Hydrodynamic Forces in Dissecting Aneurysms

It has been argued that pulse wave characteristics are important factors in extension and rupture of acute dissecting aneurysms. To test this, a standard model of an aorta was constructed, consisting of an outer layer of Tygon tubing and an inner layer of rubber cement. An "intimal tear" was produced and the "aorta" was subjected to nonpulsatile and pulsatile flow with increasing increments of pressure. With nonpulsatile flow alone (97 experiments) no dissection occurred at pressures up to 400 mm Hg. Pulsatile flow produced rapid and usually complete dissection with a maximum systolic pressure of 120 mm Hg. The extent of dissection per pulse was related to dp/dt max in the fluid. No dissection occurred until a critical value of dp/dt max (790 mm Hg/sec) was reached. Dog aortas were then used in place of the Tygon tube "aorta" with similar results; i.e., dissection did not occur with nonpulsatile flow, but did occur with pulsatile flow (3800 mm Hg/sec). The dissecting dog aorta ruptured to the outside or reentered the vessel lumen. It was concluded that pulse wave characteristics, particularly dp/dt max , are important in the propagation of dissection.