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Das Schicksal des thorakoabdominellen Postdissektionsaortenaneurysmas: die histopathologische Narbe

The fate of thoracoabdominal post-dissection aortic aneurysms: the histopathological scar

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Zusammenfassung

Hintergrund

Neben hämodynamischen Veränderungen im Lumen der dissezierten Aorta, spielen Veränderungen der Wandintegrität eine entscheidende Rolle bei der Entstehung des thorakoabdominellen Postdissektionsaneurysmas.

Fragestellung

Evaluation der manifesten Degeneration der Media und der elastischen Fasern bei Postdissektionsaneurysmen.

Material und Methode

Histopathologische Begutachtung des Aortenwandgewebes von Patienten und Primaten mithilfe von HE- und Movat-Färbungen. Statistische Auswertung der Degenerationsmerkmale und Diskussion der aktuellen Literatur.

Ergebnisse

Diffuse Mediadegenerationen und Fibrosen werden ubiquitär in der aneurysmatischen Aorta gefunden. Signifikante Unterschiede lassen sich in allen aortalen Segmenten zwischen Patienten- und Primatenproben nachweisen, jedoch wird der größte Unterschied in den abdominellen Bereichen beobachtet. Von der Degeneration der elastischen Fasern ist die abdominelle Aorta am stärksten betroffen. In der Gruppe der Primaten wurden die höchsten Werte in den thorakalen Bereichen detektiert.

Schlussfolgerungen

Postdissektionsaneurysmen zeigen sich histopathologisch mit einer End-stage-Mediadegeneration und Vernarbung der aortalen Wand. Die kompromittierte Wandintegrität weist auf eine zelluläre Umwandlung der Gefäßwandschicht hin, die neben der veränderten Hämodynamik der Dissektion, die Wachstumsprogredienz der Aneurysmen begünstigen könnte. Zukünftige Untersuchungen der zugrunde liegenden zellulären Prozesse und ihre eventuelle Korrelation mit zirkulierenden Biomarkern könnten zu neuen Screening-Methoden führen.

Abstract

Background

In addition to changes in the intraluminal hemodynamics of a dissected aorta, changes in the integrity of the aortic wall also plays an important role in the development of thoracoabdominal post-dissection aneurysms.

Objective

Evaluation of manifest degeneration of the aortic tunica media and elastic fibers in post-dissection aneurysms.

Material and methods

Histopathological assessment of aortic wall tissue taken from patients and primates using HE and Movat staining. Statistical analysis of degeneration characteristics and discussion of the current literature.

Results

Diffuse degeneration of the tunica media and fibrosis were ubiquitously found in aneurysmatic aortic segments. Significant differences between humans and primate samples were also observed in every aortic segment; however, the biggest difference was detected in the abdominal aorta. Elastic fiber degradation also reached its peak in the abdominal aorta. In contrast, the highest values in the primate group were found in the thoracic region.

Conclusion

Post-dissection aneurysms histologically show an end-stage media degradation and scarring of the aortic wall. The compromised wall integrity implicates a cellular transformation of the vascular wall layers, which facilitates aneurysmatic growth progression in addition to the altered hemodynamics of the dissection. Future investigations of the underlying cellular processes and their possible correlation with circulating biomarkers could lead to new screening methods.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    Panagiotis Doukas, Bernhard Hruschka, Cathryn Bassett, Michael Jacobs & Alexander Gombert

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  1. Panagiotis Doukas
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  2. Bernhard Hruschka
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  3. Cathryn Bassett
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  4. Michael Jacobs
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  5. Alexander Gombert
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Correspondence to Panagiotis Doukas.

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Interessenkonflikt

P. Doukas, B. Hruschka, C. Bassett, M. Jacobs und A. Gombert geben an, dass kein Interessenkonflikt besteht.

Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Doukas, P., Hruschka, B., Bassett, C. et al. Das Schicksal des thorakoabdominellen Postdissektionsaortenaneurysmas: die histopathologische Narbe. Gefässchirurgie 27, 246–252 (2022). https://doi.org/10.1007/s00772-022-00902-4

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