Aa. Milne et al., ENDOTHELIAL-CELL ULTRASTRUCTURE AFTER AORTIC-ANEURYSM RUPTURE - AN ELECTRON-MICROSCOPY STUDY, British Journal of Surgery, 82(5), 1995, pp. 635-637
Endothelial cell activation as an early response to hypovolaemic shock
may be important in the pathogenesis of coagulopathy and multiple org
an failure after aortic aneurysm rupture. The aim of this study was to
determine whether any evidence could be found of changes in endotheli
al cell ultrastructure in patients undergoing operation for ruptured a
neurysm and to establish a model for future studies of endothelial cel
ls in these patients. At the start of operation, fat samples from the
anterior abdominal wall were taken from five patients with ruptured ab
dominal aortic aneurysms and in an identical fashion from five control
patients undergoing elective surgery. Endothelial cells lining capill
aries were examined by transmission electron microscopy. Photomicrogra
phs were taken of all capillaries present and these were assessed blin
dly by three independent observers. When compared with controls it was
found that the luminal surface of the endothelial cells in patients w
ith aneurysm rupture was more convoluted, with more frequent processes
projecting into the lumen of the capillary. Budding of the luminal su
rface of the endothelial cell was seen in 11 of 45 capillaries in the
rupture group and in none of 44 capillaries in the control group (P<0.
005). Budding was seen in at least one capillary of all five patients
presenting with rupture but in none of the control group (P < 0.05). I
n conclusion, at the ultrastructural level there are changes within en
dothelial cells in capillaries at an early stage after ruptured abdomi
nal aortic aneurysm.