The blood flow channel index as novel predictor of abdominal aortic aneurysm impending rupture based on the intraluminal thrombus angio-CT study

Objective: In this study the hypothesis that the thickness of the thinnest part of the thrombus, combined with bleeding into the intraluminal thrombus (ILT), is associated with a possible higher risk of abdominal aortic aneurysm (AAA) rupture was investigated, independently of aneurysm diameter, by using angio-CT. This article describes blood flow channel index based on the CT imaging findings that may help identify impending rupture prior to complete rupture. Methods: Computed tomographic images of 310 hospitalized patients with infrarenal AAA, were collected over a three-year period. They were divided into two main groups: 125 with bleeding into the ILT and control group 185 without the presence of blood in the thrombus. Patients were also analyzed in subgroups with ruptured, symptomatic and asymptomatic AAAs. A blood flow channel index was formulated as: maximal/minimal thickness ratio of thrombus from the same CT scan. Results: In dissected ILT group blood flow channel index was over a twofold higher than in group with intact ILT (19.0 [1.2-89.3] vs. (9.7 [1.3-38.9]; p < 0.001), respectively. Median thickness at the thinnest part of the ILT in dissected thrombus group was lower (1.3 mm [0.3-16.0]) than in group with intact ILT (1.7 mm [0.2-23.4]; p < 0.003). Conclusion: An association between a high blood flow channel index and bleeding into the ILT based on angio-CT study was demonstrated, and can suggest the aneurysm propensity for rupture. (C) 2015 Elsevier Ireland Ltd. All rights reserved.