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Vascular Biology

Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease

W. Charles O’Neill, Kum Hyun Han, Thomas M. Schneider, Randolph A. Hennigar
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https://doi.org/10.1161/ATVBAHA.114.304764
Arteriosclerosis, Thrombosis, and Vascular Biology. 2014;ATVBAHA.114.304764
Originally published December 4, 2014
W. Charles O’Neill
From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
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Kum Hyun Han
From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
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Thomas M. Schneider
From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
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Randolph A. Hennigar
From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
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Abstract

Objectives—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.

  • arteriosclerosis
  • atherosclerosis
  • pathology
  • peripheral vascular diseases
  • vascular calcification
  • Received March 26, 2014.
  • Accepted November 7, 2014.
  • © 2014 American Heart Association, Inc.
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    Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease
    W. Charles O’Neill, Kum Hyun Han, Thomas M. Schneider and Randolph A. Hennigar
    Arteriosclerosis, Thrombosis, and Vascular Biology. 2014;ATVBAHA.114.304764, originally published December 4, 2014
    https://doi.org/10.1161/ATVBAHA.114.304764

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    Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease
    W. Charles O’Neill, Kum Hyun Han, Thomas M. Schneider and Randolph A. Hennigar
    Arteriosclerosis, Thrombosis, and Vascular Biology. 2014;ATVBAHA.114.304764, originally published December 4, 2014
    https://doi.org/10.1161/ATVBAHA.114.304764
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