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Intraluminal thrombus: Innocent bystander or factor in abdominal aortic aneurysm pathogenesis?

April J Boyd1

  • 1Department of Vascular Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.

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|October 7, 2021
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Summary
This summary is machine-generated.

Intraluminal thrombus (ILT) in abdominal aortic aneurysms (AAAs) is not benign. While potentially protective initially, growing ILT volume and age increase rupture risk by damaging the aortic wall.

Keywords:
Abdominal aortic aneurysmAortic ruptureIntraluminal thrombus

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Area of Science:

  • Vascular Biology
  • Biomedical Engineering
  • Pathophysiology

Background:

  • Abdominal aortic aneurysms (AAAs) are complex conditions involving hemodynamic, thrombotic, and inflammatory processes, often leading to fatal rupture.
  • Despite advances in screening and surgery, AAA rupture mortality remains high, with limited nonoperative treatment options.
  • Intraluminal thrombus (ILT), common in AAAs, is increasingly implicated in aneurysm pathogenesis.

Purpose of the Study:

  • To review current clinical and experimental evidence on the role of intraluminal thrombus (ILT) in abdominal aortic aneurysm (AAA) growth and rupture.
  • To examine the structure, composition, and hemodynamics of ILT formation and its relation to AAA wall degeneration.
  • To discuss controversies and emerging evidence regarding ILT's impact on AAA rupture risk.

Main Methods:

  • Literature review of PubMed database from 2012 to June 2020.
  • Search terms included "abdominal aortic aneurysm" and "intraluminal thrombus."
  • Analysis of clinical and experimental studies on ILT characteristics and AAA progression.

Main Results:

  • ILT formation involves complex hemostatic and proteolytic factors.
  • While ILT may initially reduce wall stress, evidence indicates increased ILT volume and age promote AAA wall degeneration.
  • Controversies exist regarding ILT's position, thickness, and composition in relation to rupture risk.

Conclusions:

  • Intraluminal thrombus (ILT) plays an active role in abdominal aortic aneurysm (AAA) pathophysiology, not merely as an "innocent bystander."
  • Evidence suggests ILT promotes AAA wall degeneration, despite some computational models indicating a protective role against wall stress.
  • Further research, particularly using chronic ILT models, is essential for understanding ILT's precise role and developing targeted therapies.