Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture
Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture
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DOI：
10.1016/j.jvs.2008.06.063
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发表时间：
2008-11-01
影响因子：
4.3
通讯作者：
Swedenborg, Jesper
中科院分区：
文献类型：
--
作者：
Roy, Joy;Labruto, Fausto;Swedenborg, Jesper
目的：应用多层螺旋CT诊断腹主动脉瘤(AAA)患者的腔内血栓出血征象及破裂部位。我们分析了瑞典斯德哥尔摩两家医院3年来42例肾下AAA破裂患者的CT图像。“新月征”或血栓内密度较高的局限性区域被解释为血栓内出血的迹象。局限性的高密度影不具有典型的新月形，与血栓中的钙化相区别。我们使用CT软件测量腔内血栓中Hounsfield单位的衰减，以量化血栓中血液的存在。结果：月牙征在破裂组的发生率较高(38%比14%，P=.02)，但两组的局部高密度区无显著差异。破裂患者的血栓衰减显著高于完整动脉瘤患者(P=0.02)。破裂部位可定位29/42例。破裂均发生在血栓覆盖和无血栓的壁上。破裂部位位于左侧占45%，位于前壁占24%，位于右侧占24%，位于后壁仅占7%。结论：常规多层螺旋CT可明确大多数AAA的破裂部位。这项研究表明，血栓中血液的存在与新月征和AAA破裂之间存在关联，这是由较高的衰减水平所提示的。如果这些发现也能预测腹主动脉破裂，还有待证实。(《外科医生杂志》2008；48：1108-13。)
Objective: The aim of this study was to determine signs of bleeding in the intraluminal thrombus and the site of rupture using multislice computed tomography (CT) imaging in patients with abdominal aortic aneurysms (AAA).Methods. We analyzed CT images of 42 patients with ruptured infrarenal AAA in two hospitals in Stockholm, Sweden during a 3-year period. A "crescent sign" or localized areas with higher attenuation in the thrombus were interpreted as signs of bleeding in the thrombus. A localized area of hyperattenuation did not have the typical crescent shape and was distinguished from calcifications in the thrombus. We measured the attenuation in Hounsfield units in the intraluminal thrombus using CT software to quantify the presence of blood in the thrombus. As controls, we analyzed 36 patients with intact AAA and a comparable aneurysm diameter and age.Results: The crescent sign vas more frequent in the ruptured group (38% vs 14%, P = .02), but there was no significant difference in the presence of localized areas of hyperattenuation in the two groups. The attenuation in the thrombus was significantly higher in patients with rupture than in those with intact aneurysms (P = .02). The site of rupture could be localized in 29/42 patients. Ruptures occurred both through the thrombus-covered and the thrombus free wall. In 45% of the patients, the rupture site was localized in the left lateral wall, in 24% in the anterior wall, in 24% ill the right lateral wall, but only in 7% in the posterior wall.Conclusion: The site of rupture could be identified in a majority of cases of AAA with routine multislice CT. This study demonstrates an association between the presence of blood in the thrombus as suggested by higher attenuation levels and a crescent sign and AAA rupture. If these findings also predict AAA rupture, remains to be established. (J Vasc Surg 2008;48:1108-13.)