Evaluation of the intraoperative specimens of the thoracic and abdominal aorta

Abstract

BackgroundLittle is known about the histological patterns of acute and chronic aortic pathology with regard to medial degeneration, atherosclerosis and aortitis as well as their distribution in different age groups. The aim of the study was to evaluate histopathological findings of intraoperatively gained aortic specimens with regard to the incidence of medial degeneration, atherosclerosis and aortitis.MethodsIntraoperatively gained aortic specimens were evaluated in 151 patients including 83 (55%) aortic aneurysms (65 thoracic, 18 abdominal) and 68 (45%) acute type A aortic dissections. Histological stainings used were hematoxylin and eosin, Van Gieson as well as alcian blue. Patients were stratified according to above and below 65 years of age. High grade medial degeneration represented pooling of mucoid material in the whole aortic wall. High grade atherosclerosis represented severe intimal fibrosis, massive accumulation of macrophages and foam cells or massive calcification of the aortic wall.ResultsMedial degeneration was diagnosed in 106 (70%) patients including 55 (52%) aortic aneurysms and 51 (48%) acute type A aortic dissections. High grade medial degeneration was found in 50% of patients with thoracic aortic aneurysms < 65 years of age vs. 44% in patients ≥ 65 years of age (p = 0.64) and in 36% of patients with thoracic aortic dissections < 65 years of age vs. 14% in patients ≥ 65 years of age (p = 0.07). Atherosclerosis was diagnosed in 71 (47%) patients including 46 (65%) aortic aneurysms and 25 (35%) aortic dissections. High grade atherosclerosis was found in 23% of patients with thoracic aneurysms < 65 years of age vs. 36% in patients ≥ 65 years of age (p = 0.24) and in 13% of patients with aortic dissections < 65 years of age vs. 52% in patients ≥ 65 years of age (p < 0.001). Aortitis was rare (n = 2).ConclusionsMedial degeneration was the most frequent diagnosis in this series of aortic specimens. Medial degeneration was equally common in patients above and below 65 years of age. However in cases with acute type A aortic dissections, high grade atherosclerosis was the leading histopathological diagnosis in patients older than 65 years. Acute type A aortic dissections seem to have different underlying pathologies in different age groups.

Aortic tissue pathology in reoperative post-dissection repair following prior use of BioGlue

“…Hypertension is a known risk factor for acute type A aortic dissection, and other factors, such as atherosclerosis, also likely contribute to the weakening of the aortic wall. 15,16 In our study, hypertension was a comorbidity present in all participants, and we are unable to determine the exact role that the presence of this or other comorbidities played in the need for aortic reoperation. While patients with history of vasculitis, chronic inflammatory disease, or autoimmune disease were excluded from enrollment, such history relied on the patient's own report, and the possibility of undiagnosed disorders should be considered.…”

“…Possible causes include cystic medial degeneration, atherosclerosis, or medial ischemia due to disruption of the vasa vasorum. [15][16][17] Mismatch between the mechanical properties of the adhesive and graft material used has also been proposed as a mechanism of pseudoaneurysm formation, particularly in cases without an associated inflammatory reaction. 1 Aortic tissue from 1 patient exhibited a marked inflammatory response consisting of a necrotizing granulomatous inflammatory infiltrate, which was not observed in tissue samples from any other patient.…”

“…These degenerative changes may be related to the patient's primary aortic disease, as medial degeneration is a common histologic finding associated with aortic dissection. 15,16 While there is no histologic evidence to directly link BioGlue with these degenerative changes, the role it may have played in the development of these complications remains unclear. BioGlue-induced local toxicity has been proposed as a likely cause of pseudoaneurysm formation following aortic surgery.…”

The Role of Atherosclerosis and Inflammation in the Development of Descending Aortic Aneurysms: Special Aspects of Medical Correction

“…For years, degenerative atherosclerotic changes in aortic wall have been blamed for the development of aneurysm of descending aorta. At the same time, some authors [4]- [7] underline a number of significant differences between atherosclerosis and aneurysm. Thus, atherosclerosis is primarily localized in the intima and is productive due to accumulated atherosclerotic plaques, which contributes to the development of aortoiliac occlusive disease (Leriche's syndrome).…”

Computed Tomography of Aortic Wall Calcifications in Aortic Dissection Patients

“…Furthermore, pathologic studies suggest that on average at all ages the amount of calcium is higher in the tunica media compared to the intima [13], [14]. Additionally, Juraszek et al [15] observed a clear association between medial degeneration and type A aortic dissections in patients below 65 years of age, while in those above 65 years type A aortic dissections were associated with atherosclerosis. Thin, mainly circular, wall calcifications in the tunica media are associated with aortic stiffening, increased pulse pressure, reduced coronary blood flow and left ventricular hypertrophy [16], [17], [18].…”