fibrin and Aneurysm

Although several studies have suggested that aneurysmal wall inflammation and laminar thrombus are associated with the rupture of saccular aneurysms, the mechanisms leading to the rupture remain obscure. We performed full exposure of aneurysms before clip application and attempted to keep the fibrin cap on the rupture point. Using these specimens in a nearly original state before surgery, we conducted a pathological analysis and studied the differences between ruptured and unruptured aneurysms to clarify the mechanism of aneurysmal wall degeneration. This study included ruptured (n = 28) and unruptured (n = 12) saccular aneurysms resected after clipping. All of the ruptured aneurysms were obtained within 24 h of onset. Immunostainings for markers of inflammatory cells (CD68) and classical histological staining techniques were performed. Clinical variables and pathological findings from ruptured and unruptured aneurysms were compared. Patients with ruptured or unruptured aneurysms did not differ by age, gender, size, location, and risk factors, such as hypertension, smoking, and hyperlipidemia. The absence or fragmentation of the internal elastica lamina, the myointimal hyperplasia, and the thinning of the aneurysmal wall were generally observed in both aneurysms. The existence of subintimal fibrin deposition, organized laminar thrombus, intramural hemorrhage, neovascularization, and monocyte infiltration are more frequently observed in ruptured aneurysms. Multivariate logistic regression analysis showed that ruptured aneurysm was associated with presence of subintimal fibrin deposition and monocyte infiltration. These findings suggest that subintimal fibrin deposition and chronic inflammation have a strong impact on degeneration of the aneurysmal wall leading to their rupture, and this finding may be caused by endothelial dysfunction.

Topics: Aged; Aged, 80 and over; Aneurysm; Aneurysm, Ruptured; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Female; Fibrin; Humans; Intracranial Aneurysm; Intracranial Hemorrhages; Male; Middle Aged; Muscle Cells; Neovascularization, Pathologic; Neurosurgical Procedures; Risk Factors; Surgical Instruments; Thrombosis

An 85 year old male suffered vision loss in both eyes due to ruptured bilateral retinal arterial macroaneurysms.. We report this unusual case and show the importance of studying these types of patients in order to detect associated systemic diseases.

Topics: Aged, 80 and over; Aneurysm; Aneurysm, Ruptured; Atrial Fibrillation; Fibrin; Humans; Hypertension; Laser Therapy; Male; Retinal Artery; Retinal Hemorrhage; Tomography, Optical Coherence; Vision Disorders

Loeys-Dietz syndrome (LDS) is a connective tissue disease caused by mutations in the genes encoding the transforming growth factor-beta receptor (TGFBR). LDS is associated with aneurysms or dissections of the aorta similar to Marfan syndrome (MFS) as well as arterial tortuosity and aneurysms in the peripheral arteries. The purpose of this study was to evaluate the arterial diseases of LDS to differentiate it from MFS.. A total of 10 LDS patients with an identified mutation in TGFBR (6 male, 4 female; mean age 36.3 years) and 20 MFS patients with an identified mutation in fibrilin-1 who were age- and sex-matched to the LDS subjects (12 male, 8 female; mean age 37.1 years) were reviewed. The prevalence of vertebral arterial tortuosity (VAT) and peripheral aneurysm (PAN) was studied using computed tomography angiography.. In all, 9 of the 10 LDS patients had VAT, and five PANs were observed in 3 patients. In contrast, 8 (40%) of the MFS patients had VAT, and 1 patient had a PAN. LDS had a higher prevalence of VAT (P = 0.017) by Fisher's exact test.. The VAT was highly prevalent among LDS patients. Thus, the presence of VAT has the potential to differentiate LDS from MFS.

Topics: Adult; Aneurysm; Chi-Square Distribution; Female; Fibrin; Humans; Loeys-Dietz Syndrome; Male; Marfan Syndrome; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Receptors, Transforming Growth Factor beta; Tomography, X-Ray Computed; Vertebral Artery

Increased vascular permeability is an important event during the initial process of Kawasaki disease (KD). One potential responsible candidate for the induction of vascular hyperpermeability is vascular endothelial growth factor (VEGF).. We investigated the expression of VEGF and its receptors (flt-1, KDR) in acute KD tissues at 7 days to 5 weeks of illness. Neuropilin-1, which enhances the binding of VEGF(165) to KDR, was also studied. Abundant expression of VEGF and flt-1 was documented immunohistochemically in many organs from acute KD, including heart and lung. VEGF and flt-1 were colocalized in all vessels that showed edema. These molecules resided in endothelium and vascular media and also in migrating smooth muscle cells in neointima and infiltrating macrophages. Compared with controls, coronary vessels of acute KD had upregulation of VEGF and flt-1 but not KDR or neuropilin-1. KDR was expressed by vessels at 7 days of illness but not later in the illness. Plasma proteins were more extensively bound to the extracellular matrix in coronary vessels in acute KD than controls. Furthermore, elevation of serum VEGF levels was correlated with low serum albumin in acute KD (n=220, r=-0.53, P<0.001).. These findings suggest that VEGF and flt-1 are upregulated in blood vessels in many organs of acute KD. Expression of KDR was limited to the early stage of acute KD. The roles of VEGF in acute KD may involve promotion of vascular permeability and macrophage activation. Low serum albumin may indicate overproduction of VEGF in acute KD.

Topics: Acute Disease; Aneurysm; Asian People; Blood Vessels; Child; Child, Preschool; Coronary Vessels; Edema; Endothelial Growth Factors; Fibrin; Fibrinogen; Humans; Immunohistochemistry; Infant; Japan; Lymphokines; Mucocutaneous Lymph Node Syndrome; Nerve Tissue Proteins; Neuropilin-1; Organ Specificity; Proto-Oncogene Proteins; Receptor Protein-Tyrosine Kinases; Receptors, Growth Factor; Receptors, Vascular Endothelial Growth Factor; Reference Values; Serum Albumin; Up-Regulation; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1; Vascular Endothelial Growth Factors; White People

We assessed the fibrinolytic activity of the organized mural thrombus lining of aneurysms and prosthetic grafts.. Between May 1995 and April 1998, the full-thickness mural thrombi of aneurysms and the pseudointima lining of vascular grafts were obtained from 12 patients, ranging from 55 to 78 years in age, who underwent elective surgery. These included five aortic arch aneurysms, four abdominal aortic aneurysms, and three patent synthetic vascular grafts. The specimens were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE)/immunoblot and immunohistochemistry for human plasmin/plasminogen, tissue plasminogen activator (tPA), and fibrin degradation product (D-dimer).. In the SDS-PAGE/immunoblot, 25- and 27-kd bands appeared specifically in experimental fibrin plates after limited digestion by plasmin and were also recognized in the mural thrombi. The presence of bands at 25 and 27 kd, which were most prominent in sections near the flow surface layer, was consistent with the hypothesis that the mural fibrin was digested by the endogenous plasmin. Apparent immunoreactivity was found at the flow surface of the masses at a thickness of 10 to 400 micrometer suggesting the presence of a plasminogen and tPA-rich layer, with D-dimer as a consequential product of fibrinolysis.. The hypothesis that fibrin surfaces in the arterial system acquire fibrinolytic activity because of digestion by circulating endogenous plasmin was confirmed; this may contribute to the antithrombogenicity of these flow surfaces.

Topics: Aged; Aneurysm; Arteries; Blood Vessel Prosthesis; Female; Fibrin; Fibrinolysin; Fibrinolysis; Humans; Immunoblotting; Immunohistochemistry; Male; Middle Aged; Neutrophils; Pancreatic Elastase; Plasminogen; Regional Blood Flow; Thrombosis; Tissue Plasminogen Activator

Topics: Aneurysm; Arteries; Blood Vessel Prosthesis; Collagen; Elasticity; Endothelium; Fibrin; Fibroblasts; Fistula; Humans; Infections; Intestinal Fistula; Plastics; Polyethylene Terephthalates; Postoperative Complications; Textiles; Thrombosis; Vascular Diseases

Topics: Afibrinogenemia; Aneurysm; Bacteria; Blood Coagulation; Blood Coagulation Tests; Blood Platelets; Diagnosis, Differential; Disseminated Intravascular Coagulation; Enzyme Activation; Fibrin; Fibrinogen; Fibrinolysis; Hemostasis; Heparin; Models, Biological; Prothrombin; Sepsis; Shwartzman Phenomenon; Thrombin; Thromboplastin

Topics: Adult; Aged; Aneurysm; Aortic Aneurysm; Arteriosclerosis; Blood Cell Count; Blood Coagulation; Blood Platelets; Buttocks; Cell Survival; Chromium Radioisotopes; Chronic Disease; Disseminated Intravascular Coagulation; Female; Fibrin; Fibrinogen; Hemangioma; Humans; Iodine Radioisotopes; Middle Aged; Purpura, Thrombocytopenic; Skin Neoplasms; Syndrome; Thrombosis

Topics: Adrenal Glands; Aneurysm; Aorta; Autopsy; Biopsy; Disseminated Intravascular Coagulation; Fibrin; Humans; Kidney; Kidney Glomerulus; Male; Meningococcal Infections; Myocarditis; Pulmonary Veins; Purpura; Renal Artery Obstruction; Testis; Thrombosis; Urinary Bladder; Vasa Vasorum; Vena Cava, Superior

Topics: Aneurysm; Basement Membrane; Blood Vessels; Cell Membrane Permeability; Cell Nucleus; Child; Cytoplasmic Granules; Dilatation; Eosinophils; Epithelium; Erythrocytes; Female; Fibrin; Gliosis; Histiocytes; Humans; Hyalin; Lipids; Macrophages; Microscopy, Electron; Phagocytosis; Pigments, Biological; Retina; Retinal Degeneration; Retinal Hemorrhage; Retinal Vessels; Retinitis; Staining and Labeling; Telangiectasis

Topics: Aneurysm; Animals; Arteritis; Autoimmune Diseases; Blood Proteins; Fibrin; Hybridization, Genetic; Kidney Diseases; Kidney Glomerulus; Mice

Topics: Aneurysm; Female; Fibrin; Heart Defects, Congenital; Histological Techniques; Humans; Hyperplasia; Hypertension, Pulmonary; Infant; Infant, Newborn; Lung; Male; Pulmonary Artery

Topics: Aneurysm; Blood Platelets; Cervical Rib; Embolism; Fibrin; Humans; Pathology; Subclavian Artery; Thoracic Outlet Syndrome; Thrombosis; Vascular Surgical Procedures