Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease
Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease
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DOI：
10.1161/atvbaha.114.304764
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发表时间：
2015-02-01
影响因子：
8.7
通讯作者：
Hennigar, Randolph A.
中科院分区：
文献类型：
--
作者：
O'Neill, W. Charles;Han, Kum Hyun;Hennigar, Randolph A.
目的：外周动脉疾病的组织病理学和伴随的钙化定义不明确，并且不知道这是否根据不同的危险因素而变化。方法与结果：对60例外周动脉疾病患者截肢标本的176条上、下肢动脉进行了组织学检查，其中58%有糖尿病，35%有终末期肾病，48%有吸烟史。最常见的表现是中膜钙化（72%的动脉）和无脂质内膜增厚（68%的动脉），只有23%的动脉存在动脉粥样硬化。内膜钙化发生率为43%，通常比内侧钙化范围小得多。非动脉粥样硬化性内膜增厚通常很严重，导致一些血管完全闭塞。油红O染色和CD68染色证实脂质和巨噬细胞的缺失。除了终末期肾脏疾病中内侧钙化的患病率和严重程度更高外，研究结果在糖尿病患者、终末期肾脏疾病患者或吸烟者之间没有差异。结论：外周动脉疾病患者的大多数动脉都有不同于动脉粥样硬化的血管病变，提示其发病机制不同。这种模式在具有不同外周动脉疾病危险因素的患者之间没有显著差异。下肢血管钙化的主要部位是内侧而不是内膜。
Objective-The histopathology of peripheral arterial disease and the accompanying calcification are poorly defined, and it is not known whether this varies according to different risk factors.Approach and Results-Sections from 176 upper and lower leg arteries were examined histologically in specimens from amputations of 60 patients with peripheral arterial disease, of whom 58% had diabetes mellitus, 35% had end-stage renal disease, and 48% had a history of smoking. The most common findings were calcification of the media (72% of arteries) and intimal thickening without lipid (68% of arteries), with the presence of atheromas in only 23% of arteries. Intimal calcification occurred in 43% and was generally much less extensive than medial calcification. Nonatheromatous intimal thickening was frequently severe, resulting in complete occlusion in some vessels. The absence of lipid and macrophages was confirmed by staining with oil red O and staining for CD68. Other than a greater prevalence and severity of medial calcification in end-stage renal disease, the findings did not differ between diabetics, patients with end-stage renal disease, or smokers.Conclusions-The results indicate that the majority of arteries in patients with peripheral arterial disease have a vascular lesion that is distinct from atherosclerosis, suggesting a different pathogenesis. This pattern does not differ substantially between patients with different risk factors for peripheral arterial disease. The bulk of vascular calcification in the lower extremities is medial rather than intimal.