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CC BY-NC-ND 4.0 · Aorta (Stamford) 2024; 12(02): 025-031
DOI: 10.1055/s-0044-1791669
Original Research Article

Relationship between Neovascularization and Aortic Wall Enhancement in Type A Aortic Dissection

Eisaku Ito 
1   Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
,
Takao Ohki
2   Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
,
Naoki Toya
1   Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
,
Hirokuni Naganuma
3   Department of Cardiac Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
,
Noriyasu Kawada
3   Department of Cardiac Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
,
Koichi Muramatsu
3   Department of Cardiac Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
,
Nei Fukasawa
4   Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
,
Misayo Miyake
4   Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
,
Miku Maeda
4   Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
,
Masayuki Shimoda
4   Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
› Author Affiliations Funding This work was supported by the Japanese Grants-in-Aid for Scientific Research/Japan Society for the Promotion of Science KAKENHI Grant (19K18194), the Japan Arteriosclerosis Prevention Fund Research Grant, and the Japan Heart Foundation Research Grant.
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Abstract

Background Aortic wall enhancement (AWE), evaluated with computed tomography angiography in Type B aortic dissection, is associated with aortic remodeling. This study aimed to evaluate the relationship between AWE and pathological findings of the aortic wall using an aortic wall sample from a Type A aortic dissection (TAD).

Methods We examined patients with TAD treated between January 2012 and February 2023.

Results Twelve cases were examined pathologically: five cases in the hyperacute phase, three in the acute phase, and four in the subacute phase. AWE thickness significantly differed as time progressed (0 vs. 1.7 vs. 2.8 mm, p < 0.001). A significant increase in granulation was observed in the acute and subacute phases (0 vs. 761 vs. 423 µm, p < 0.001). Furthermore, a fibrous complex of internal adventitia (FCIA) developed on the medial side of the adventitia over time since its onset and was found to be thickened (175 vs. 415 vs. 1,078 µm, p < 0.001). The thickness of the granulation tissue and FCIA, where there was abundant neovascularization, was consistent with the thickness of the AWE.

Conclusion AWE was observed in TAD and increased as time progressed. FCIA and granulation tissue developed, and AWE reflected neovascularization at the adventitia.

Keywords

aortic wall enhancement - Type A aortic dissection

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Authors' Contribution

Concept/design: E.I., N.T., and N.F.; data collection: E.I., N.F., K.M., and M.Ma.; data analysis/interpretation: E.I. and N.F.; statistics: E.I. and N.F.; drafting article: E.I. and N.F.; critical revision: E.I., T.O., N.T., H.N., N.K., K.M., N.F., M.Mi., M.Ma., and M.S.; approval: E.I., T.O., N.T., H.N., N.K., K.M., N.F., M.Mi., M.Ma., and M.S.




Publication History

Received: 08 September 2023

Accepted: 01 September 2024

Article published online:
31 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Durham CA, Cambria RP, Wang LJ. et al. The natural history of medically managed acute type B aortic dissection. J Vasc Surg 2015; 61 (05) 1192-1198
    CrossrefPubMedSearch in Google Scholar
  • 2 Afifi RO, Sandhu HK, Leake SS. et al. Outcomes of patients with acute Type B (DeBakey III) aortic dissection: a 13-year, single-center experience. Circulation 2015; 132 (08) 748-754
    CrossrefPubMedSearch in Google Scholar
  • 3 Jonker FH, Trimarchi S, Rampoldi V. et al; International Registry of Acute Aortic Dissection (IRAD) Investigators. Aortic expansion after acute type B aortic dissection. Ann Thorac Surg 2012; 94 (04) 1223-1229
    CrossrefPubMedSearch in Google Scholar
  • 4 Evangelista A, Isselbacher EM, Bossone E. et al; IRAD Investigators. Insights from the International Registry of Acute Aortic Dissection: a 20-year experience of collaborative clinical research. Circulation 2018; 137 (17) 1846-1860
    CrossrefPubMedSearch in Google Scholar
  • 5 Tian DH, De Silva RP, Wang T, Yan TD. Open surgical repair for chronic type B aortic dissection: a systematic review. Ann Cardiothorac Surg 2014; 3 (04) 340-350
    PubMedSearch in Google Scholar
  • 6 Nienaber CA, Kische S, Rousseau H. et al; INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013; 6 (04) 407-416
    CrossrefPubMedSearch in Google Scholar
  • 7 Kanaoka Y, Ohki T, Toya N. et al. Technical challenges in endovascular repair of complex thoracic aortic aneurysms. Ann Vasc Dis 2012; 5 (01) 21-29
    CrossrefPubMedSearch in Google Scholar
  • 8 Kanaoka Y, Ohki T. Midterm results of endovascular treatment for the patients with thoracoabdominal aortic aneurysms. Ann Vasc Dis 2019; 12 (02) 163-170
    CrossrefPubMedSearch in Google Scholar
  • 9 Charilaou P, Ziganshin BA, Peterss S. et al. Current experience with acute Type B aortic dissection: validity of the complication-specific approach in the present era. Ann Thorac Surg 2016; 101 (03) 936-943
    CrossrefPubMedSearch in Google Scholar
  • 10 Ito E, Toya N, Fukushima S, Murakami Y, Akiba T, Ohki T. Aneurysm wall enhancement detected by contrast computed tomography scan is associated with aneurysm shrinkage after endovascular aneurysm repair for abdominal aortic aneurysm. Circ J 2018; 82 (02) 340-345
    CrossrefPubMedSearch in Google Scholar
  • 11 Ito E, Ohki T, Toya N. et al. Aortic wall enhancement detected by contrast computed tomography scan predicts aortic remodeling after conservative therapy for acute uncomplicated Type B dissection. Ann Vasc Surg 2020; 68: 361-368
    CrossrefPubMedSearch in Google Scholar
  • 12 Okata S, Hoshina K, Miyahara K. et al. High aneurysm wall enhancement values are associated with late sac shrinkage after endovascular repair of abdominal aortic aneurysms. Medicine (Baltimore) 2021; 100 (02) e24133
    CrossrefPubMedSearch in Google Scholar
  • 13 Del Porto F, di Gioia C, Tritapepe L. et al. The multitasking role of macrophages in Stanford type A acute aortic dissection. Cardiology 2014; 127 (02) 123-129
    CrossrefPubMedSearch in Google Scholar
  • 14 Michel JB, Martin-Ventura JL, Egido J. et al; FAD EU consortium. Novel aspects of the pathogenesis of aneurysms of the abdominal aorta in humans. Cardiovasc Res 2011; 90 (01) 18-27
    CrossrefPubMedSearch in Google Scholar
  • 15 Kumar V, Abbas AK, Aster JC. Robbins Basic Pathology, 10th ed. Elsevier; 2017
    Search in Google Scholar
  • 16 Tanaka H, Unno N, Suzuki Y, Sano H, Yata T, Urano T. Hypoperfusion of the aortic wall secondary to degeneration of adventitial vasa vasorum causes abdominal aortic aneurysms. Curr Drug Targets 2018; 19 (11) 1327-1332
    CrossrefPubMedSearch in Google Scholar
  • 17 Wakefield TW, Linn MJ, Henke PK. et al. Neovascularization during venous thrombosis organization: a preliminary study. J Vasc Surg 1999; 30 (05) 885-892
    CrossrefPubMedSearch in Google Scholar
  • 18 Labropoulos N, Bhatti AF, Amaral S. et al. Neovascularization in acute venous thrombosis. J Vasc Surg 2005; 42 (03) 515-518
    CrossrefPubMedSearch in Google Scholar