Orcel L, el-Salem C, Natali J, Lecomte D, Jagueux M
Sem Hop. 1979;55(15-16):743-7.
It appears that the classical concept of atherosclerosis cannot be applied indiscriminately to all cases and that it is essentially valid for the aorta and its large branches of predominantly elastic structure. When more peripheral arterial trunks are considered, those of muscular type, the lesions are in great part characterized by a dystrophic fibrosis of the media, associated with a diffuse intimal thickening and with stratified fibro-hyaline plaques narrowing the lumen; the latter are responsible for the circulatory insufficiency and gangrene. Comparative analysis of 50 surgical specimens allow us to conclude that those fibro-hyaline plaques represent progressively stratified parietal thrombi that are populated by myocytes, at the contact of which ultrastructural investigation reveals important phenomena of elastogenesis and elastolysis. Most probably, the myocytes originate from the media, through fenestration within the inner elastic membrane. These facts have more than just a purely speculative interest: they express the great plasticity of the arterial walls and their capacity of adaptation to new hemodynamic and biologic conditions. It is interesting to note that this lesion constantly presents signs of metabolic activity and structural remodeling despite its long standing caracter.
看来，动脉粥样硬化的经典概念不能不加区分地应用于所有病例，它基本上适用于主动脉及其主要为弹性结构的大分支。当考虑更多外周动脉主干，即肌肉型动脉时，病变在很大程度上表现为中膜的营养不良性纤维化，伴有弥漫性内膜增厚和分层的纤维透明斑块，使管腔狭窄；后者是循环功能不全和坏疽的原因。对50个手术标本的比较分析使我们得出结论，那些纤维透明斑块代表逐渐分层的壁内血栓，其中有肌细胞，在其接触处超微结构研究揭示了重要的弹性生成和弹性溶解现象。很可能，肌细胞起源于中膜，通过内弹性膜的窗孔。这些事实不仅仅具有纯粹的推测意义：它们体现了动脉壁的巨大可塑性及其适应新的血流动力学和生物学条件的能力。有趣的是，尽管这种病变存在时间很长，但其始终表现出代谢活动和结构重塑的迹象。
