Histopathologie der AV-Gefäßanschlüsse Dr. med. Jan Janzen, MPhil
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1 Histopathologie der AV-Gefäßanschlüsse Dr. med. Jan Janzen, MPhil
2 Stenosen, Thrombosen und aneurysmatische Dilatationen sind die häufigsten Komplikationen in der Shuntchirurgie.
3 Microscopic Results
4 Vascular pathology 1. Subendothelial Intimal hyperplasia hyperplasia 2. Venous atrophy and/or arterialization 3. Atherosclerosis 4. Thrombosis, calcification and ossifications 5. Prosthesis insufficiency, Aneurysma spurium 6. Adventitial compression and vascular tumors
5 Subendothelial Hyperplasia Neointimal type
6 Neointimaler Typ
7 Subendothelial Hyperplasia Fibrotic type
8 Subendothelial Hyperplasia Mixed type
9 Kombinierter Typ Danksagung: Frau Prof. Dr. Barbara Rothen-Rutishauser und Herr Dr. Dimitri Vanhecke, Fribourg.
10 Mythos Intimahyperplasie Subendotheliale Hyperplasie... ist eine der Hauptursachen für die Ausbildung von Stenosen
11 Subendotheliale Hyperplasie Neointimaler Typ Fibrotischer Typ Kombinierter Typ Myointimaler Typ
12
13
14
15 Vascular pathology 1. Intimal hyperplasia 2. Venous atrophy and/or arterialization 3. Atherosclerosis 4. Thrombosis, calcification and ossifications 5. Prosthesis insufficiency, Aneurysma spurium 6. Adventitial compression and vascular tumors
16 Clinical Results Case 1: W.K., man, 50 yrs Fistulae aneurysm (10 x 4 x 4 cm) with thrombosis and adjacent skin (6 x 2 cm) Arterialization
17 Clinical Results Case 1: W.K., man, 50 yrs Fistulae aneurysm (10 x 4 x 4 cm) with thrombosis and adjacent skin (6 x 2 cm) Irregular medial fibrosis
18 Clinical Results Case 2: W.R., male, 80 yrs Fistulae aneurysm (14 x 5 x 3 cm) with thrombosis Newly formed internal elastic membrane
19 Ruptured internal elastic membrane
20 Arterialization and aneurysm
21 Vascular pathology 1. Intimal hyperplasia 2. Venous atrophy and/or arterialization 3. Atherosclerosis 4. Thrombosis, calcification and ossifications 5. Prosthesis insufficiency, Aneurysma spurium 6. Adventitial compression and vascular tumors
22 Grad Histologische Kriterien I Vereinzelte Makrophagen und mononukleäre Entzündungszellen in der Intima II Zunahme der Makrophagen; Schaumzellen, lipidspeichernde glatte Muskelzellen und mononukleäre Entzündungszellen III Präatherom zusätzliche extrazelluläre Lipideinlagerungen und granuläre Kalzifikationen IV Atherom intakte fibröse Kappe; konfluierender Lipidkern, Nekrosen, Cholesterinkristalle und diffuse mononukleäre Entzündungszellen; granuläre Kalzifikationen; sekundäre Mediakompression V Fibroatherom Zunahme des Bindegewebes; weitere Mediakompression und/oder atrophie VI Atherom rupturierte fibröse Kappe; Hämorrhagien / Hämatom; Parietalthrombose; Cholesterin- bzw. Kalkembolie VII Kalzifiziertes Atherombeet VIII Fibrosiertes ( abgeheiltes ) Atherombeet
23 Early atherosclerotic lesion Stary III
24 Venous atherosclerosis
25 Vascular pathology 1. Intimal hyperplasia 2. Venous atrophy and/or arterialization 3. Atherosclerosis 4. Thrombosis, calcification and ossification ossifications 5. Prosthesis insufficiency, Aneurysma spurium 6. Adventitial compression and vascular tumors
26 Aneurysm and parietal thrombosis
27 Parietal thrombosis
28 Calcification and ossification
29 Vascular pathology 1. Intimal hyperplasia 2. Venous atrophy and/or arterialization 3. Atherosclerosis 4. Thrombosis, calcification and ossifications 5. Prosthesis insufficiency, Aneurysma spurium 6. Adventitial compression and vascular tumors
30 Alter, Geschlecht: 78 Jahre, weiblich Vaskuläre Pathologie: Rupturierte PTFE-Prothese und ein angrenzendes Aneurysma spurium (falsum).
31 Prosthesis degeneration
32 Prosthesis calcification
33 Vascular pathology 1. Intimal hyperplasia 2. Venous atrophy and/or arterialization 3. Atherosclerosis 4. Thrombosis, calcification and ossifications 5. Prosthesis insufficiency, Aneurysma spurium 6. Adventitial compression and vascular tumors
34 Vascular tumors Kaposiformes haemangioendothelioma; Acroangiodermatitis; Stewart-Bluefarb syndrome; Epithelioid angiosarcoma.
35 Vascular pathology Subendothelial hyperplasia Venous atrophy and/or arterialization Atherosclerosis Thrombosis, calcification and ossification Prosthesis insufficiency, Aneurysma spurium Adventitial compression and vascular tumors
36 Danke für die Aufmerksamkeit!
37 VascPath Schweiz Dr. med. J. Janzen, MPhil Postfach 350 CH BERN 22 info@janlab.ch
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