[Ruptured proximal aorta after operation for type A dissection presenting as opacified left hemothorax; report of a case]

We report an unusual clinical presentation of ruptured proximal aorta as a left hemothorax after operation for type A dissection. A 74-year-old man who had undergone ascending aortic replacement for acute type A dissection 4 months previously developed a loss of consciousness followed by shock state. Both chest X-ray and computed tomography (CT) scan revealed opacified left hemothorax. The patient died during a diagnostic procedure. Post mortem examination showed rupture of proximal aortic dissection extended to the left pleural cavity path through the right atrial wall and the right ventricular wall.

Doxycycline delays aneurysm rupture in a mouse model of Marfan syndrome

OBJECTIVES

Thoracic aneurysms are the main cardiovascular complication of Marfan syndrome (MFS) resulting in premature death. MFS has been associated with mutations of the gene encoding fibrillin-1 (FBN1), a major constituent of the elastic fibers. Matrix metalloproteinases (MMPs) are important in the pathogenesis of abdominal aortic aneurysms but their precise role in MFS is not clear. Doxycycline is a nonspecific MMP inhibitor. The objective of the study was to determine whether docycycline can attenuate matrix degradation and prolong the survival of mice with MFS.

METHODS

The study employed a well-characterized animal model of MFS, namely fibrillin-1 under-expressing mice (mgR/mgR mice) that die spontaneously from rupture of the thoracic aorta between 2 to 4 months of age. Mutant and wild type mice were given doxycycline in their drinking water at a concentration designed to provide 100 mg/kg/day beginning at postnatal day (PD) 1, whereas control mice were given water. Treated mice were divided into two groups. One group of animals was followed until death or for 7 months to determine lifespan. In the second group of mice, the ascending thoracic aortas were collected for histological analysis (H&E staining, trichrome staining) and zymography for examining MMP-2 and MMP-9 levels at 6 weeks.

RESULTS

MMP-2 and MMP-9 levels were higher in the thoracic aorta of mgR/mgR mice compared with wild type littermates. Doxycycline-treated mgR/mgR mice lived 132 +/- 14.6 days (n = 16) or significantly longer than untreated mutant mice (79 +/- 6.7 days, n = 30) (P < 0.01). Connective tissue staining showed that doxycycline treatment decreased elastic fiber degradation in mgR/mgR mice. Furthermore, mgR/mgR mice treated with doxycycline had lower MMP-2 and MMP-9 levels compared with untreated mgR/mgR mice.

CONCLUSIONS

This study demonstrates that doxycycline significantly delays aneurysm rupture in MFS-like mice by inhibiting expression of tissue MMP-2 and MMP-9 and thus, degradation of the elastic matrix. The results suggest that MMPs contribute to the progression of thoracic aneurysm in MFS and that doxycycline has the potential to significantly alter the course of the disease.

Kernohan's phenomenon associated with left ruptured occipital arteriovenous malformation

A 23-year-old woman presented with ipsilateral hemiparesia due to rupture of a left occipital arteriovenous malformation (AVM). Emergency decompression (the onset-operation interval was 46 minutes,) was carried out and the patient could leave the hospital upon recovery without neurological deficits. In general, Kernohan's phenomenon is caused by the gradual displacement of the cerebral peduncle against the tentorial edge caused by compression by the contralateral mass. This phenomenon is very rare among the cases with spontaneous intracranial hemorrhage and only three cases including the present one have been reported in the literature. In all cases the onset-operation intervals of were very short. Kernohan's phenomenon associated with a ruptured AVM is a rare condition and emergency decompression is required.

The development of abdominal aortic aneurysms in mice is enhanced by benzo(a)pyrene

Cigarette smoking has been strongly associated with abdominal aortic aneurysm (AAA), but the components of tobacco smoke involved in AAA have not been identified. Benzo(a)pyrene (BaP) is an important constituent in cigarette smoke capable of induction of alterations strikingly similar to the pathological changes seen during AAA development. We therefore hypothesized that BaP exposure contributes to the development of AAA. In this study, C57/B6J mice were treated with vehicle, angiotensin II (AngII) (0.72 mg/kg/day), BaP (10 mg/kg/week), or the combination of AngII and BaP, for 5 weeks, and then examined for incidence of AAA and pathological changes of the aortic wall. Results showed that incidence of AAA formation in C57/B6J mice treated with BaP and AngII was significantly higher than that in AngII-treated mice (7 of 12 compared to 2 of 12). Further, five mice in the group treated with AngII/BaP and one in the group treated with AngII exhibited AAA rupture and hematoma. BaP caused macrophage infiltration, disarray of elastic lamella, and loss of vascular smooth muscle cells (VSMCs). We conclude that BaP aggravates AAA formation and rupture in C57/B6J mice by promoting macrophage infiltration, degeneration of elastic lamella, and loss of VSMCs in the aortic wall.

Medical Management of Abdominal Aortic Aneurysm

Medical management of patients with abdominal aortic aneurysm (AAA) is required for several different reasons. Since these patients have an increased risk of cardiovascular death therapy to reduce cardiovascular events is essential. Treatment is in line with the medical management of coronary artery disease including smoking cessation, statins and anti-platelet therapy. Some of these therapies also will slow aneurysm growth. Currently there is no proven focused therapy that reduces aneurysm growth, but the emerging strategies are discussed. Medical management also is required to reduce peri-operative risks and stabilise endovascular aneurysm repair. Whilst some of the therapies targeting cardiovascular risk reduction may be helpful, other emerging strategies are discussed.

Differential secretion of prostaglandin E(2), thromboxane A(2) and interleukin-6 in intact and ruptured abdominal aortic aneurysms

Ruptured abdominal aortic aneurysm (AAA) contributes largely to aneurysm-related morbidity and mortality. An inflammatory gene, COX-2, was found to be widely expressed in AAA. However, the involvement of COX-2 metabolites and other inflammatory mediators in the disease and particularly in AAA rupture still needs elucidation. The purpose of the present study was to evaluate the secretion of inflammatory mediators and the expression of macrophages in aneurysms and determine their significance in ruptured AAA. Aortic tissue was harvested at time of aortic reconstructive surgery for the group of intact AAA (n=20) and ruptured AAA (n=10) or at time of organ harvest for normal aortic tissue (n=4). Aortic explant cultures were immediately established and the culture medium was collected after 72 h. Specific enzyme-linked immunoassorbent assays were used to quantify COX-2 metabolites and inflammatory cytokines. Inflammatory macrophage cells were also quantified in the corresponding aortic walls immunohistochemically. Differences in the secretory levels of inflammatory metabolites and the macrophage quantity in all groups were assessed. All three explant culture groups secreted detectable levels of studied COX-2 metabolites, including PGE(2), PGF(2alpha), PGI(2) and TxB(2) and inflammatory cytokines, including interleukin (IL)-1beta, IL-6, IL-8 and IL-10. The secretory levels of PGE(2), TXB(2) and IL-6 were highest in the ruptured AAA explant cultures and statistically higher than those in intact AAA cultures (p<0.05). The secretion of those inflammatory mediators and the local expression of macrophages in ruptured aneurysm probably reflects the active inflammatory processes in the aortic lesions. A means of modifying the inflammatory process in the wall of AAAs might play an important role in preventing aneurysm rupture.

Who should we operate on and how do we decide: predicting rupture and survival in patients with aortic aneurysm

The decision to operate on a patient with an aortic aneurysm is based on the risk of aneurysm rupture versus the risk of aneurysm repair, within the context of the patient's overall life expectancy. Risk of rupture is still primarily based on the maximum aneurysm diameter, with some allowances made for factors that modify rupture risk, such as gender and current smoking. Newer methods for determining rupture risk, such as aneurysm-wall stress analysis, appear promising, but are not yet broadly available. Until then, diameter-based prediction rules for rupture risk will "fail" 10% to 25% of patients with both small and large abdominal aortic aneurysms. With regard to predicting operative mortality and life expectancy after open or endovascular aneurysm repair, multiple risk-stratification algorithms have been created. The best of these algorithms are accurate in 75% to 80% of patients, meaning that they fail in 20% to 25% of cases. Prediction algorithms provide significant guidance, but cannot take the place of an experienced clinician at this point. Somehow, experienced surgeons are able to sift through a massive amount of information and properly select patients who are appropriate for surgery, with quite reasonable perioperative and long-term mortality rates.

Presentation and outcome of Marfan's syndrome patients with dissection and thoraco-abdominal aortic aneurysm

BACKGROUND

In Marfan's syndrome, there is a paucity of data regarding intervention criteria for surgery of the dissected thoraco-abdominal aorta.

METHODS

A retrospective analysis of 22 Marfan's patients with distal aortic dissection managed between September 1999 and April 2006 was performed. Serial diameters and linear expansion rates were calculated from imaging studies and the outcome of intervention was analysed.

RESULTS

There were 14/22 male patients (median age 38 years), and 18 had prior aortic surgery. Surgery was recommended in 20 patients and undertaken in 19 (1 died prior to operation). Of the operated patients, 2 presented with rupture, 2 with airway obstruction, 1 with intermittent paraplegia and 14 underwent planned surgery for increased expansion rate or pain. All patients had residual type A or chronic type B dissection. The median aortic dimension at surgery was 6.7 cm (interquartile range (IQR) 5.5-8.2). The preoperative mean expansion rate increased from 0.5 cm/year to 1.7 cm/year (p<0.001), prior to operation. Fifteen patients underwent Crawford Extent II, two underwent Extent I and two underwent Extent III repair. Profound hypothermia and CSF drainage was used in 16 and 18 patients, respectively. There was no early mortality, paraplegia or renal failure. At a median postoperative follow-up of 56 months (range 6-86), the survival of the operated cohort was 90%.

CONCLUSIONS

Thoraco-abdominal aortic aneurysm repair in Marfan's syndrome can be performed with good outcomes. Intervention should be based on size or accelerated expansion. Any role of endovascular management needs careful consideration.

Ruptured mycotic abdominal aortic aneurysm secondary to Mycobacterium bovis after intravesical treatment with bacillus Calmette-Guérin

Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has proven effective in the treatment of early-stage bladder cancer. Although intravesical therapy with BCG is generally considered safe, serious complications including hematuria, granulomatous pneumonitis, hepatitis, and life-threatening BCG sepsis are well known. BCG-related vascular infections are rarely reported. We present a case of a ruptured abdominal aortic aneurysm secondary to M bovis infection 2 years after intravesical instillation of BCG and review the related literature.

An autopsy case report of annuloaortic ectasia with cardiac tamponade ruptured from an aneurysm of the right Valsalva sinus

Annuloaortic ectasia (AAE) is a clinicopathologic condition with primary or secondary dilatation of the aortic annulus and aneurysm of the proximal thoracic aorta, leading to aortic regurgitation. We herein report an autopsy case of a Japanese 57-year-old male with AAE who died of a cardiac tamponade rupture from the sinus of the right coronary. The wall of the aortic root, particularly that of the sinus of the right coronary Valsalva, underwent extensive fibrosis with loss or fragmentation of the elastic lamina in the medial layer and perforation directly into the pericardial space. The adventitia of the proximal aorta to the aortic arch was diffusely fibrotic with both acute and chronic hemorrhage and chronic inflammatory infiltrate. However, the ascending aortic media was largely intact, except for focal laminar necrosis at the center of the medial layer; no medial cystic necrosis, laminar necrosis, or mesoaortitis/panaortitis was present in the thoracic or abdominal aorta, nor in the main aortic branches, which was suggestive of Takayasu disease and giant cell arteritis. Thus, this patient was diagnosed to have idiopathic AAE with sustained peri-aortic hemorrhage, and he finally died of a cardiac tamponade resulting from an aneurysmal rupture.

[Cardiac tamponade due to rupture of healed and sealed aortic intimomedial tear--case report]

INTRODUCTION

The healed and sealed intimomedial aortic tears showed clearly defined edges and U-shaped defect of the tissue extending from intima into the media of a varying depth, filled by paler tissue with smooth surface. These tears can be solitary or multilocular, localized in different parts of the aorta, followed by limited intramural incomplete dissection. They can be provoked by diseases or injury. This part of the aortic wall filled with scar tissue is very vulnerable and could be the site of new rupture, followed by tamponade or fatal internal bleeding.

CASE OUTLINE

In this paper, we report a case of unexpected unknown death of a young male, 26-years-old, found on the ground, near his car. At autopsy, we established the old healed and open intimomedial tear on the posterior wall of the ascending aorta, with a remaining little dissection flap. This part of the wall with scar tissue was ruptured, causing bleeding in the pericardial sac, and tamponade. Histologically, the early stage of cystic medial degeneration was recognized. There were no injuries of the skin, soft tissue and bones.

CONCLUSION

In the paper, we discussed the manner of death in this case, as well as the medicolegal implications.

Multiple subfailures characterize blunt aortic injury

BACKGROUND

Blunt aortic injuries result from rapid deceleration of the thorax as may occur during automotive impacts and falls from extreme heights. Pathological findings can range from failure of specific vessel layers to immediate vessel wall rupture. The purpose of this investigation was to determine the sequence of local structural events that may lead to aortic wall disruption.

METHODS

Fourteen porcine aorta specimens were opened to expose the intima and longitudinally distracted until rupture. Longitudinal mechanics were quantified and subfailures were identified. Histology was used to examine internal layer subfailure.

RESULTS

Videography demonstrated that subfailures propagated into complete vessel wall rupture. Subfailures occurred before complete vessel rupture in 93% of specimens. Intimal and medial subfailures were present at 74% of the stress and 82% of the strain to rupture. Multiple subfailures were evident in 79% of specimens.

CONCLUSION

Present results supported the clinical theory that nonimmediate death as a result of blunt aortic injury is commonly caused by propagation of lesser lesions, initiating on the intimal layer, into complete vessel rupture including the adventitial layer. This finding, along with histologic evidence of subfailure pathological findings, confirms the presence of an acute window during which recognition and initiation of permissive hypotension may be lifesaving.

Development of a reexpandable covered stent for children

The use of covered stents in children is limited by the need for a large long sheath for delivery and the impossibility of redilation once implanted. The authors developed a reexpandable covered stent implantable in children through a small sheath and evaluated its clinical feasibility in mini piglets. An original Palmaz stent was covered with a polyurethane membrane that could be stretched up to 700%. Under general anesthesia, the authors implanted the covered stents in six mini piglets using a long sheath with a diameter approximately 1 French larger than the recommended size required to deliver an uncovered Palmaz stent. The implantation technique was similar to conventional stent implantation. In six piglets, the stent could be redilated from 7.5 to 8.7 mm 28-70 days after implantation. Macroscopic and microscopic examination showed intimal coverage of the coating with minimal inflammatory reaction around the stent. Our newly designed reexpandable stent covered with a polyurethane membrane is promising for use in children.

Turning back the clock: regression of abdominal aortic aneurysms via pharmacotherapy

Abdominal aortic aneurysm (AAA) is a common disease that causes progressive expansion and rupture of the aorta with high mortality. There is a large and unmet need for nonsurgical treatment for AAA. Research has shown that an intricate network of inflammatory cells and interstitial cells contributes to the formation of AAA by producing pro-inflammatory mediators that activate enzymes to degrade the extracellular matrix (ECM) and impair ECM biosynthesis. Pharmacological agents such as statins and angiotensin-converting enzyme inhibitors may promote tissue stabilization in AAA by diminishing pro-inflammatory signaling and normalizing metabolism of the ECM. Our recent experiments in animal models demonstrate that inhibition of c-Jun N terminal kinase (JNK) inhibits multiple pathological processes and causes regression of established AAA. Thus, emerging evidence indicates that pharmacological intervention targeting pro-inflammatory signaling and abnormal ECM metabolism is a promising strategy for treatment of AAA.

Influence of sex on expansion rate of abdominal aortic aneurysms

BACKGROUND

The UK Small Aneurysm Trial suggested that female sex is an independent risk factor for rupture of abdominal aortic aneurysm (AAA). This study assessed the effect of sex on the growth rate of AAA.

METHODS

Between January 1985 and August 2005 all patients who were referred to the Royal Infirmary of Edinburgh with an AAA who were not considered for early aneurysm repair were assessed by serial abdominal ultrasonography. Maximum anteroposterior and transverse diameters of the AAAs were measured.

RESULTS

A total of 1255 patients (824 men and 431 women) were followed up for a median of 30 (range 6-185) months. A median of six examinations (range 2-37) was performed for each patient. Median diameter on initial examination was 41 (range 25-83) mm. Median growth rate overall was 2.79 (range - 4.80-37.02) mm per year. Median growth rate of AAA was significantly greater in women than men (3.67 (range - 1.2-37.02) versus 2.03 (range - 4.80-21.00) mm per year; P < 0.01). Weighted linear regression analysis revealed that large initial anteroposterior AAA diameter and female sex were significant predictors of faster aneurysm growth rate (P < 0.001 and P = 0.006 respectively).

CONCLUSION

The growth rate of AAA was significantly greater in women than in men. This may have implications for the frequency of follow-up and timing of repair of AAA in women.

Increased angiogenesis at the site of abdominal aortic aneurysm rupture

Abdominal aortic aneurysm (AAA) rupture is associated with elevated levels of matrix metalloproteinase (MMP). Medial neovascularization is a known characteristic of established AAAs and involves proteolytic degradation of extracellular matrix by MMPs to facilitate endothelial cell proliferation and migration. This study evaluated the extent of neovascularization in abdominal aortic aneurysm rupture. Results indicated upregulation of proangiogenic cytokines and increased medial neovascularization at the aneurysm rupture edge compared with paired aneurysm anterior sac. Further investigations into the role of angiogenesis in aneurysm rupture may open novel therapeutic avenues to prevent aneurysm rupture.

Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: clinical outcomes with 1-year follow-up

OBJECTIVE

To compare the clinical outcomes of treatment after endovascular repair and open surgery in patients with ruptured infrarenal abdominal aortic aneurysms (AAAs), including 1-year follow-up.

METHODS

All consecutive conscious patients with ruptured infrarenal AAAs who presented to our tertiary care teaching hospital between January 1, 2001, and December 31, 2005, were included in this study (n = 55). Twenty-six patients underwent endovascular repair, and 29 patients underwent open surgery. Patients who were hemodynamically too unstable to undergo a computed tomography angiography scan were excluded. Outcomes evaluated were intraoperative mortality, 30-day mortality, systemic complications, complications necessitating surgical intervention, and mortality and complications during 1-year follow-up. The statistical tests we used were the Student t test, chi2 test, Fisher exact test, and Mann-Whitney U test (two sided; alpha = .05).

RESULTS

Thirty-day mortality was 8 (31%) of 26 patients who underwent endovascular repair and 9 (31%) of 29 patients who underwent open surgery (P = .98). Systemic complications and complications necessitating surgical intervention during the initial hospital stay were similar in both treatment groups (8/26 [31%] and 5/26 [19%] for endovascular repair, respectively, and 9/29 [31%] and 8/29 [28%] for open surgery, respectively; P > .40). During 1-year follow-up, two patients initially treated with endovascular repair died as a result of non-aneurysm-related causes; no death occurred in the open surgery group. Complications during 1-year follow-up were 1 (5%) of 20 for endovascular repair and 4 (16%) of 25 for open surgery (P = .36).

CONCLUSIONS

On the basis of our study with a highly selected population, the mortality and complication rates after endovascular repair may be similar compared with those after open surgery in patients treated for ruptured infrarenal AAAs.

Small vessel avulsion and acute aortic syndrome: a putative aetiology for initiation and propagation of blunt traumatic aortic injury at the isthmus

Based on literature, clinical observation and the analysis of material properties of the aorta, we hypothesize that the aortic isthmus is intrinsically susceptible to blunt trauma because it has a higher density of tributary vessels than other elements of the aortic tree, the avulsion of which during trauma, is a contributory factor in the development of an acute aortic syndrome resulting from intra-mural haematoma, localized dissection and ultimately rupture. This hypothesis provides putative explanations for several aspects of the injury profile including: localized peri-isthmus injuries, inside out injury profiles and the concept of initiation versus propagation of blunt traumatic aortic injury.

Determinants of In-Hospital Death and Rupture in Patients With a Stanford B Aortic Dissection

BACKGROUND

In Stanford B acute aortic dissection (AAD), medical treatment is the choice of therapy in the acute phase, however, a portion of patients experience complications caused by serious clinical outcomes including aortic rupture and abdominal visceral ischemia. The objective of this study was to determine the predictors of in-hospital events in an Asian cohort of Stanford type B AAD.

METHODS AND RESULTS

Hospital records were queried to identify patients that met following criteria: (1) AAD presenting within 14 days of symptom onset; and (2) computed tomography (CT) confirmation of a dissected descending aorta not involving the ascending aorta. An in-hospital event was defined as death, rupture/impending rupture, or organ malperfusion. Patient characteristics, inflammatory markers, and CT findings were obtained from clinical case records and retrospectively analyzed. Two hundred and twenty patients with Stanford B AAD were identified. In-hospital events occurred in 15 patients (there were 8 deaths, and 5 patients need to undergo emergent surgery because of impending rupture or rupture, and 4 patients experienced organ malperfusion). In univariate logistic regression analysis, the non-thrombosed type (odds ratio (OR) 3.88, 95% confidence interval (CI) 1.20-12.61, p=0.02) and maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.61, 95% CI 1.20-2.15, p=0.001) were significant predictors of in-hospital events. In multiple logistic regression analysis, the only significant predictor was maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.41, 95% CI 1.04-1.92, p=0.03).

CONCLUSION

The results identified a large maximum aortic diameter as the independent predictor of in-hospital events in Stanford type B AAD. The non-thrombosed type might also help differentiate high-risk patients.

Ruptured abdominal aortic aneurysm after resection of an infected cardiac myxoma

A 12-year-old girl with a high fever underwent echocardiography and was found to have a myxoma that arose from the atrial side of the anterior mitral valve leaflet. The tumor was successfully excised. Histologic examination of the tumor showed myxoma cells and an organized thrombus with bacterial colonization. The patient was discharged from the hospital on antibiotic treatment. After remaining asymptomatic for 3 weeks, she was readmitted with acute abdomen. Ultrasonography and magnetic resonance angiography detected intra-abdominal hemorrhaging and a saccular aneurysm of the abdominal aorta. The patient underwent successful emergency surgery. To our knowledge, no other report has been published concerning an abdominal aortic aneurysm secondary to bacterial infection of a cardiac myxoma. Although complications this severe are rarely observed in patients who have endocarditis, early recognition and treatment can be life-saving.

Hyperhomocysteinaemia is associated with the rate of abdominal aortic aneurysm expansion

OBJECTIVES

Previous literature has suggested an association between AAA and the presence of elevated plasma homocysteine levels (HCY). Homocysteine can stimulate elastolysis in the arterial media via activation of elastase and matrix metalloproteinases. No evidence in the literature exists correlating aneurysm expansion and HCY. The study objective is to identify whether the rate of AAA expansion is related to HCY.

METHODS

108 patients undergoing surveillance for AAA were identified at our vascular surgical unit. AAA size and growth rate were assessed by serial ultrasonographic measurements. Fasting total HCY levels were measured using fluorescence polarisation immunoassays. Demographic details and atherosclerotic risk factors were noted all AAA patients. A multivariate analysis was performed for growth rate vs. HCY, hypertension and hypercholesterolaemia. The correlation between AAA growth rate, AAA size and HCY levels were calculated.

RESULTS

60% of patients with AAA had some degree of hyperhomocysteinaemia (> 15 micromol/l). Multivariate analysis showed HCY to be the only significant factor affecting AAA growth rate. A positive correlation was demonstrated between HCY levels and AAA growth rate using a linear regression model (R=0.28, p=0.003). Median growth rate among patients with hyperHCY was double that of patients with normal HCY (0.5 mm/month vs. 0.25 mm/month, p=0.003). A growth rate of > 10 mm/year was seen in 25% of hyper HCY patients and in only 2% of patients with normal HCY. In addition patients with hyper HCY and larger AAAs (> 4 cm) had a growth rate twice as fast as patients with hyper HCY and AAAs < 4 cm.

CONCLUSIONS

A correlation between HCY and growth rate exists, although this is weak due to the multifactorial aetiology of AAAs. HyperHCY patients have faster expansion rates than patients with normal HCY, with significant numbers demonstrating rapid expansion (> 10 mm/year) and therefore an increased risk of rupture.

[Diverticulum of the ductus arteriosus. Cause of traumatic aortic ruptures?]

INTRODUCTION

According to angiographic studies 9-26% of all adult aortae show a ductus arteriosus diverticulum (DAD), i.e. an indention of the aortic wall at the insertion of the obliterated ductus arteriosus. This region is predisposed for traumatic aortic rupture. Up to now fixation at the transition from aorta transversa to fixed aorta descendens is regarded as cause. It is unclear whether ductus diverticulum favours traumatic aortic rupture.

MATERIAL AND METHODS

A total of 143 thoracic aortas (female symbol:37; male symbol:106, 17-91 years) were scanned histomorphologically for DAD. Calcification was quantified by CT multislice volume scan.

RESULTS

A DAD was detected in 44% of macroscopically non-calcified and slightly calcified aortic specimens. Histologically, autochthonal elastic and collagenous fibres of the media were disrupted. CT in macroscopically non-calcified aortas proved isolated calcification in 78%.

DISCUSSION

The incidence of 44% DAD-higher than in angiographic studies-can be explained by the method (histopathology), allowing diagnosis of diverticula down to microm. These morphological alterations are to be seen, at least in part, as a causative factor for the predilection to traumatic aortic ruptures.