Peripheral vascular disease: who gets it and why? A histomorphological analysis of 261 arterial segments from 58 cases

Soor, Gursharan S.; Vukin, Iva; Leong, Shaun W.; Oreopoulos, George; Butany, Jagdish

doi:10.1080/00313020802036764

Cited by 75 publications

(50 citation statements)

References 16 publications

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“…However, because the assessment of intimal calcification was qualitative, an effect of ESRD cannot be ruled out. The increased medial calcification in ESRD is consistent with previous histological studies in peripheral arteries, 14 coronary arteries, 5 radial arteries, 4 and breast arteries. 19 Unlike previous findings in peripheral arteries, medial calcification was not greater in arteries from patients with diabetes mellitus or a history of smoking.…”

Section: Discussionsupporting

confidence: 91%

“…Previous studies of amputation specimens have documented intimal thickening that was described as atherosclerotic, although there was no mention of specific atheromatous changes. 13,14 The prevalence of intimal thickening noted by Soor et al 14 from 261 arteries from 58 lower-extremity amputations was similar to that observed in this study. Although described as atherosclerosis, specific criteria for this designation were not provided, and neither lipid nor inflammation is apparent in many of the images.…”

Section: Discussionsupporting

confidence: 88%

“…Intimal thickening was circumferential in 74% of involved arteries, similar to the current study and not typical for atherosclerotic plaques. It should be noted that Soor et al 14 specifically studied only the most stenotic portions of arteries and yet detected lipid cores in only 39%, again consistent with clinically significant nonatheromatous disease. They also observed less atherosclerosis in distal arteries.…”

Section: Discussionmentioning

confidence: 91%

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Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease

O’Neill

Han

Schneider

et al. 2015

ATVB

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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. ResultsSpecimens were examined from 60 patients, of which 29 had diabetes mellitus, 35 had a history of smoking, and 21 had ESRD, with many having >1 risk factor. Detailed characteristics of the patients are shown in Table I in the online-only Data Supplement. Other than the reduced prevalence of smoking in the ESRD patients, there were no significant differences between the groups. Only 4 patients did not have diabetes mellitus, ESRD, or a smoking history. Of the 15 patients receiving warfarin at the time of the amputation, 7 had atrial fibrillation, 4 had thrombotic disease, and 2 had mechanical heart valves. In the remaining 2, the indication was critical limb ischemia. Histopathology of the IntimaThe distribution of arteries examined and the histological findings in the intima are shown in Table 1. Many sections were labeled as margins, or proximal or distal, precluding the identification of specific arteries. Specimens frequently contained both tibial arteries, which could not be distinguished, and the peroneal artery was identified in only 4 specimens and was not analyzed separately. Because of the limited numbers of specific arteries, reliable comparisons could be made only between arteries above and below the knee. Intimal thickening was present in >90% of vessels (concentric in most cases) and did not differ between arteries above and below the knee. Thickening was associated with a greater patient age (66.0±1.2 versus 56.8±2.8 years; P<0.02) but not with sex. In the majority of arteries, other intimal changes were absent ( Figure 1A). Spec...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 91%

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Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease

O’Neill

Han

Schneider

et al. 2015

ATVB

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“…[12][13][14][15][16][17] The calcification present in the vessel media is most often dystrophic; however, the presence of real bone and chondrogenic metaplasia has also been reported, particularly in patients with diabetes mellitus. 12,13,18 Anecdotal evidence from vascular surgeons suggests that these bone-like calcifications can actually protrude into the vessel lumen. MAC can extend from the small digital arteries of the toes up to the large tibial, popliteal, and femoral arteries of the leg.…”

mentioning

confidence: 99%

Medial Arterial Calcification

Shanahan

2016

ATVB

166

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Abstract-Peripheral arterial disease (PAD) is a global health issue that is becoming more prevalent in an aging world population. Diabetes mellitus and chronic kidney disease are also on the increase, and both are associated with accelerated vascular calcification and an unfavorable prognosis in PAD. These data challenge the traditional athero-centric view of PAD, instead pointing toward a disease process complicated by medial arterial calcification. Like atherosclerosis, aging is a potent risk factor for medial arterial calcification, and accelerated vascular aging may underpin the devastating manifestations of PAD, particularly in patients prone to calcification. Consequently, this review will attempt to dissect the relationship between medial arterial calcification and atherosclerosis in PAD and identify common as well as novel risk factors that may contribute to and accelerate progression of PAD. In this context, we focus on the complex interplay between oxidative stress, DNA damage, and vascular aging, as well as the unexplored role of neuropathy.

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“…Diabetes mellitus (DM), characterized by high blood glucose, is associated with an increased prevalence of arterial sclerosis (1)(2)(3). Recent studies have revealed that vascular calcification is an active, cell-mediated process (1)(2).…”

Section: Introductionmentioning

confidence: 99%

Calcification on cultured human dental pulp cells exposed to high glucose level

2009

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Abstract:The progenitor cells of odontoblasts have been considered to be undifferentiated dental pulp cells positive for α-smooth muscle actin (α-SMA). α-SMA is also expressed in vascular smooth muscle cells, which are well-known to differentiate into osteoblastlike cells. The osteogenesis is up-regulated under hyperglycemic conditions. Proliferation and differentiation of dental pulp cells are also considered to be upregulated under high-glucose conditions. The present study was designed to clarify the relation among human dental pulp cells (HDPCs), odontoblast progenitors and odontogenesis. Differentiation of HDPCs into odontoblasts was confirmed by examining ALP activity and calcified nodules as well as gene expressions of osteocalcin and dentin sialoprotein. The endothelial cell marker eNOS and mural cell markers, NG2, calponin and α-SMA, were immunostained. Both proliferation and differentiation of HDPCs were up-regulated in high-glucose media. NG2 and calponin proved to be more suitable markers for odontoblast progenitors than α-SMA. Odontogenesis may be related to endothelial cells.

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Peripheral vascular disease: who gets it and why? A histomorphological analysis of 261 arterial segments from 58 cases

Cited by 75 publications

References 16 publications

Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease

Prevalence of Nonatheromatous Lesions in Peripheral Arterial Disease

Medial Arterial Calcification

Calcification on cultured human dental pulp cells exposed to high glucose level

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