Medial neovascularization in abdominal aortic aneurysms: a histopathologic marker of aneurysmal degeneration with pathophysiologic implications.

OBJECTIVE

The purpose of this study was to characterize the distribution of aortic wall microvessels in normal aorta, atheroocclusive disease (AOD), and abdominal aortic aneurysms (AAA) and to evaluate whether medial neovascularization (MNV) is a reliable histopathologic marker of aneurysmal degeneration.

METHODS

Aortic tissue specimens (9 normal, 10 AOD, and 10 AAA) were examined for elastin with Verhoeff-van Gieson stain and for Ulex europaeus type I lectin, an endothelial-specific antigen, and laminin, a marker of basement membranes, by immunohistochemistry. The density of MNV was determined by morphometry of aortic sections stained for endothelium. The spatial distribution of aortic microvessels was compared with that of elastin destruction and chronic inflammation.

RESULTS

Evidence of medial neovascularization was generally not observed in normal aorta or AOD, whereas AAAs showed strong spatial correlations between MNV, disruption and degradation of elastin, and chronic inflammation in the outer aortic wall. Several specimens of AOD had focal areas of MNV associated with localized elastin fragmentation and monocytic infiltration located at the interface between the atherosclerotic plaque and the inner media. The density of MNV was about fifteenfold higher in AAA compared with normal aorta and about threefold higher compared with AOD (microvessels per high-power field): normal aorta, 0.77 +/- 0.28; AOD, 3.40 +/- 0.51; AAA, 11.32 +/- 1.58 (ANOVA, p < 0.001).

CONCLUSIONS

The presence and density of MNV in the abdominal aorta is a consistent histopathologic marker of aneurysmal degeneration that is spatially correlated with the destruction of elastin and chronic inflammation. The observation of focal MNV in some specimens of AOD, associated with partial elastin disruption, raises the possibility that early changes of aneurysm disease might develop by an extension of angiogenic/inflammatory processes from the atherosclerotic plaque into the aortic media.