Patrick J. O'Hara, M. D. , Norman B. Ratliff, M. D. , Robert A

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Presentation transcript:

Medial agenesis associated with multiple extracranial peripheral and visceral arterial aneurysms Patrick J. O'Hara, M.D., Norman B. Ratliff, M.D., Robert A. Graor, M.D., Andrew Novick, M.D., Edwin G. Beven, M.D. Journal of Vascular Surgery Volume 2, Issue 2, Pages 298-306 (March 1985) DOI: 10.1016/0741-5214(85)90069-2 Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Selected arteriograms of patient Y.F. (case 1). A, Transfemoral aortogram demonstrating right renal artery aneurysm and residual distal abdominal aortic aneurysm. B, Femoral arteriograms revealing bilateral superficial femoral artery aneurysms. C, Selective right axillary arteriogram demonstrating aneurysms involving brachial and circumflex humeral arteries. Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Selected arteriograms of patient W.D. (case 2). A, Transfemoral aortogram (anteroposterior view) demonstrating right renal artery aneurysm. B, Lateral transfemoral aortogram demonstrating aneurysm of celiac axis with irregularity and ectasia of midsuperior mesenteric artery. C, Pelvic runoff arteriogram revealing hypogastric and external iliac artery aneurysms with displacement of left common iliac artery laterally by hypogastric aneurysm. D, Coronary arteriogram demonstrating saccular aneurysm of right coronary artery (right anterior oblique projection). Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Section taken through junction of branch artery with aneurysmal iliac artery. Elastic tissue is stained black. More normal branch artery is to upper left (lumen, L). Adventitia sweeps across bottom. External elastic membrane, which stains black, can be seen separating adventitia from its adjacent layers. Note that black staining elastic lamina clearly delineates media of branch vessel. Section is cut so that branch vessel is invested, as it joins aneurysm, by intima and adventitia of external iliac artery. Where media of branch vessel ends, intima and adventitia of aneurysmal iliac artery become directly opposed to each other with no intervening media (arrow). Failure of media of branch vessel to continue on into external iliac artery is evident. Intima of aneurysm is thickened, with overlying thrombus at upper right (asterisk). (Elastic stain; original magnification × 40.) Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Higher magnification photograph of area in Fig. 3 where branch vessel and aneurysmal iliac artery come together. Lumen of branch artery is to left (L). Heavy black line is folding artifact. Black staining elastic lamina clearly outlines media of branch vessel. There is no continuation of media into aneurysmal iliac artery. At lower right are elastic fibers of external elastic membrane of adventitia. Intima sweeps down at upper right and abuts directly against adventitia with no intervening media in aneurysmal segment to right (arrow). (Elastic stain; original magnification × 100.) Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Light micrograph of aneurysmal iliac artery. Intima at top lies directly on adventitia, separated only by black-staining external elastic membrane. There is no interposed media. Bottom layer of intima is relatively cellular; toward top intima becomes less cellular with more loose myxoid matrix and at very top edge of organizing thrombus is being incorporated into intima. (Elastic stain; original magnification × 100.) Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Electron micrograph taken near junction of adventitia and intima from aneurysmal segment. There is no organized structure suggesting media. Isolated collagen and elastin fibrils and thin cell processes are embedded, almost at random, in loose amorphous matrix. (Lead citrate and uranyl acetate stain; original magnification × 8200.) Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Electron micrograph of media of branched vessel. Compact smooth muscle cells abut normal elastic lamina (e), exhibiting normal medial structure. (Lead citrate and uranyl acetate stain; original magnification × 9000.) Journal of Vascular Surgery 1985 2, 298-306DOI: (10.1016/0741-5214(85)90069-2) Copyright © 1985 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions