Steady flow in models of abdominal aortic aneurysms. Part II: Wall stresses and their implication for in vivo thrombosis and rupture.

In a continuing investigation into the mechanical factors that lead to rupture of abdominal aortic aneurysms, wall pressure and shear stress measurements are presented for steady flow through the series aneurysm models described in Part I. These models simulate in vivo aortic aneurysms of diameters from 3.3 to 7.5 cm; the flow rates through the models were dynamically matched to aortic flows under conditions ranging from rest to exercise. For all models, at all flow rates, a pressure maximum was found at the midpoint of the model bulge. This maximum increased with bulge diameter, suggesting that the largest aneurysms in vivo are exposed to the greatest pressures. When the flow was turbulent, the mean wall shear stress at the proximal end of the model bulge had magnitude 2 to 4 dynes/cm2, approximately equal to its value in an undilated tube. However, at the distal end of the model bulge the mean shear stress increased to 5 to 10 dynes/cm2, whereas the peak instantaneous shear stress exceeded the mean by an order of magnitude. When extrapolated to in vivo parameters, the maximum distal wall shear stress reached levels near those capable of disrupting endothelium. This suggests that turbulence in in vivo aneurysms may precipitate thrombus formation. Subsequent decreased luminal diameters in the presence of thrombus would then lessen the likelihood of turbulent flow and reduce the strength of any turbulence that did occur. It would also reduce the pressure in the aneurysmal bulge. Thus, the presence of turbulent flow may significantly affect risk of rupture.