A histopathological classification scheme for abdominal aortic aneurysm disease

JVS Vascular Science, vol. 2, pp. 260–273

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Authors 14

1. Laura E. Bruijn Aachen Division of Vascular Surgery Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands

2. Charid G. van Stroe Gómez Aachen Division of Vascular Surgery Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands

3. John A. Curci

   Vanderbilt University · Vanderbilt University Medical Center

   Affiliation as printed

   Section of Surgical Sciences, Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, Tenn

4. Jonathan Golledge

   Townsville Hospital · Australian Institute of Tropical Health and Medicine · James Cook University

   Affiliation as printed

   Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia

   Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia

   Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia

5. Jaap F. Hamming Aachen Division of Vascular Surgery Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands

6. Gregory T. Jones

   University of Otago

   Affiliation as printed

   Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

7. Regent Lee

   University of Oxford

   Affiliation as printed

   Nuffield Dept. of Surgical Sciences, University of Oxford, Headington, United Kingdom

8. Ljubica Perisic Matic

   Karolinska Institutet

   Affiliation as printed

   Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden

9. Connie van Rhijn Aachen Division of Vascular Surgery Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands

10. Patrick W.H.E. Vriens

    Elisabeth-TweeSteden Ziekenhuis

    Affiliation as printed

    Department of Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands

11. Dick Wågsäter

    Uppsala University

    Affiliation as printed

    Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden

12. Baohui Xu

    Stanford Medicine · Stanford University

    Affiliation as printed

    Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif

13. Dai Yamanouchi

    University of Wisconsin–Madison

    Affiliation as printed

    Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc

14. Jan H.N. Lindeman corresponding Aachen Division of Vascular Surgery Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Division of Vascular Surgery, Department of Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands