THE ROLE OF HISTOPATHOLOGICAL EXAMINATION IN THE DEFINITIVE DIAGNOSIS OF ASCENDING AORTIC ANEURYSMS

Abstract

Ascending aortic aneurysm(AAA) is a potentially life-threatening patology  with diverse etiologies, including degenerative, genetic, inflammatory, infectious, and autoimmune diseases. Although modern imaging techniques are essential for diagnosis and surgical planning, they often cannot determine the precise underlying cause of aneurysm formation. Histopathological examination of resected aortic tissue, commonly referred to as biopsy, remains the gold standard for establishing the definitive diagnosis following surgical repair. This review summarizes the role of histopathological assessment in ascending aortic aneurysms, emphasizing its value in differentiating degenerative aortopathy from inherited connective tissue disorders, inflammatory vasculitis, and infectious aortitis. Characteristic microscopic findings, current classification systems, and ancillary molecular techniques are discussed. Histopathological evaluation not only confirms the diagnosis but also provides prognostic information, guides postoperative surveillance, and facilitates genetic counseling in selected patients. Although routine preoperative biopsy is contraindicated because of the risk of aortic rupture, systematic examination of surgically resected specimens remains an integral component of comprehensive patient management.