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    Arteries and veins

    Background

    Small biopsies of arteries may be required in the investigation of vasculitis and other vascular disease.1 A specific protocol is provided for temporal artery biopsy.

    Resection of medium-sized arteries occurs due in cases of trauma, aneurysm, dissection, infection and other vascular surgery. Resection of veins may be undertaken to treat dilation, thrombosis or infection.1

    Endarterectomy may be undertaken to remove atherosclerotic plaque or excessive intimal hyperplasia but does not routinely result in tissue for histopathological examination. However, rarely specimens may be received.1

    This protocol includes small biopsies of artery, medium-sized artery, endarterectomy and vein specimens.


    Record the patient identifying information and any clinical information supplied together with the specimen description as designated on the container. See overview page for more detail on identification principles.

    • No
      • Non-routine fixation (not formalin), describe.
    • Yes
      • Special studies required, describe.
      • Ensure samples are taken prior to fixation (e.g. microbiology).
    • Not performed
    • Performed, describe type and result
      • Frozen section
      • Imprints
      • Other, describe

    See general information for more detail on specimen handling procedures.

    Inspect the specimen and dictate a macroscopic description.


    External Inspection

    Orientate and identify the anatomical features of the specimen.

    Record additional orientation or designation provided by operating clinician:

    • Absent
    • Present
      • Method of designation (e.g. suture, incision)
      • Featured denoted

    Photograph the intact specimen if required.

    Describe the following features of the specimen:

    Procedure

    Record as stated by the clinican

    • Artery small biopsy
    • Artery resection
    • Vein resection
    • Endarterectomy
    • Other, specify

    Anatomical components included (more than one may apply) and specimen dimensions (mm)

    Describe and measure the anatomical components present.

    • Vessel (or artery/vein if known), in three dimensions, length x diameter x thickness1
    • Endarterectomy, in three dimensions1 and weight (g)
    • Other, describe

    Specimen description

    As applicable:

    Artery1

    • Shape
      • Fusiform
      • Saccular
      • Other, describe

    Vein1

    • Diameter of wall
      • Uniform
      • Irregular
    • Valves present, describe
    • Abnormalities present
      • Thrombus
      • Purulent exudate
      • Other, describe

    Endarterectomy1

    • Shape
      • Fusiform
      • Saccular
      • Other, describe
    • Degree of stenosis (if completely intact tubular specimen received)1
    • Abnormalities present
      • Thrombus
    • Stent or other device2
      • Absent
      • Present

    Dissection

    Small biopsies do not require dissection and can be transferred directly for processing.

    Arteries should be dissected perpendicularly to the direction of blood flow (cross-sections) at 1-2mm intervals. However if fibromuscular dysplasia is indicated (especially in renal arteries), longitudinal sectioning may be required.1

    Veins should be dissected transversely (cross-sections)1 at 1-2mm intervals.

    Carefully remove any stent present ensuring all tissue is retrieved.2

    Decalcification may be required on some specimens prior to dissection.1,2

    Dissect transversely (cross-sections1) at 1-2mm intervals. Tubular specimens can be dissected perpendicularly to the luminal axis.1


    Internal Inspection

    Describe the appearance of the luminal surface including the following items:

    Thrombus (if present)

    • Size (including length of artery involved)

    Stenosis (if present)

    • Measure diameter of stenosis and background artery
    • Measure length of stenosis

    Other abnormalities

    • Lipid core debris
    • Calcification
    • Other, describe

    Processing

    Submit specimen in its entirety into cassettes for processing and communicate instructions to cut end down in the block. Lens paper, biopsy pads or similar are required to prevent loss of tissue during processing.

    Submit all sections into cassettes for processing. Lens paper, biopsy pads or similar are required to prevent loss of tissue during processing.1

    Submit representative sections in a single cassette.1

    Submit 3-4 representative sections into a single cassette for processing. Lens paper, biopsy pads or similar are required to prevent loss of tissue during processing.1 Instructions must be communicated to embedding staff for the specimen to be embedded cut end down in the block.

    Standard protocols for sectioning and special stains required should be available.4 Care should be taken to conserve tissue in case ancillary studies are required.

    Artery

    • Three or more levels for H&E
    • Elastin stain (to confirm artery)
    • Retain intervening unstained sections for trichrome (for vessel wall scarring) and immunohistochemistry (for inflammatory infiltrates) if requested

    Vein

    • One H&E
    • Connective tissue stain (to confirm vein and evaluate integrity of the wall)
    • Elastin stain (to confirm vessel is not an artery. Note, however, that veins have internal, often incomplete, elastic laminae that should not be confused with the more prominent elastic fibres present in an artery).
    • Microorganism stains (e.g. Gram, Ziehl-Neelsen, Gomori Methenamine Silver) for septic phlebitis if requested

    Endarterectomy

    • One H&E
    • Oil Red O stain3 on a frozen section from fresh or formalin-fixed tissue prior to processing may be considered if the clinician needs information on the fatty content of the plaque. (Post-fixation in osmium tetroxide to preserve fat during processing is not recommended due to the toxicity3 of osmium).
    • Elastin stain (to identify tunica media of artery)
    • Microorganism stains (e.g. Gram, Ziehl-Neelsen, Gomori Methenamine Silver) if requested
    • Immunohistochemistry (for inflammatory infiltrates) if requested

    See the reference provided (Recommendations for processing cardiovascular surgical pathology specimens)1 for more detail on sectioning and special stains.

    Record details of each cassette.

    An illustrated block key similar to the one provided may be useful.

    Acknowledgements

    Prof Tony Thomas for his contribution in reviewing and editing this protocol.

    Block allocation key

    Cassette id Site No. of pieces
    A Artery bx  
    Cassette id Site No. of pieces
    A Artery  
    Cassette id Site No. of pieces
    A Vein, representative sections  
    Cassette id Site No. of pieces
    A Endarterectomy, representative sections  

    References

    1. Stone JR, Basso C, Baandrup UT, Bruneval P, et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovasc Pathol. 2012;21(1):2-16.
    2. Boyle JJ, Rassl DM, Neil D, Suvarna K and Doran H (2008). Tissue Pathways for Cardiovascular Pathology, The Royal College of Pathologists, London.
    3. Suvarna KS, Layton C, Bancroft JD. Bancroft's Theory and Practice of Histological Techniques. 7th ed: Churchill Livingstone; 2012 26 Oct 2012.

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    21-Mar-2019
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