Inflammation in the Wall of Abdominal Aortic Aneurysm and its Correlation with Aneurysm Symptomatology

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Vladislav Treska, Professor of Surgery.
University Hospital, Plzen, Czech Republic.

OBJECTIVES:The etiopathogenesis of AAA is a complex process resulting in degradation of aortic wall. Inflammation plays the leading role in the development of changes in the extracellular matrix.Cytokines are probably the key factores in the invasion of inflammatory cells into the aortic wall. Tumor necrosis factor (TNFα) and interleukins (IL 1b, IL6, IL8) could be hypothetically the main inflammatory cytokines, important for AAA pathogenesis.The purpose of study was to find if any correlation exists between inflammatory changes in the AAA wall and AAA symptomatology.
METHODS: Cytosol levels of IL1b, 6, 8, TNF α in aneurysm walls were evaluated in a prospective non-randomised study of 110 patients. The group was divided into two subgroups: subgroup I ( ruptured aneurysms, N=41) and subgroup II (asymptomatic aneurysms, N=54). A control group consisted of 15 kidney donors. Aortic walls were examined by immunohistochemistry and microscopy to detect inflammatory cells.
RESULTS: More pronounced inflammatory changes (Image) and higher cytosol cytokines levels were found in the walls of the ruptured aneurysms compared with those of the asymptomatic aneurysms - IL6 ( p< 0,001), IL8 ( p< 0,0003) and TNFα ( p< 0,002)- Tab. Immunohistochemically most cells within the inflammatory infiltrates stained positively with the monoclonal antibody against the leucocyte common antigen (CD 45). The majority of B-cell origin which was demonstrated by positive staining with the monoclonal antibody L26 directed against the CD 20 antigen.
CONCLUSIONS:Inflammation plays a significant role in the pathogenesis of abdominal aortic aneurysm rupture. A target treatment of the inflammatory process in the AAAs wall might play an important role in the prevention of aneurysm rupture.