Differentiation of vascular pseudointima under normal and disturbed blood flow conditions: ultrastructural observations in the rat.

To study the effect of haemodynamic stress on the morphological differentiation of pseudointima, the ultrastructure of the cells lining normally shaped and aneurysmal polyurethane vascular prostheses implanted into the abdominal aorta of rats was examined. In the normally shaped vascular prostheses the pseudointima was composed of several layers of smooth muscle cells, which varied in differentiation from normal smooth muscle cells to myofibroblasts, and which were lined by a continuous sheet of endothelial cells. In the aneurysmal vascular prostheses, a pseudointima, composed of only layers of smooth muscle cells had developed. Those smooth muscle cells which lined the lumen had a typical morphology: they were polygonal, flat cells of unequal size, with a distinct organelle-free zone, containing myofilaments, at the luminal peripheral cytoplasmic side. The other smooth muscle cells varied in differentiation from normal smooth muscle cells to myofibroblasts. Under severe haemodynamic stresses, such as occur in the aneurysmal vascular prostheses, the regeneration of endothelial cells is impaired and smooth muscle cells undergo morphological changes to form a pseudoendothelial lining.