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.).
Arterioscler Thromb Vasc Biol. 2015 Feb;35(2):439-47. doi: 10.1161/ATVBAHA.114.304764. Epub 2014 Dec 4.
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.
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.
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.
外周动脉疾病的组织病理学和伴随的钙化定义不明确，也不知道其是否因不同的危险因素而有所不同。
对 60 例因外周动脉疾病行截肢术患者的标本进行了 176 个上下肢动脉切片的组织学检查，其中 58%有糖尿病，35%有终末期肾病，48%有吸烟史。最常见的发现是中膜钙化（72%的动脉）和无脂质的内膜增厚（68%的动脉），仅 23%的动脉有动脉粥样硬化。内膜钙化发生率为 43%，通常比中膜钙化程度轻得多。非动脉粥样硬化性内膜增厚常很严重，导致一些血管完全闭塞。用油红 O 染色和 CD68 染色证实不存在脂质和巨噬细胞。除了终末期肾病患者中膜钙化的患病率和严重程度更高外，糖尿病患者、终末期肾病患者或吸烟者之间的发现没有差异。
结果表明，外周动脉疾病患者的大多数动脉都有不同于动脉粥样硬化的血管病变，提示其发病机制不同。这种模式在外周动脉疾病不同危险因素的患者之间没有显著差异。下肢血管钙化的大部分是中膜钙化而不是内膜钙化。
