Division of Human Pathology, Department of Pathology and Microbiology, Nihon University School of Medicine.
Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
J Atheroscler Thromb. 2023 Dec 1;30(12):1893-1904. doi: 10.5551/jat.64259. Epub 2023 Jun 17.
Though the number of patients with peripheral arterial disease (PAD) and critical limb ischemia (CLI) is increasing, few histopathological studies of PAD, particularly that involving below-the-knee arteries, has been reported. We analyzed the pathology of anterior tibial artery (ATA) and posterior tibial artery (PTA) specimens obtained from patients who underwent lower extremity amputation due to CLIMethods: Dissected ATAs and PTAs were subjected to ex-vivo soft X-ray radiography, followed by pathological examination using 860 histological sections. This protocol was approved by the Ethics Review Board of Nihon University Itabashi Hospital (RK-190910-01) and Kyorin University Hospital (R02-179).
The calcified area distribution was significantly larger in PTAs than in ATAs on soft X-ray radiographic images (ATAs, 48.3% ±19.2 versus PTAs, 61.6% ±23.9; p＜0.001). Eccentric plaque with necrotic core and macrophage infiltration were more prominent in ATAs than in PTAs (eccentric plaque: ATAs, 63.7% versus PTAs, 49.1%; p＜0.0001, macrophage: ATAs, 0.29% [0.095 - 1.1%] versus PTAs, 0.12% [0.029 - 0.36%]; p＜0.001), histopathologically. Thromboembolic lesions were more frequently identified in PTAs than in ATAs (ATAs, 11.1% versus PTAs 15.8%; p＜0.05). Moreover, post-balloon injury pathology differed between ATAs and PTAs.
Histological features differed strikingly between ATAs and PTAs obtained from CLI patients. Clarifying the pathological features of CLI would contribute to establishing therapeutic strategies for PAD, particularly disease involving below-the knee-arteries.
尽管外周动脉疾病（PAD）和严重肢体缺血（CLI）患者的数量在不断增加，但很少有关于 PAD 的组织病理学研究，特别是涉及膝下动脉的研究。我们分析了因 CLI 而行下肢截肢患者的胫前动脉（ATA）和胫后动脉（PTA）标本的病理学。
对解剖后的 ATA 和 PTA 进行离体软 X 射线放射照相，然后使用 860 个组织切片进行病理检查。该方案获得日本大学板桥医院伦理审查委员会（RK-190910-01）和桐荫大学医院（R02-179）的批准。
软 X 射线图像上 PTA 的钙化面积分布明显大于 ATA（ATA，48.3%±19.2 比 PTA，61.6%±23.9；p＜0.001）。ATA 中的偏心斑块伴坏死核心和巨噬细胞浸润比 PTA 更明显（偏心斑块：ATA，63.7%比 PTA，49.1%；p＜0.0001，巨噬细胞：ATA，0.29%[0.095-1.1%]比 PTA，0.12%[0.029-0.36%]；p＜0.001）。PTA 中的血栓栓塞病变比 ATA 更常见（ATA，11.1%比 PTA，15.8%；p＜0.05）。此外，球囊扩张后损伤的病理学在 ATA 和 PTA 之间也有所不同。
CLI 患者的 ATA 和 PTA 的组织学特征差异显著。阐明 CLI 的病理特征将有助于制定 PAD 的治疗策略，特别是涉及膝下动脉的疾病。
