Chen Hongbing, Su Tong, Wang Qi, Zheng Zhe, Li Hongwei, Li Jianbo
Department of Forensic Medicine, Faculty of Basic Medical Sciences, Chongqing Medical University, Chongqing, China.
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Technol Health Care. 2023;31(3):1003-1015. doi: 10.3233/THC-220481.
Aneurysms are associated with a mortality rate of 81% or more in cases of rupture. Intraluminal thrombus (ILT) is a common complication of aneurysms, it can greatly increase the risk of rupture. Especially for some of the more complex aneurysms, physicians need to consider the risk of thrombosis or progression and precisely formulate a treatment plan. Therefore, it is particularly important to assess the level of thrombosis risk through haemodynamics.
To analyse the haemodynamic indices and compare the thrombosis risk in a double false lumen abdominal aortic dissection aneurysm using computational fluid dynamics (CFD).
Computer tomography angiography (CTA) imaging data were collected from a patient with a double false lumen abdominal aortic dissection aneurysm, and three different lesion morphology aneurysm models were established, double false lumen abdominal aortic dissection aneurysm, single false lumen abdominal aortic dissection aneurysm and saccular abdominal aortic aneurysm, in order to analyse the flow velocity, time-averaged shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT) of blood flow, and endothelial cell activation potential (ECAP).
All three aneurysms were in a low-flow state within the body, and the low-flow velocity flow in the proximal vessel wall extended to the right common iliac artery; the vortex intensity was more intense in the abdominal aortic dissection aneurysm than in the saccular abdominal aortic aneurysm. The risk area for thrombosis was concentrated in the expansion part of the aneurysm and the false lumen. The RRT and ECAP maxima of the double false lumen abdominal aortic dissection aneurysm were much greater than those of the single false lumen dissection aneurysm and saccular aortic aneurysm.
Low-velocity blood flow, high OSI, low TAWSS, high RRT, and high ECAP regions correlate with the risk of thrombosis. The double false lumen type of abdominal aortic dissection aneurysm had some specificity in this case. The risk of thrombosis in the patient was extremely high, and the largest risk zone was within the smaller false lumen, which could be because the smaller false lumen was connected to the true lumen by only one breach. The results of the study provide some guidance in the early screening and development of treatment plans.
动脉瘤破裂时的死亡率高达81%或更高。腔内血栓（ILT）是动脉瘤的常见并发症，会大大增加破裂风险。特别是对于一些较为复杂的动脉瘤，医生需要考虑血栓形成或进展的风险，并精确制定治疗方案。因此，通过血流动力学评估血栓形成风险水平尤为重要。
利用计算流体动力学（CFD）分析双腔假腔腹主动脉夹层动脉瘤的血流动力学指标并比较其血栓形成风险。
收集一名双腔假腔腹主动脉夹层动脉瘤患者的计算机断层血管造影（CTA）成像数据，建立三种不同病变形态的动脉瘤模型，即双腔假腔腹主动脉夹层动脉瘤、单腔假腔腹主动脉夹层动脉瘤和囊状腹主动脉瘤，以分析血流速度、时间平均剪应力（TAWSS）、振荡剪应力指数（OSI）、血流相对停留时间（RRT）和内皮细胞激活潜能（ECAP）。
三种动脉瘤在体内均处于低血流状态，近端血管壁的低流速血流延伸至右髂总动脉；腹主动脉夹层动脉瘤内的涡流强度比囊状腹主动脉瘤更强。血栓形成的风险区域集中在动脉瘤的扩张部位和假腔内。双腔假腔腹主动脉夹层动脉瘤的RRT和ECAP最大值远大于单腔假腔夹层动脉瘤和囊状主动脉瘤。
低血流速度、高OSI、低TAWSS、高RRT和高ECAP区域与血栓形成风险相关。在该病例中，双腔假腔型腹主动脉夹层动脉瘤具有一定特异性。该患者的血栓形成风险极高，最大风险区域位于较小的假腔内，这可能是因为较小的假腔仅通过一个破口与真腔相连。本研究结果为早期筛查和治疗方案制定提供了一定指导。
