Mechanisms of Abdominal Aortic Aneurysm Formation in Persons With Traumatic Amputation of a Lower Extremity

Abdominal aortic aneurysms (AAA) are a major cause of morbidity and mortality in the US. The incidence of AAA in older Americans approaches 30%. The most common place of AAA is infrarenal abdominal aorta where oscillatory shear stress (OSS) is present. OSS is known to initiate an inflammatory response in the endothelium. It is known that there is up to a 5-fold increase in the occurrence of AAA in individuals with traumatic amputation of a lower extremity. This increased AAA occurrence is unrelated to co-morbid conditions. We recruited 3 healthy volunteers who underwent infrarenal abdominal aortic Magnetic Resonance angiography and phase contrast imaging. These measurements were done at base line and with acute arterial blood flow occlusion to lower extremity with a blood pressure cuff to mimic amputation. The collected data was used to calculate systolic forward and diastolic retrograde blood flow and wall shear stress during cardiac cycle. Our results suggest that mimicking amputation produces a nearly doubling of retrograde blood flow with ∼50% increase of negative WSS. These changes are more pronounced on the contralateral to the “amputation” side. We conclude that lower extremity traumatic amputations may lead to augmentation of OSS in infrarenal aorta causing AAA development.