Relationship between histomorphology and biomechanical properties of the ascending aortic wall in the aneurysm zone

Abstract

Introduction. Thoracic aortic aneurysm (TAA) ranks 17th among all causes of a death. Over the past decade, the incidence rate of TAA increased several times and occurs in about 10 out of 100 thousand people per year. The search for the causes that lead to TAA is an urgent task. Local mechanical stress on the aortic wall leads to significant molecular and cellular changes in its tissue.Aim: To investigate the relationship between biomechanical properties and histological changes in the TAA tissue.Material and Methods. Thirty patients with TAA were included in the study. During surgery, fragments of the resected ascending aorta were obtained from each patient and subjected to uniaxial biomechanical testing to failure on an Instron 3343 testing machine (Instron, USA). Ultimate tensile stress at failure (σv, MPa), ultimate strain at failure (ε, mm/mm × %) and area under stress-strain curves (S, cm2) were calculated. In addition, the intraoperative material was fixed in formalin for histological examination of cellular and tissue changes in the aneurysm area. Inflammatory changes, the severity of aortic wall fibrosis and collagen/elastin ratio were assessed.Results. Atherosclerotic changes of the thoracic aortic wall were found in 43.3% (subgroup 1), aortitis – in 3.3%, connective tissue dysplasia – in 53.3% (subgroup 2) of the patients. Patient with inflammatory changes of the aortic wall was excluded. The biomechanical properties of the aorta were not statistically different between groups. A correlation was found between age with εcirc (r = –0.49) and Scirc (r = –0.54) and Slong (r = –0.5). A correlation was also found between εcirc and the degree of fibrosis in the medial layer of the aortic wall (r = –0.5) and collagen/elastin ratio (r = –0.61).Conclusions. Atherosclerotic changes in the aortic wall do not change the biomechanical properties of the TAA. However, structural changes in the medial layer of the aortic wall in the aneurysm zone result in reduced of its mechanical strength.