Morphologic Features of At Hero Sclerotic
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Transcript of Morphologic Features of At Hero Sclerotic
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8/6/2019 Morphologic Features of At Hero Sclerotic
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ObservatiOns On the heart50 the aMeriCan JOUrnaL OF GeriatriC CarDiOLOGY 2008 vOL. 17 nO. 1
There is an impression among some cardiologiststhat the atherosclerotic process, even in patientswho have had 1 or more atherosclerotic event, is focal (ie,involves one circulatory system while sparing another),and that within a single circulatory system the athero-sclerotic plaque involves portions of an artery and sparesother portions of the same artery. Both suppositions arefalse. Among patients with atherosclerotic disease severeenough to cause a clinical event, the atherosclerotic pro-cess involves all arterial systems, and within each systemthe atherosclerotic process involves every 5-mm segmentof every artery, at least when there is an opportunity toexamine each artery morphologically.
One of the authors (GJP) has performed, over theyears, endarterectomy of the superficial femoral arteryin many patients with obstructive disease of this artery.The endarterectomy specimens on this artery are com-monly about 25 cm in length (Figure 1). Recently, in2 such patients, another author (WCR) divided eachfemoral artery endarterectomy specimen after forma-lin fixation into 5-mm segments, processed the speci-mens in alcohol, embedded them in paraffin blocks,and prepared a histologic section stained by the Movatmethod from each 5-mm segment.
Eighteen photomicrographs from 18 of the 28 sec-tions prepared from the endarterectomy specimen of a
60-year-old man (patient 1) who had debilitating clau-dication are shown in Figure 2. At the age of 44 years,
he had percutaneous coronary intervention because ofangina pectoris, and at age 58 years he had coronaryartery bypass grafting surgery for recurrence of anginapectoris. Every 5-mm segment of his superficial femo-ral artery contained a large quantity of plaque.
Twelve photomicrographs from 12 of the 17 sec-tions prepared from an endarterectomy specimen ofthe superficial femoral artery in an 82-year-old man(patient 2) who also had debilitating claudication andangina pectoris without percutaneous or surgical inter-vention are shown in Figure 3. Again, every 5-mm seg-ment of this artery contained a large quantity of plaqueand, in addition, focal thrombus, ruptured plaque and,
as in the other patient, bone and marrow in some por-tions of the plaque (Figure 4 and Figure 5).
CommentsThese 2 cases illustrate that chronic obstructive diseaseof the superficial femoral artery is a diffuse processand, as illustrated by both patients, is commonly asso-ciated with clinically apparent atherosclerotic diseaseof 1 or more other arterial systems. Although patient1 was 22 years younger than patient 2, the quantity ofplaque in the lumen of the endarterectomy specimenwas similar in both patients. As Grundy has written,We are as old as our arteries.1
RefeRence
1 Grundy SM. Age as a risk factor: you are as old as yourarteries.Am J Cardiol. 1999;83:14551457.
obrvai h HarWllm Clffod ro, MD, sco edo
Baylor University Medical Center, Dallas, TX
mrphlgic Faur f AhrclricPlaqu i occluiv Fral ArryDia trad by edarrcyWllm Clffod ro, MD;1,2,4 Jog M Ko, ba;4 Ggoy Jo Pl, MD3,4
From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of
Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TX
Address for correspondence: William C. Roberts, MD, Baylor Heart and Vascular Institute, Baylor University Medical
Center, 621 North Hall Street, Suite H-030, Dallas, TX 75226
E-mail: [email protected]
www.lejacq.com ID: 7672
Figure 1. Patient 1: Femoral artery endarterectomy specimen that is 25 cm in length.
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ObservatiOns On the heart 51the aMeriCan JOUrnaL OF GeriatriC CarDiOLOGY 2008 vOL. 17 nO. 1
Figure2.
Pa
tien
t1:P
ho
tom
icrograp
hs
frome
ighteen
5-mmsegmen
tsof
the
femora
larteryen
darterec
tomy.
Thecrosssec
tionsproxima
llyarerepresen
tedby
theearliera
lpha
be
tic
lettersan
dthosemore
distally,
by
the
later
letters.
Throm
busw
ithrup
ture
dp
laque
isseen
ina
throug
hd
.Thrombu
sw
ithou
tun
derly
ingp
laquerup
ture
issee
nine.
Injan
dk,the
lumen
istotallyocc
luded
byma
inlyfibrousp
laque.
Me
diaispresen
tc
ircum
feren
tiallyona
llsect
ions,
indica
ting
that
the
dissec
tionp
lanewas
intheou
termedia.A
llsec
tionscon
tain
plaque.
Bonemarrow
ispresen
tinsegmen
tlan
daclose-upviewo
fthe
area
inbrac
ketsisshown
inFigure
4(Mo
vatsta
in,
orig
ina
lmagn
ifica
tion
100).
Figure
3.
Pat
ien
t2:
Pho
tomicrograp
hs
from
twe
lve
5-mmsegmen
tsof
femora
larteryen
darterectomy.
Thecrosssect
ionsproxima
llyarerepresen
tedbytheearliera
lpha
be
tic
lettersan
dthosemore
distally
,by
the
later
letters.
Port
ionso
fp
laquesarecalc
ified,
an
dsome
lumensare
totallyo
cc
lude
d.
Me
diaisabsen
tinthesesec
tion
s,indica
ting
tha
tthe
planeo
fdissec
tionwaspro
bablya
tthe
junc
tiono
fthe
intimaan
dmedia
.Ac
lose-upviewo
fbonemarrow
iniiss
hown
inFigure
5.
Ac
lose-upviewo
fthis
newarteryseen
inc
isshown
inFigure
6.
Allsectionscon
tainp
laque
(Mova
tsta
in,
orig
ina
lmagn
ifica
tion
100).
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ObservatiOns On the heart52 the aMeriCan JOUrnaL OF GeriatriC CarDiOLOGY 2008 vOL. 17 nO. 1
Figure 4. Patient 1: Portion of bone marrow within theartery shown in Figure 2l (Movat stain, original magnifica-tion 100).
Figure 5. Patient 2: Close-up view of bone marrow in thefemoral artery shown in brackets in Figure 3i (Movat stain,original magnification 100).
Figure 6. Patient 2: Close-up view of reformed arterywithin the plaque shown in Figure 3c (Movat stain, original
magnification 100).