Adult: Aorta
The complex interplay among atherosclerosis, inflammation, and degeneration in ascending thoracic aortic aneurysms

https://doi.org/10.1016/j.jtcvs.2019.08.108Get rights and content
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Abstract

Objective

To assess the histopathological findings of a large series of ascending thoracic aortic aneurysm (TAA) surgical specimens applying the updated classification on noninflammatory degenerative and inflammatory aortic diseases proposed by the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology clinicopathological correlations.

Methods

A total of 255 patients surgically treated for ascending TAA were enrolled. Surgical ascending aorta specimens were examined.

Results

The histopathological substrate of ascending TAAs was mainly degenerative (67.5%), but with a remarkable prevalence of atherosclerotic lesions (18.8%) and aortitis (13.7%). Degenerative patients more frequently had bicuspid aortic valve (37.2%; P = .002). Patients in the atherosclerotic group were older (median age, 69 years; P < .001), more often with a history of hypertension (87.5%; P = .059), hypercholesterolemia (75%; P = .019), diabetes (16.6%; P = .054), current smoking (22.9%; P = .066), and a history of coronary artery disease (18.7%; P = .063). Patients with aortitis represented the older group (median age, 75 years, P < .001), were mostly females (68.6%; P < .001), and had a larger ascending aorta diameter (median, 56 mm; P < .001). Both patients with atherosclerosis and aortitis presented a higher incidence of concomitant abdominal aortic aneurysm (20.8% and 22.8%, respectively; P < .001).

Conclusions

Although degenerative histopathology is the most frequent substrate in ascending TAA, atherosclerosis and inflammation significantly contribute to the development of chronic aortic thoracic disease.

Key Words

aortic aneurysm
aortitis
atherosclerosis
aortic media degeneration
cardiac surgery

Abbreviations and Acronyms

AAS
acute aortic syndrome
AECVP
Association for European Cardiovascular Pathology
AHA
American Heart Association
BAV
bicuspid aortic valve
CAD
coronary artery disease
EFFL
elastic fiber fragmentation/loss
EFTO
elastic fiber thinning out
ICI
intralamellar collagen increase
I-MEMA
intralamellar mucoid extracellular matrix accumulation
LMC
laminar medial collapse
MD
medial degeneration
SCVP
Society for Cardiovascular Pathology
TAA
thoracic aortic aneurysm
TCI
translamellar collagen increase
T-MEMA
translamellar mucoid extracellular matrix accumulation

Cited by (0)

This study was partially funded by the Fanti Melloni Foundation, University of Bologna.