Ruengsakulrach P, Sinclair R, Komeda M, Raman J, Gordon I, Buxton B
Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
Circulation. 1999 Nov 9;100(19 Suppl):II139-44. doi: 10.1161/01.cir.100.suppl_2.ii-139.
In this study, we examined the comparative histopathology, morphometry, and risk factors for the development of intimal hyperplasia and atherosclerosis in the radial artery (RA) and the internal thoracic artery (ITA).
Paired specimens of RAs and ITAs, obtained from 150 patients who underwent CABG, were evaluated with histopathology; 110 pairs of arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio. Risk factors were determined with stepwise linear regression. Intimal hyperplasia was seen in 141 RAs (94%) and 103 ITAs (69%) (P<0.001). Atherosclerosis was seen in 5% of RAs and 0.7% of ITAs (P=0.04). Medial calcification was found only in RAs (20 of 150, 13.3%) (P<0.001). Morphometric analysis showed that compared with ITAs, RAs had a significantly higher intimal area, medial area, percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio (all P<0.001) Factors found to be significant (P<0.05) predictors of the 3 severity indices of intimal hyperplasia, including atherosclerosis, in RAs were peripheral vascular disease, smoking, age, and diabetes. Risk factors for intimal hyperplasia in ITAs were age and smoking.
The RA is more likely to have atherosclerosis, intimal hyperplasia, and medial calcification than the ITA. Morphometric analysis indices showed marked differences between the RA and the ITA. Care should be taken when selecting the RA as a conduit in CABG, particularly in patients who are elderly, diabetic, smoke, or have peripheral vascular disease.
在本研究中，我们检查了桡动脉（RA）和胸廓内动脉（ITA）内膜增生和动脉粥样硬化发展的比较组织病理学、形态计量学及危险因素。
从150例行冠状动脉旁路移植术（CABG）的患者获取配对的RA和ITA标本，进行组织病理学评估；110对动脉适合进行形态计量学分析。根据管腔狭窄百分比、内膜厚度指数和内膜与中膜比值评估疾病严重程度。通过逐步线性回归确定危险因素。141条RA（94%）和103条ITA（69%）可见内膜增生（P<0.001）。5%的RA和0.7%的ITA可见动脉粥样硬化（P=0.04）。仅在RA中发现中膜钙化（150条中的20条，13.3%）（P<0.001）。形态计量学分析显示，与ITA相比，RA的内膜面积、中膜面积、管腔狭窄百分比、内膜厚度指数和内膜与中膜比值显著更高（均P<0.001）。在RA中，被发现是内膜增生包括动脉粥样硬化的3个严重程度指数的显著（P<0.05）预测因素的有外周血管疾病、吸烟、年龄和糖尿病。ITA内膜增生的危险因素是年龄和吸烟。
与ITA相比，RA更易发生动脉粥样硬化、内膜增生和中膜钙化。形态计量学分析指标显示RA和ITA之间存在显著差异。在CABG中选择RA作为血管 conduit时应谨慎，尤其是在老年、糖尿病、吸烟或有外周血管疾病的患者中。
