New York Presbyterian Hospital and Weill Cornell Medicine, New York, New York; NYU Langone Medical Center, New York, New York.
New York Presbyterian Hospital and Weill Cornell Medicine, New York, New York.
J Am Coll Cardiol. 2018 Oct 30;72(18):2152-2163. doi: 10.1016/j.jacc.2018.08.002. Epub 2018 Aug 27.
Critical limb ischemia (CLI) is the most serious complication of peripheral artery disease (PAD).
The purpose of this study was to characterize pathology of PAD in below- and above-knee amputation specimens in patients presenting with CLI.
Peripheral arteries from 95 patients (121 amputation specimens) were examined; 75 patients had presented with CLI, and the remaining 20 had amputations performed for other reasons. The pathological characteristics were separately recorded for femoral and popliteal arteries (FEM-POP), and infrapopliteal arteries (INFRA-POP).
A total of 299 arteries were examined. In the 239 arteries from CLI patients, atherosclerotic plaques were more frequent in FEM-POP (23 of 34, 67.6%) compared with INFRA-POP (79 of 205, 38.5%) arteries. Of these 239 arteries, 165 (69%) showed ≥70% stenosis, which was due to significant pathological intimal thickening, fibroatheroma, fibrocalcific lesions, or restenosis in 45 of 165 (27.3%), or was due to luminal thrombi with (39 of 165, 23.6%) or without (81 of 165, 49.1%) significant atherosclerotic lesions. Presence of chronic luminal thrombi was more frequently observed in arteries with insignificant atherosclerosis (OR: 16.7; p = 0.0002), more so in INFRA-POP compared with FEM-POP (OR: 2.14; p = 0.0041) arteries. Acute thrombotic occlusion was less frequently encountered in INFRA-POP than FEM-POP arteries (OR: 0.27; p = 0.0067). Medial calcification was present in 170 of 239 (71.1%) large arteries.
Thrombotic luminal occlusion associated with insignificant atherosclerosis is commonly observed in CLI and suggests the possibility of atherothromboembolic disease. The pathological characteristics of arteries in CLI suggest possible mechanisms of progression of PAD to CLI, especially in INFRA-POP arteries, and may support the preventive role of antithrombotic agents.
严重肢体缺血（CLI）是外周动脉疾病（PAD）最严重的并发症。
本研究旨在分析 CLI 患者截肢标本中 PAD 的病理学特征。
对 95 例患者（121 个截肢标本）的外周动脉进行了检查；其中 75 例患者为 CLI 患者，其余 20 例患者因其他原因进行截肢。分别记录股动脉和腘动脉（FEM-POP）和小腿动脉（INFRA-POP）的病理特征。
共检查了 299 条动脉。在 239 条 CLI 患者的动脉中，FEM-POP 动脉（23/34，67.6%）比 INFRA-POP 动脉（79/205，38.5%）更常出现动脉粥样硬化斑块。在这 239 条动脉中，165 条（69%）存在≥70%的狭窄，其狭窄原因分别为内膜显著增厚、纤维粥样瘤、纤维钙化病变或再狭窄（45/165，27.3%），或由于管腔内血栓（39/165，23.6%）或无显著动脉粥样硬化病变（81/165，49.1%）所致。在无明显动脉粥样硬化病变的动脉中，慢性管腔内血栓的存在更为常见（OR：16.7；p=0.0002），在 INFRA-POP 动脉中比 FEM-POP 动脉更为常见（OR：2.14；p=0.0041）。与 FEM-POP 动脉相比，INFRA-POP 动脉急性血栓闭塞的发生率较低（OR：0.27；p=0.0067）。239 条大血管中，170 条（71.1%）有中膜钙化。
CLI 患者中常可见与非狭窄性动脉粥样硬化相关的血栓性管腔闭塞，提示可能存在动脉粥样血栓栓塞性疾病。CLI 患者的动脉病理学特征提示 PAD 进展为 CLI 的可能机制，特别是在 INFRA-POP 动脉中，这可能支持抗血栓药物的预防作用。
