Vallabhaneni Srinivasa R, Gilling-Smith Geoffrey L, Brennan John A, Heyes Richard R, Hunt John A, How Thien V, Harris Peter L
Regional Vascular Unit, Royal Liverpool University Hospital, England, UK.
J Endovasc Ther. 2003 Jun;10(3):524-30. doi: 10.1177/152660280301000318.
To determine if pressure measured at a single location within aneurysm sac thrombus accurately reflects the force applied to the aneurysm wall and the risk of rupture by examining (1) if pressure is distributed uniformly within aneurysm thrombus, (2) the pressure transmission through aneurysm thrombus, and (3) the microstructural basis for pressure transmission.
Pressure within aneurysm thrombus was measured by direct puncture through the aneurysm wall at 121 sites in 26 patients during open abdominal aortic aneurysm repair. Measurements were taken prior to cross clamping and compared with intrasac pressure measured at 30 sites in 6 patients without aneurysm thrombus (controls). Transmission of pressure through aneurysm thrombus was further examined ex vivo by subjecting fresh thrombus to a pressure gradient in a custom-made pressure cell. Pressure transmission was correlated with matrix density as determined by light microscopy and image analysis.
Mean pressure within aneurysm thrombus was higher than mean systemic pressure in 11 patients, lower in 1, and identical in 9. In 5 patients, the pressure was greater than systemic in some areas of the thrombus but less in others. Sac pressure was identical to systemic pressure at all sites in the controls. In 12 thrombus specimens (6 patients) examined in the pressure cell, pressure transmission varied significantly between specimens, correlating directly with matrix density (R(2)=0.747, p=0.001).
Pressure transmission through aneurysm thrombus is variable and depends upon the microstructure of the thrombus. Pressure measured at a single location may not, therefore, accurately reflect the pressure acting on the aneurysm wall.
通过研究（1）动脉瘤血栓内压力是否均匀分布，（2）压力通过动脉瘤血栓的传递情况，以及（3）压力传递的微观结构基础，来确定在动脉瘤囊血栓内单个位置测量的压力是否能准确反映施加于动脉瘤壁的力以及破裂风险。
在开放腹主动脉瘤修复术中，通过直接穿刺动脉瘤壁在26例患者的121个部位测量动脉瘤血栓内的压力。在交叉钳夹前进行测量，并与6例无动脉瘤血栓患者（对照组）在30个部位测量的瘤内压力进行比较。通过在定制的压力池中使新鲜血栓承受压力梯度，对压力通过动脉瘤血栓的传递进行离体进一步研究。压力传递与通过光学显微镜和图像分析确定的基质密度相关。
11例患者动脉瘤血栓内的平均压力高于平均体循环压力，1例低于平均体循环压力，9例相同。在5例患者中，血栓某些区域的压力高于体循环压力，而其他区域则较低。对照组所有部位的囊内压力与体循环压力相同。在压力池中检查的12个血栓标本（6例患者）中，标本之间的压力传递差异显著，与基质密度直接相关（R² = 0.747，p = 0.001）。
压力通过动脉瘤血栓的传递是可变的，取决于血栓的微观结构。因此，在单个位置测量的压力可能无法准确反映作用于动脉瘤壁的压力。
