Pathological findings of the aortic wall at the site of ligation against the rigid rings of an intraluminal graft for acute DeBakey type I aortic dissection

• Published in: [Zasshi] [Journal]. Nihon Kyobu Geka Gakkai Vol. 37; no. 9; p. 2020
• Main Authors: Kanabuchi, K, Koide, S, Kawada, S, Shohtsu, A
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.09.1989
• Subjects: Acute Disease; Aneurysm, Dissecting - pathology; Aneurysm, Dissecting - surgery; Aorta - pathology; Aorta - surgery; Aortic Aneurysm - pathology; Aortic Aneurysm - surgery; Blood Vessel Prosthesis; Humans; Ligation; Male; Middle Aged
• ISSN: 0369-4739

A ringed intraluminal graft has been utilized in the surgical treatment for dissecting aneurysm since 1978. Histological findings of the aortic wall long after surgery, however, have not been described in detail, and concern remains about possible pressure necrosis at the point of encirclement. The following report is for a case of acute type I aortic dissection which required the use of an intraluminal surgical graft in a patient who died eight months postoperatively of a disease unrelated to previous surgical management. The pathological findings at autopsy were as follows. At the site of circumferential ligations around the aorta, 1) discontinuity of the elastic fibers in the media was found only at the outer surface, 2) there was no compression necrosis in the outer half of the media, although a dark shade of elastic fibers was recognized, 3) there were no pathological changes in the inner half of the media. In addition, complete repair of the intimal tear as well as closure of the false lumen replaced by collagen fibers was confirmed histologically in the whole length of aorta where the intraluminal graft had been placed. We conclude that concerns about the fragility of the aortic wall at the site of circumferential ligation, the migration of prosthesis, and the formation of thrombi is alleviated by these pathological observation.