Chronic aortiс dissection: pathomorphological characteristics.

Authors

DOI:

https://doi.org/10.26641/1997-9665.2018.3.85-89

Keywords:

chronic dissection aortic aneurysms, aortic vascular remodeling, aortic pathology

Abstract

Background. Chronic aortic dissection (CAD) is a poorly understood vascular pathology. Etiology, pathogenesis, pathomorphological and clinical changes are not fully elucidated. The presence of open questions in their morphogenesis and pathomorphological picture creates difficulties in clinical diagnosis and gives rise to discussions in the choice of treatment. Objective – determinate pathomorphological changes of CAD. Methods. The analysis of 31 cases of surgical material for patients undergoing surgery on CAD was conducted. Among the operatives men dominated – 22 (70.9%), women were nine (29.1%). The age of patients ranged from 47 to 59 years. Aortic preparations were painted hematoxylin-eosin, resorcinol-fuchin for Chart, picrofuscin for Weigert, trichrome Mason. Results. The cavity of the dissection looked like a two-channel, located on the verge of adventitia and mediums, filled with blood convections, with the spread of hemorrhagic infiltration to periadventicial fatty tissue. The new pseudo-channel in one third of cases contained blood convection and fresh thrombi, and the old one was completely covered with endothelium with neointimal formation. In the media were detected massive elastolysis with contours of hyperchromic elastic fibers with signs of hyperlastosis, multiple thin layers of connective tissue fibers located between randomly scattered smooth muscle cells and collagen fibers, deeper definitions of massive enlargement of connective tissue. Conclusions. In the pathomorphological study of CAD, connective tissue remodeling of the aorta in the form of randomly located immature mesenchymal cells in combination with muscular and connective tissue transformation was revealed. The processes of vascular remodeling can provide the relative clinical stability of HRAA.

References

  1. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease. J Am Coll Cardiol. 2010;55(14):27-129. doi:10.1016/j.jacc.2010.02.015
  2. Zerbino DD, Kuzyk JuI. [Dissecting aortic aneurysm: clinical masks, features of differential diagnosis]. Clinical medicine. 2002;5:58–61. Russian.
  3. Oda T, Minatoya K, Sasaki H, Tanaka H, Seike Y, Itonaga T, Inoue Y, Higashi M, Nishimura K, Kobayashi J. Surgical Indication for Chronic Aortic Dissection in Descending Thoracic and Thoracoabdominal Aorta. Circ Cardiovasc Interv. 2017;10:1-7. doi:10.1161/CIRCINTERVENTIONS.116.004292.
  4. Carnevale D, Lembo G, Frati G. Chronic type A aortic dissection: Could surgical intervention be guided by molecular markers? J Cell Mol Med. 2011;15:1615-19. doi:10.1111/j.1582-4934.2011.01314.
  5. Hynes CF, Greenberg MD, Sarin S, Trachiotis GD. Chronic Type A Aortic Dissection. Two Cases and a Review of Current Management Strategies. Aorta (Stamford). 2016;4(1):16-21. doi:10.19161/etd.418028
  6. Beebeejaun M, Malec A, Gupta R. Conservative management of chronic aortic dissection with underlying aortic aneurysm. Heart International. 2013;8(4):15-8. doi:10.4081/hi.2013.e4
  7. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, Rakowski H, Struyven J, Radegran K, Sechtem U, Taylor J, Zollikofer Ch, Klein WW, Mulder B, Providencia LA. Diagnosis and management of aortic dissection. Eur Heart J. 2001;22:1641–81. doi:10.1053/euhj.2001.2782
  8. Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O'Gara PT, Shahian DM, Schaff HV, Akins CW, Bavaria JE, Blackstone EH, David TE, Desai ND, Dewey TM, D'Agostino RS, Gleason TG, Harrington KB, Kodali S, Kapadia S, Leon MB, Lima B, Lytle BW, Mack MJ, Reardon M, Reece TB, Reiss GR, Roselli EE, Smith CR, Thourani VH, Tuzcu EM, Webb J, Williams MR. Aortic valve and ascending aorta guidelines for management and quality measures. Ann Thorac Surg. 2013;95:1491–505. doi:10.1016/j.athoracsur.2012.12.027.
  9. Frederick JR, Woo YJ. Thoracoabdominal aortic aneurysm. Ann Cardiothorac Surg. 2012;1:277–85. doi:10.3978/j.issn.2225-319x.2012.09.01
  10. Palma J, Gaia D, Guilhen JS, Buffolo E. Endovascular treatment of chronic type A dissection. Interact Cardiovasc Thorac Surg. 2008;7:164–6. doi:10.1510/icvts
  11. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca RN, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos J, Robles Y, Llovet A, Gilon D, Sugata K, Armstrong WF, Deeb GM, Eagle KA. The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease. JAMA. 2000;283(7):897-903. doi:10.1001/JAMA.283.7.897.

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Kuzyk, Y. I., & Sira, O. O. (2018). Chronic aortiс dissection: pathomorphological characteristics. Морфологія / Morphologia / Morfologìâ, 12(3), 85–89. https://doi.org/10.26641/1997-9665.2018.3.85-89

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Vol. 12 No. 3 (2018)

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