A histopathological classification scheme for abdominal aortic aneurysm disease

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...

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Autores principales:	Laura E. Bruijn, BSc, Charid G. van Stroe Gómez, BSc, John A. Curci, MD, Jonathan Golledge, MChir, Jaap F. Hamming, MD, PhD, Greg T. Jones, PhD, Regent Lee, MD, PhD, Ljubica Matic, PhD, Connie van Rhijn, BSc, Patrick W. Vriens, MD, PhD, Dick Wågsäter, PhD, Baohui Xu, PhD, Dai Yamanouchi, MD, PhD, Jan H. Lindeman, MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Abdominal aortic aneurysm Classification Histology Thoracic aortic aneurysm Vascular remodeling Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/7c4355b2d53d4b15864a35f6cc00cde6
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spelling	oai:doaj.org-article:7c4355b2d53d4b15864a35f6cc00cde62021-11-16T04:11:28ZA histopathological classification scheme for abdominal aortic aneurysm disease2666-350310.1016/j.jvssci.2021.09.001https://doaj.org/article/7c4355b2d53d4b15864a35f6cc00cde62021-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666350321000225https://doaj.org/toc/2666-3503Objective: 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. : Clinical Relevance: The pathophysiology of abdominal aortic aneurysm (AAA) disease remains an enigma. Histological evaluation is critical for appreciation of the tissue remodeling and spatial aspects of AAA disease. Histopathological classification schemes have been devised for aortic pathology. Unfortunately, these schemes do not specifically address the most common aortic pathology, AAA disease. In order to facilitate interstudy comparisons and pathophysiologic understanding of AAA disease, we here present a multiparameter consensus histopathological AAA classification scheme. The scheme clearly discriminates AAA disease from thoracic aortic aneurysm disease. Systematic implementation of this AAA classification system indicates a substantial biological variation for AAA disease, and stresses the need for adequate group sizes in order to adequately cover the natural variability. Examples illustrating the diagnostic value of the classification system are provided.Laura E. Bruijn, BScCharid G. van Stroe Gómez, BScJohn A. Curci, MDJonathan Golledge, MChirJaap F. Hamming, MD, PhDGreg T. Jones, PhDRegent Lee, MD, PhDLjubica Matic, PhDConnie van Rhijn, BScPatrick W. Vriens, MD, PhDDick Wågsäter, PhDBaohui Xu, PhDDai Yamanouchi, MD, PhDJan H. Lindeman, MD, PhDElsevierarticleAbdominal aortic aneurysmClassificationHistologyThoracic aortic aneurysmVascular remodelingDiseases of the circulatory (Cardiovascular) systemRC666-701ENJVS - Vascular Science, Vol 2, Iss , Pp 260-273 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Abdominal aortic aneurysm Classification Histology Thoracic aortic aneurysm Vascular remodeling Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Abdominal aortic aneurysm Classification Histology Thoracic aortic aneurysm Vascular remodeling Diseases of the circulatory (Cardiovascular) system RC666-701 Laura E. Bruijn, BSc Charid G. van Stroe Gómez, BSc John A. Curci, MD Jonathan Golledge, MChir Jaap F. Hamming, MD, PhD Greg T. Jones, PhD Regent Lee, MD, PhD Ljubica Matic, PhD Connie van Rhijn, BSc Patrick W. Vriens, MD, PhD Dick Wågsäter, PhD Baohui Xu, PhD Dai Yamanouchi, MD, PhD Jan H. Lindeman, MD, PhD A histopathological classification scheme for abdominal aortic aneurysm disease
description	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. : Clinical Relevance: The pathophysiology of abdominal aortic aneurysm (AAA) disease remains an enigma. Histological evaluation is critical for appreciation of the tissue remodeling and spatial aspects of AAA disease. Histopathological classification schemes have been devised for aortic pathology. Unfortunately, these schemes do not specifically address the most common aortic pathology, AAA disease. In order to facilitate interstudy comparisons and pathophysiologic understanding of AAA disease, we here present a multiparameter consensus histopathological AAA classification scheme. The scheme clearly discriminates AAA disease from thoracic aortic aneurysm disease. Systematic implementation of this AAA classification system indicates a substantial biological variation for AAA disease, and stresses the need for adequate group sizes in order to adequately cover the natural variability. Examples illustrating the diagnostic value of the classification system are provided.
format	article
author	Laura E. Bruijn, BSc Charid G. van Stroe Gómez, BSc John A. Curci, MD Jonathan Golledge, MChir Jaap F. Hamming, MD, PhD Greg T. Jones, PhD Regent Lee, MD, PhD Ljubica Matic, PhD Connie van Rhijn, BSc Patrick W. Vriens, MD, PhD Dick Wågsäter, PhD Baohui Xu, PhD Dai Yamanouchi, MD, PhD Jan H. Lindeman, MD, PhD
author_facet	Laura E. Bruijn, BSc Charid G. van Stroe Gómez, BSc John A. Curci, MD Jonathan Golledge, MChir Jaap F. Hamming, MD, PhD Greg T. Jones, PhD Regent Lee, MD, PhD Ljubica Matic, PhD Connie van Rhijn, BSc Patrick W. Vriens, MD, PhD Dick Wågsäter, PhD Baohui Xu, PhD Dai Yamanouchi, MD, PhD Jan H. Lindeman, MD, PhD
author_sort	Laura E. Bruijn, BSc
title	A histopathological classification scheme for abdominal aortic aneurysm disease
title_short	A histopathological classification scheme for abdominal aortic aneurysm disease
title_full	A histopathological classification scheme for abdominal aortic aneurysm disease
title_fullStr	A histopathological classification scheme for abdominal aortic aneurysm disease
title_full_unstemmed	A histopathological classification scheme for abdominal aortic aneurysm disease
title_sort	histopathological classification scheme for abdominal aortic aneurysm disease
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/7c4355b2d53d4b15864a35f6cc00cde6
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A histopathological classification scheme for abdominal aortic aneurysm disease

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