morphologic features of at hero sclerotic

8/6/2019 Morphologic Features of At Hero Sclerotic

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ObservatiOns On the heart50 the aMeriCan JOUrnaL OF GeriatriC CarDiOLOGY 2008 vOL. 17 nO. 1

There is an impression among some cardiologiststhat the atherosclerotic process, even in patientswho have had 1 or more atherosclerotic event, is focal (ie,involves one circulatory system while sparing another),and that within a single circulatory system the athero-sclerotic plaque involves portions of an artery and sparesother portions of the same artery. Both suppositions arefalse. Among patients with atherosclerotic disease severeenough to cause a clinical event, the atherosclerotic pro-cess involves all arterial systems, and within each systemthe atherosclerotic process involves every 5-mm segmentof every artery, at least when there is an opportunity toexamine each artery morphologically.

One of the authors (GJP) has performed, over theyears, endarterectomy of the superficial femoral arteryin many patients with obstructive disease of this artery.The endarterectomy specimens on this artery are com-monly about 25 cm in length (Figure 1). Recently, in2 such patients, another author (WCR) divided eachfemoral artery endarterectomy specimen after forma-lin fixation into 5-mm segments, processed the speci-mens in alcohol, embedded them in paraffin blocks,and prepared a histologic section stained by the Movatmethod from each 5-mm segment.

Eighteen photomicrographs from 18 of the 28 sec-tions prepared from the endarterectomy specimen of a

60-year-old man (patient 1) who had debilitating clau-dication are shown in Figure 2. At the age of 44 years,

he had percutaneous coronary intervention because ofangina pectoris, and at age 58 years he had coronaryartery bypass grafting surgery for recurrence of anginapectoris. Every 5-mm segment of his superficial femo-ral artery contained a large quantity of plaque.

Twelve photomicrographs from 12 of the 17 sec-tions prepared from an endarterectomy specimen ofthe superficial femoral artery in an 82-year-old man(patient 2) who also had debilitating claudication andangina pectoris without percutaneous or surgical inter-vention are shown in Figure 3. Again, every 5-mm seg-ment of this artery contained a large quantity of plaqueand, in addition, focal thrombus, ruptured plaque and,

as in the other patient, bone and marrow in some por-tions of the plaque (Figure 4 and Figure 5).

CommentsThese 2 cases illustrate that chronic obstructive diseaseof the superficial femoral artery is a diffuse processand, as illustrated by both patients, is commonly asso-ciated with clinically apparent atherosclerotic diseaseof 1 or more other arterial systems. Although patient1 was 22 years younger than patient 2, the quantity ofplaque in the lumen of the endarterectomy specimenwas similar in both patients. As Grundy has written,We are as old as our arteries.1

RefeRence

1 Grundy SM. Age as a risk factor: you are as old as yourarteries.Am J Cardiol. 1999;83:14551457.

obrvai h HarWllm Clffod ro, MD, sco edo

Baylor University Medical Center, Dallas, TX

mrphlgic Faur f AhrclricPlaqu i occluiv Fral ArryDia trad by edarrcyWllm Clffod ro, MD;1,2,4 Jog M Ko, ba;4 Ggoy Jo Pl, MD3,4

From the Department of Internal Medicine, Division of Cardiology,1 the Department of Pathology,2 the Department of

Surgery,3 and Baylor Heart and Vascular Institute,4 Baylor University Medical Center, Dallas, TX

Address for correspondence: William C. Roberts, MD, Baylor Heart and Vascular Institute, Baylor University Medical

Center, 621 North Hall Street, Suite H-030, Dallas, TX 75226

E-mail: [email protected]

www.lejacq.com ID: 7672

Figure 1. Patient 1: Femoral artery endarterectomy specimen that is 25 cm in length.


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ObservatiOns On the heart 51the aMeriCan JOUrnaL OF GeriatriC CarDiOLOGY 2008 vOL. 17 nO. 1

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ObservatiOns On the heart52 the aMeriCan JOUrnaL OF GeriatriC CarDiOLOGY 2008 vOL. 17 nO. 1

Figure 4. Patient 1: Portion of bone marrow within theartery shown in Figure 2l (Movat stain, original magnifica-tion 100).

Figure 5. Patient 2: Close-up view of bone marrow in thefemoral artery shown in brackets in Figure 3i (Movat stain,original magnification 100).

Figure 6. Patient 2: Close-up view of reformed arterywithin the plaque shown in Figure 3c (Movat stain, original

magnification 100).

morphologic features of at hero sclerotic

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