Papers of the Month - May 1997

1. Satta J, Haukipuro K, Kairaluoma MI, Juvonen T. 
Aminoterminal propeptide of type III procollagen in the
follow-up of patients with AAA.  J Vasc Surg  1997; 25:
909-15.


Purpose: To evaluate whether changes in the concentration
of aminoterminal propeptide of collagen type III (PIIINP)
in serum has any relationship to rate of AAA enlargement
or risk of rupture.

Method: 139 patients c AAA followed at intervals of 6-12
months.

Result: The primary correlation between serum PIIINP and
AAA diameter was 0.22 (p = 0.01).  Serum values were very
high among 18 patients with rupture.

Conclusion:  Acceleration of AAA growth is reflected in
serum PIIINP, and a marked elevation of serum PIIINP may
predict an approaching rupture event.


Brief comment by mdt: This is a rather interesting paper,
and it is among the first to indicate that serum tests
might be indicators of rate of expansion or risk of
rupture in AAA disease.  Our group has had an abstract
accepted by the ACS Surgical Forum (to be presented in
October) re detection of serum antibodies against aortic
adventitial proteins that may be autoantigens in AAA
inflammation.  Time will tell whether these different
markers may be synchronous.


2. Adolph R, Vorp DA, Steed DL, Webster MW, Kameneva MV,
Watkins SC.  Cellular content and permeability of
intraluminal thrombus in AAA.  J Vasc Surg  1997; 25:
916-26.


Purpose:  To determine whether structural features of AAA
thrombi suggest that the thrombus is involved in the
pathogenesis of AAA.

Methods and Results: The thrombus is structurally complex
and is traversed by a continuous network of
interconnected canaliculi.  There is cellular penetration
for at least 1 cm from the luminal surface of the
thrombus.  

Conclusion: The thrombus appears to be a self-sustaining
entity that may be significant in the pathophysiological
mechanism of AAA.  
Comment by mdt: I think Vorp, Webster, and their
colleagues may be on to something, which Jessie Jean-
Claude and others in my lab may have in part anticipated. 
Jessie wrote a paper from our group about the detection
of plasmin in extracts of AAA tissue, and plasmin is an
activator of the whole group of matrix metalloproteases. 
Perhaps the plasmin leaches into the AAA wall from a
metabolically active thrombus.  Previous papers reviewed
in this feature include the one from my late friend Gene
Bernstein, about the correlation concerning the extent of
the thrombus and the rate of enlargement of the AAA.