Origuchi N, Ohkawa S, Esaki Y, Yoshida Y, Shigematsu H
Department of Vascular Surgery, University of Tokyo, Japan.
Jpn Heart J. 2001 Sep;42(5):597-606. doi: 10.1536/jhj.42.597.
The purpose of this study was to examine complicated lesions of saccular aneurysm and dissection. We investigated the ascending aortae in 5865 consecutive elderly autopsy cases, and 5 cases (0.085%) of aortic saccular aneurysms associated with dissection at the edges were selected. Their edges characteristically protruded like a shelf, which histologically consisted of an inner part of the dissected media. All patients were female and their mean age was 76.8 (67-89) years. The aneurysmal walls at the center showed severe fragmentation and disappearance of the elastic lamellae of the remaining outer media. Thus, partial sections of these lesions were not sufficient but cross-sections of the whole diseased regions including the edges were essential for diagnosis. One patient had 3 saccular aneurysms and an adjacent shallow depression, which we called "healed microscopic dissection". Histologically, it showed disappearance of the inner media and was replaced by fibrosis in continuation from the intima. This lesion showed no findings of intramural hemorrhage or thrombus, and thus it will differ from organized thrombi in the dissected false lumen. Another patient presented had an aneurysmal rupture which resulted in cardiac tamponade. This case implies the need for surgical treatment of this entity.
本研究的目的是检查囊状动脉瘤和夹层的复杂病变。我们对5865例连续的老年尸检病例的升主动脉进行了调查，选择了5例（0.085%）边缘伴有夹层的主动脉囊状动脉瘤。其边缘特征性地像架子一样突出，组织学上由夹层中膜的内部部分组成。所有患者均为女性，平均年龄为76.8（67 - 89）岁。中心部位的动脉瘤壁显示剩余外膜的弹性板严重破碎和消失。因此，这些病变的部分切片不足以诊断，而包括边缘在内的整个病变区域的横截面对于诊断至关重要。一名患者有3个囊状动脉瘤和一个相邻的浅凹陷，我们称之为“愈合的微观夹层”。组织学上，它显示内膜中层消失，并被来自内膜的纤维化所取代。该病变未显示壁内出血或血栓的迹象，因此它将与夹层假腔内的机化血栓不同。另一名患者出现动脉瘤破裂并导致心脏压塞。该病例表明需要对该实体进行手术治疗。
