title: Circumferential heterogeneity in the abdominal aortic aneurysm wall composition suggests lateral sides to be more rupture prone.
abstract: OBJECTIVE
  The purpose of this study was to identify local differences in inflammation and tissue degradation within the circumference of the abdominal aortic aneurysm (AAA).
  
  
  BACKGROUND
  AAAs have the potential to rupture, and it is unknown why this predominantly occurs at the posterolateral wall. Blood flow dynamics likely influence rupture location but do not explain the whole picture, suggesting that other factors inside the AAA wall have a prominent role.
  
  
  METHODS
  As part of the Aneurysm-Express study, full thickness circular biopsy specimens of AAAs from 25 patients were obtained during surgery according to a standardized protocol. Tissue from the dorsal, ventral, and lateral sides was processed for histology and protein extraction. Levels of matrix metalloproteinase (MMP)-2 and MMP-9 and various cytokines were measured.
  
  
  RESULTS
  Lateral AAA sites, when compared with the ventral and dorsal segments, showed more microvessels (median [interquartile range] per mm(2), 91.8 [72.6-124.6] vs 73.9 [63.0-108.0] and 73.6 [52.7-109.5]; P = .013 and P = .005, respectively) and more adventitial inflammation (16.1% [13.5%-24.7%] vs 5.8% [2.8%-18.6%] and 6.3% [4.3%-13.5%]; P = .001 and P < .001, respectively). We observed a higher active MMP-9 (0.139 [0.059-0.339] ng/mL vs 0.060 [0.000-0.157] ng/mL and 0.045 [0.000-0.147] ng/mL; P = .001 and P = .014, respectively) and higher interleukin-8 (28.644 [11.921-62.587] pg/mL vs 16.442 [4.300-34.130] pg/mL and 18.258 [8.273-44.989] pg/mL; P < .001 and P = .010, respectively).
  
  
  CONCLUSIONS
  Biopsy specimens of the ventral AAA wall do not optimally reflect the magnitude of inflammatory processes in the AAA. The lateral sides of the AAA contain more microvessels, more inflammatory cells, more active proteases, and higher cytokine levels. These results suggest that the lateral aortic regions are more rupture-prone and may better reflect the inflammatory status in histopathologic examinations.
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands. r.hurks@umcutrecht.nl
authors.forename: Rob
authors.initials: R
authors.lastname: Hurks
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.forename: Aryan
authors.initials: A
authors.lastname: Vink
authors.forename: Imo E
authors.initials: IE
authors.lastname: Hoefer
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Henricus D W M
authors.initials: HD
authors.lastname: van de Pavoordt
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000201:enzymology / Q000276:immunology / Q000473:pathology*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000201:enzymology / Q000276:immunology / Q000473:pathology*; D001027:Aortography / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D001706:Biopsy; D016009:Chi-Square Distribution; D016207:Cytokines / Q000032:analysis; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D018836:Inflammation Mediators / Q000032:analysis; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000032:analysis; D020780:Matrix Metalloproteinase 9 / Q000032:analysis; D008875:Middle Aged; D009426:Netherlands; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9