Juraszek Andrzej, Bayer Günther, Dziodzio Tomasz, Kral Artur, Laufer Günther, Ehrlich Marek
Department of Cardiac Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
J Cardiothorac Surg. 2013 Apr 24;8:110. doi: 10.1186/1749-8090-8-110.
Little 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.
Intraoperatively 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.
Medial 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).
Medial 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.
关于急性和慢性主动脉病变在中膜退变、动脉粥样硬化和主动脉炎方面的组织学模式，以及它们在不同年龄组中的分布，目前了解甚少。本研究的目的是评估术中获取的主动脉标本的组织病理学发现，以了解中膜退变、动脉粥样硬化和主动脉炎的发生率。
对151例患者术中获取的主动脉标本进行评估，其中包括83例（55%）主动脉瘤（65例胸主动脉瘤，18例腹主动脉瘤）和68例（45%）急性A型主动脉夹层。使用的组织学染色方法包括苏木精-伊红染色、范吉森染色以及阿尔辛蓝染色。患者按年龄65岁上下进行分层。高度中膜退变表现为整个主动脉壁内黏液样物质积聚。高度动脉粥样硬化表现为严重的内膜纤维化、巨噬细胞和泡沫细胞大量积聚或主动脉壁大量钙化。
106例（70%）患者诊断为中膜退变，其中55例（52%）为主动脉瘤，51例（48%）为急性A型主动脉夹层。年龄<65岁的胸主动脉瘤患者中50%存在高度中膜退变，≥65岁的患者中这一比例为44%（p = 0.64）；年龄<65岁的胸主动脉夹层患者中36%存在高度中膜退变，≥65岁的患者中这一比例为14%（p = 0.07）。71例（47%）患者诊断为动脉粥样硬化，其中46例（65%）为主动脉瘤，25例（35%）为主动脉夹层。年龄<65岁的胸主动脉瘤患者中23%存在高度动脉粥样硬化，≥65岁的患者中这一比例为36%（p = 0.24）；年龄<65岁的主动脉夹层患者中13%存在高度动脉粥样硬化，≥65岁的患者中这一比例为52%（p < 0.001）。主动脉炎罕见（n = 2）。
在这一系列主动脉标本中，中膜退变是最常见的诊断。中膜退变在65岁以上和以下的患者中同样常见。然而，在急性A型主动脉夹层病例中，高度动脉粥样硬化是65岁以上患者的主要组织病理学诊断。急性A型主动脉夹层在不同年龄组似乎有不同的潜在病理改变。
