Bruijn Laura E, van Stroe Gómez Charid G, Curci John A, Golledge Jonathan, Hamming Jaap F, Jones Greg T, Lee Regent, Matic Ljubica, van Rhijn Connie, Vriens Patrick W, Wågsäter Dick, Xu Baohui, Yamanouchi Dai, Lindeman Jan H
Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
Section of Surgical Sciences, Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
JVS Vasc Sci. 2021 Oct 7;2:260-273. doi: 10.1016/j.jvssci.2021.09.001. eCollection 2021.
Two consensus histopathological classifications for thoracic aortic aneurysms (TAAs) and inflammatory aortic diseases have been issued to facilitate clinical decision-making and inter-study comparison. However, these consensus classifications do not specifically encompass abdominal aortic aneurysms (AAAs). Given its high prevalence and the existing profound pathophysiologic knowledge gaps, extension of the consensus classification scheme to AAAs would be highly instrumental. The aim of this study was to test the applicability of, and if necessary to adapt, the issued consensus classification schemes for AAAs.
Seventy-two AAA anterolateral wall samples were collected during elective and emergency open aneurysm repair performed between 2002 and 2013. Histologic analysis (hematoxylin and eosin and Movat Pentachrome) and (semi-quantitative and qualitative) grading were performed in order to map the histological aspects of AAA. Immunohistochemistry was performed for visualization of aspects of the adaptive and innate immune system, and for a more detailed analysis of atherosclerotic lesions in AAA.
Because the existing consensus classification schemes do not adequately capture the aspects of AAA disease, an AAA-specific 11-point histopathological consensus classification was devised. Systematic application of this classification indicated several universal features for AAA (eg, [almost] complete elastolysis), but considerable variation for other aspects (eg, inflammation and atherosclerotic lesions).
This first multiparameter histopathological AAA consensus classification illustrates the sharp histological contrasts between thoracic and abdominal aneurysms. The value of the proposed scoring system for AAA disease is illustrated by its discriminatory capacity to identify samples from patients with a nonclassical (genetic) variant of AAA disease.
已发布了两种关于胸主动脉瘤（TAA）和炎性主动脉疾病的共识组织病理学分类，以促进临床决策和研究间比较。然而，这些共识分类并未特别涵盖腹主动脉瘤（AAA）。鉴于其高患病率以及现有的深刻病理生理学知识空白，将共识分类方案扩展至AAA将非常有用。本研究的目的是测试已发布的AAA共识分类方案的适用性，并在必要时进行调整。
在2002年至2013年期间进行的择期和急诊开放性动脉瘤修复术中收集了72个AAA前外侧壁样本。进行了组织学分析（苏木精和伊红染色以及Movat五色染色）和（半定量和定性）分级，以描绘AAA的组织学特征。进行免疫组织化学以观察适应性和先天性免疫系统的特征，并对AAA中的动脉粥样硬化病变进行更详细的分析。
由于现有的共识分类方案不能充分涵盖AAA疾病的特征，因此设计了一种特定于AAA的11分组织病理学共识分类。该分类的系统应用表明AAA有几个普遍特征（例如，[几乎]完全弹性纤维溶解），但其他方面（例如，炎症和动脉粥样硬化病变）存在相当大的差异。
这首个多参数AAA组织病理学共识分类说明了胸主动脉瘤和腹主动脉瘤之间明显的组织学差异。所提出的AAA疾病评分系统的价值体现在其能够区分来自患有非典型（遗传）变异AAA疾病患者的样本。
