From the Department of Surgery, University of Nebraska Medical Center, Omaha.
Arterioscler Thromb Vasc Biol. 2018 Apr;38(4):e48-e57. doi: 10.1161/ATVBAHA.117.310490. Epub 2018 Jan 25.
Arterial calcification and stiffening increase the risk of reconstruction failure, amputation, and mortality in patients with peripheral arterial disease, but underlying mechanisms and prevalence are unclear.
Fresh human femoropopliteal arteries were obtained from n=431 tissue donors aged 13 to 82 years (mean age, 53±16 years) recording the in situ longitudinal prestretch. Arterial diameter, wall thickness, and opening angles were measured optically, and stiffness was assessed using planar biaxial extension and constitutive modeling. Histological features were determined using transverse and longitudinal Verhoeff-Van Gieson and Alizarin stains. Medial calcification was quantified using a 7-stage grading scale and was correlated with structural and mechanical properties and clinical characteristics. Almost half (46%) of the femoropopliteal arteries had identifiable medial calcification. Older arteries were more calcified, but small calcium deposits were observed in arteries as young as 18 years old. After controlling for age, positive correlations were observed between calcification, diabetes mellitus, dyslipidemia, and body mass index. Tobacco use demonstrated a negative correlation. Calcified arteries were larger in diameter but had smaller circumferential opening angles. They were also stiffer longitudinally and circumferentially and had thinner tunica media and external elastic lamina with more discontinuous elastic fibers.
Although aging is the dominant risk factor for femoropopliteal artery calcification and stiffening, these processes seem to be linked and can begin at a young age. Calcification is associated with the presence of certain risk factors and with elastic fiber degradation, suggesting overlapping molecular pathways that require further investigation.
动脉钙化和僵硬会增加外周动脉疾病患者重建失败、截肢和死亡的风险，但潜在机制和流行程度尚不清楚。
从 431 名年龄在 13 至 82 岁（平均年龄 53±16 岁）的组织供体中获得新鲜的人股腘动脉，记录原位纵向预拉伸。使用光学方法测量动脉直径、壁厚和开口角度，并使用平面双向拉伸和本构模型评估僵硬度。使用横切和纵切的 Verhoeff-Van Gieson 和茜素染色法确定组织学特征。使用 7 级分级量表量化中膜钙化，并将其与结构和机械性能以及临床特征相关联。几乎一半（46%）的股腘动脉有可识别的中膜钙化。较老的动脉钙化程度更高，但在 18 岁的动脉中也观察到小的钙沉积。在控制年龄后，钙化与糖尿病、血脂异常和体重指数之间存在正相关。吸烟与钙化呈负相关。钙化的动脉直径较大，但周向开口角度较小。它们在纵向和周向也更僵硬，中膜和外弹性膜较薄，弹性纤维更不连续。
尽管衰老是股腘动脉钙化和僵硬的主要危险因素，但这些过程似乎是相互关联的，并且可以在年轻时开始。钙化与某些危险因素的存在以及弹性纤维降解有关，这表明存在重叠的分子途径，需要进一步研究。
