treatment of small abdominal aortic aneurysms. Arterioscler Thromb Vasc Biol 24:241–245
Carrell TW, Burnand KG, Booth NA, Humphries J, Smith A (2006) Intraluminal thrombus enhances proteolysis in abdominal aortic aneurysms. Vascular 14:9–16
Fontaine V, Touat Z, Mtairag el M et al (2004) Role of leukocyte elastase in preventing cellular re-colonization of the mural thrombus. Am J Pathol 164:2077–2087
Panek B, Gacko M, Palka J (2004) Metalloproteinases, insulin-like growth factor-I and its binding proteins in aortic aneurysm. Int J Exp Pathol 85:159–164
Al-Barjas HS, Ariens R, Grant P, Scott JA (2006) Raised plasma fibrinogen concentration in patients with abdominal aortic aneurysm. Angiology 57:607–614
Faggioli GL, Stella A, Gargiulo M, Tarantini S, D’Addato M, Ricotta JJ (1994) Morphology of small aneurysms: definition and impact on risk of rupture. Am J Surg 168:131–135
Hans SS, Jareunpoon O, Huang R, Hans B, Bove P, Zelenock GB (2003) Relationship of residual intraluminal to intrathrombotic pressure in a closed aneurysmal sac. J Vasc Surg 37:949–953
Hatakeyama T, Shigematsu H, Muto T (2001) Risk factors for rupture of abdominal aortic aneurysm based on three-dimensional study. J Vasc Surg 33:453–461
Roberts WC, Ko JM, Pearl GJ (2006) Relation of weights of intraaneurysmal thrombi to maximal right-to-left diameters of abdominal aortic aneurysms. Am J Cardiol 98:1519–1524
Sampaio SM, Panneton JM, Mozes GI (2005) Aneurysm sac thrombus load predicts type II endoleaks after endovascular aneurysm repair. Ann Vasc Surg 19:302–309
Satta J, Laara E, Juvonen T (1996) Intraluminal thrombus predicts rupture of an abdominal aortic aneurysm. J Vasc Surg 23:737–739
Stenbaek J, Kalin B, Swedenborg J (2000) Growth of thrombus may be a better predictor of rupture than diameter in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 20:466–469
Wolf YG, Thomas WS, Brennan FJ, Goff WG, Sise MJ, Bernstein EF (1994) Computed tomography scanning findings associated with rapid expansion of abdominal aortic aneurysms. J Vasc Surg 20:529–535; discussion 535–528
Yasuhara H, Ohara N, Nagawa H (2001) Influence of gender on intraluminal thrombus of abdominal aortic aneurysms. Am J Surg 182:89–92
Wilmink AB, Hubbard CS, Day NE, Quick CR (2001) The incidence of small abdominal aortic aneurysms and the change in normal infrarenal aortic diameter: implications for screening. Eur J Vasc Endovasc Surg 21:165–170
Golledge J, Leicht A, Crowther RG, Clancy P, Spinks WL, Quigley F (2007) Association of obesity and metabolic syndrome with the severity and outcome of intermittent claudication. J Vasc Surg 45:40–46
Jayalath RW, Jackson P, Golledge J (2006) Quantification of abdominal aortic calcification on CT. Arterioscler Thromb Vasc Biol 26:429–430
Golledge J, Jones L, Oliver L, Quigley F, Karan M (2006) Folic acid, vitamin B12, MTHFR genotypes, and plasma homocysteine. Clin Chem 52:1205–1206
Di Martino E, Mantero S, Inzoli F (1998) Biomechanics of abdominal aortic aneurysm in the presence of endoluminal thrombus: experimental characterisation and structural static computational analysis. Eur J Vasc Endovasc Surg 15:290–299
Di Martino ES, Vorp DA (2003) Effect of variation in intraluminal thrombus constitutive properties on abdominal aortic aneurysm wall stress. Ann Biomed Eng 31:804–809
Mower WR, Quinones WJ, Gambhir SS (1997) Effect of intraluminal thrombus on abdominal aortic aneurysm wall stress. J Vasc Surg 26:602–608
Hans SS, Jareunpoon O, Balasubramaniam M, Zelenock GB (2005) Size and location of thrombus in intact and ruptured abdominal aortic aneurysms. J Vasc Surg 41:584–588
Fontaine V, Jacob MP, Houard X (2002) Involvement of the mural thrombus as a site of protease release and activation in human aortic aneurysms. Am J Pathol 161:1701–1710
Vorp DA, Lee PC, Wang DH (2001) Association of intraluminal thrombus in abdominal aortic aneurysm with local hypoxia and wall weakening. J Vasc Surg 34:291–299
Kazi M, Thyberg J, Religa P (2003) Influence of intraluminal thrombus on structural and cellular composition of abdominal aortic aneurysm wall. J Vasc Surg 38:1283–1292
Touat Z, Ollivier V, Dai J (2006) Renewal of mural thrombus releases plasma markers and is involved in aortic abdominal aneurysm evolution. Am J Pathol 168:1022–1030
Tornwall ME, Virtamo J, Haukka JK, Albanes D, Huttunen JK (2001) Life-style factors and risk for abdominal aortic aneurysm in a cohort of Finnish male smokers. Epidemiology 12:94–100
Alcorn HG, Wolfson SK Jr, Sutton-Tyrrell K, Kuller LH, O’Leary D (1996) Risk factors for abdominal aortic aneurysms in older adults enrolled in The Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 16:963–970
Eichinger S, Pecheniuk NM, Hron G (2007) High-density lipoprotein and the risk of recurrent venous thromboembolism. Circulation 115:1609–1614
Aronow WS, Ahn C (1994) Correlation of serum lipids with the presence or absence of atherothrombotic brain infarction and peripheral arterial disease in 1,834 men and women aged > or = 62 years. Am J Cardiol 73:995–997
Korporaal SJ, Akkerman JW (2006) Platelet activation by low density lipoprotein and high density lipoprotein. Pathophysiol Haemost Thromb 35:270–280
Mineo C, Deguchi H, Griffin JH, Shaul PW (2006) Endothelial and antithrombotic actions of HDL. Circ Res 98:1352–1364
Acknowledgements
This study was supported by funding from the NHMRC (379600) and NIH (R01 HL080010–01). J.G. holds a Practitioner’s Fellowship from the NHMRC (431503). We thank Mr Keith Rich for his assistance with examination of CT images.
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Golledge, J., Wolanski, P., Parr, A. et al. Measurement and determinants of infrarenal aortic thrombus volume. Eur Radiol 18, 1987–1994 (2008). https://doi.org/10.1007/s00330-008-0956-3
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DOI: https://doi.org/10.1007/s00330-008-0956-3