title: Histologic, histochemical, and biomechanical properties of fragments isolated from the anterior wall of abdominal aortic aneurysms.
abstract: OBJECTIVE
  To analyze biomechanical, histologic, and histochemical properties of anterior fragments of abdominal aortic aneurysms (AAA) and to correlate them with the maximum transverse diameter (MTD) and symptoms associated to the aneurysms.
  
  
  METHODS
  Fragments of the anterior aneurysm wall were obtained from 90 patients submitted to open repair of AAA of degenerative etiology from 2004 to 2009 in the Clinics Hospital of São Paulo University Medical School. Two specimens were produced from the fragments: one for histologic analysis for quantification of collagen fibers, elastic fibers, smooth muscle cells, and degree of inflammatory activity and the other for uniaxial tensile test to assess biomechanical failure properties of the material, such as strength, tension, and stress. Cases were classified according to symptoms and to the AAA MTD.
  
  
  RESULTS
  Fragments from AAA with MTD < 5.5 cm showed higher values for biomechanical failure properties than those of AAA with MTD < 5.5 cm (strength, 5.32 ± 2.07 × 4.1 ± 2.41 N; tension, 13.83 ± 5.58 × 10.82 ± 6.48 N/cm; stress, 103.02 × 77.03 N/cm(2); P < .05). No differences were observed between the groups in relation to failure strain (0.41 ± 0.12 × 0.37 ± 0.14; P = .260) and thickness of the fragments (1.58 ± 0.41 × 1.53 ± 0.42 mm; P = .662). The average values of fiber compositions of all the fragments were as follows: collagen fibers, 44.34 ± 0.48% and 61.85 ± 10.14% (Masson trichrome staining and Picrosirius red staining, respectively); smooth muscle cells, 3.46 ± 2.23% (immunohistochemistry/alpha-actin); and elastic fibers, less than 1% (traces) (Verhoeff-van Gieson staining). No differences in fiber percentages (collagen, elastic, and smooth muscle) were observed in fragments from AAA with MTD <5.5 cm and <5.5 cm, but more intense inflammatory activity was seen in larger AAA (grade 3; 70% × 28.6%; P = .011). Compared with asymptomatic aneurysms, symptomatic aneurysms showed no differences in the biomechanical failure properties (strength, 5.32 ± 2.36 × 4.65 ± 2.05 N; P = .155; tension, 14.08 ± 6.11 × 12.81 ± 5.77 N/cm; P = .154; stress, 103.02 × 84.76 N/cm(2); P = .144), strain (0.38 ± 0.12 × 0.41 ± 0.13; P = .287), thickness of the fragments (1.56 ± 0.41 × 1.57 ± 0.41 mm; P = .848), and histologic composition (collagen fibers, 44.67 ± 11.17 × 44.02 ± 13.79%; P = .808; smooth muscle fibers, 2.52 × 2.35%; P = .751; elastic fibers, <1%)
  
  
  CONCLUSIONS
  Fragments of the anterior wall from larger aneurysms were more resistant than those from smaller AAA, with no tissue properties that could explain this phenomenon in the histologic or histochemical analyses utilized.
  
  
  CONCLUSIONS
  The fragments of the anterior midsection from larger aneurysms were more resistant than those from smaller abdominal aortic aneurysms, with no tissue properties that could explain this phenomenon in the histologic or histochemical analyses. Larger aneurysms, at least in this place may be stronger than smaller aneurysms. It could point toward regional differences (heterogeneity, localized pathologies) as an important player in aneurysm rupture. Uniaxial strain tests are an important tool for the comprehension of a complex behavior such as that from an aneurysmal aortic wall. However, these tests still have limitations in providing information that would allow the calculation of the risk of rupture for abdominal aortic aneurysms.
authors.affiliation: Department of Surgery, Vascular and Endovascular Division and Surgical Technique Division, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: zautmonteiro@uol.com.br.
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Tavares Monteiro
authors.affiliation: Department of Surgery, Vascular and Endovascular Division and Surgical Technique Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Erasmo Simão
authors.initials: ES
authors.lastname: da Silva
authors.affiliation: Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa.
authors.forename: Madhavan L
authors.initials: ML
authors.lastname: Raghavan
authors.affiliation: Department of Surgery, Vascular and Endovascular Division and Surgical Technique Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
authors.affiliation: Department of Surgery, Vascular and Endovascular Division and Surgical Technique Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: de Lourdes Higuchi
authors.affiliation: Department of Surgery, Vascular and Endovascular Division and Surgical Technique Division, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: José Pinhata
authors.initials: JP
authors.lastname: Otoch
mesh_terms: D001012:Aorta, Abdominal / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology / Q000473:pathology; D001696:Biomechanical Phenomena; D001938:Brazil; D004547:Elastic Tissue / Q000473:pathology; D004548:Elasticity; D005260:Female; D024022:Fibrillar Collagens / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D032389:Myocytes, Smooth Muscle / Q000473:pathology; D011446:Prospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D013718:Tensile Strength; D059289:Vascular Stiffness
chemical_list: D024022:Fibrillar Collagens