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PubMed1994

Reassessment of the value of post-vascularization biopsy performed at renal transplantation: the effects of arteriosclerosis.

Between January 1, 1984 and December 31, 1991, 471 cadaver renal transplants were performed. We reviewed 130 transplants, which were biopsied 30 minutes to 1 hour after the establishment of renal allograft blood flow. Analysis showed a significant difference in 2-year graft survival rate between the groups with and without arteriosclerosis (71.8% versus 65.9%, p < 0.05). Arteriosclerotic changes were noted more frequently in biopsies from older donors (37 versus 28 years, p < 0.005). There was also a difference in ischemic time between the groups with and without tubular degeneration (30.1 hours versus 26.7 hours, p < 0.02), which did not correlate with the need for dialysis in the perioperative period (48% versus 49%, p > 0.8).

Adult↗
PubMed1983

beta-Pyridylcarbinol (Ronicol) releases a prostacyclin-like substance into arterial blood of patients with arteriosclerosis obliterans.

Beta-pyridylcarbinol (Ronicol) when injected (1,2-1,4 mg/kg i.v.) into four patients with arteriosclerosis obliterans caused a release of an unstable disaggregatory substance into arterial blood of those patients. This release was not observed in other two patients who had been pretreated with aspirin (1,8 g p.o.daily). It is postulated that some of pharmacological properties of nicotinic acid derivatives are mediated through the release of endogenous PGI2-like substance.

Arteriosclerosis Obliterans↗
PubMed1986

Management alternatives of infrainguinal arteriosclerosis obliterans in the elderly.

An aggressive approach to limb salvage for infrainguinal arteriosclerosis obliterans in the elderly is recommended because of the generally poor rehabilitation and poor quality of life resulting from primary amputation. Profundaplasty, femoral-popliteal, and femoral-distal infrageniculate bypasses yield excellent results with minimum mortality.

Amputation, Surgical↗
PubMed1979

Successful therapy of advanced arteriosclerosis obliterans with prostacyclin.

Five patients with advanced arteriosclerosis obliterans of the lower extremities, as evidenced by resting pain, ischaemic ulcers, and focal necrosis, received intra-arterial infusions of prostacyclin at doses of 5--10 ng/kg/min for 72 h. Within 2 days of termination of the infusion, pain at rest had disappeared in all patients. In three of the five, the necrosis had completely regressed and the ischaemic ulcers healed within 2 months. The other two patients showed considerable improvement. Prostacyclin therapy was not associated with changes in the radiographic appearance of the major blood-vessels. However, muscle blood-flow, as measured by xenon-133 clearance, was significantly increased both during prostacyclin infusion and for the 6 weeks of measurement after its termination.

Aged↗
PubMed1980

Mönckeberg's arteriosclerosis and metabolic bone disease.

Mönckeberg's medial arteriosclerosis was diagnosed in 34 of 297 patients referred for pelvic radiography for a variety of reasons. It is strongly associated with metabolic bone disease, especially osteoporosis, whether induced by corticosteroids or arising spontaneously.

Adolescent↗
PubMed1987

Effect of cigarette smoking on the pattern of arterial blood flow: possible insight into mechanisms underlying the development of arteriosclerosis.

By means of non-invasive multichannel doppler ultrasound measurements, cigarette smoking in healthy subjects was shown to increase arterial wall stiffness and to alter the pattern of arterial blood flow, decreasing the pulsatility index. The pattern of blood flow seems to be a contributory factor in the development of arteriosclerosis, and these findings may provide insight into the underlying mechanisms.

Adult↗
PubMed1990

Description of a simple method to study some aspects of the pathogenesis of arteriosclerosis by perfusion of arterial segments.

A perfusion apparatus is described which permits the perfusion of arterial segments of about 5 cm in length. It works under physiological conditions. During the perfusion, temperature and pressure constancy or pressure variation, respectively, pulsation, sufficient oxygen supply, and high sterility are guaranteed. Hitherto, the duration of the perfusion has been extended to 10 h. After this time the endothelium was well preserved. The method shall be used for the study of some problems in arteriosclerosis research.

Animals↗
PubMed1992

Severe arteriosclerosis in the kidney of a cocaine addict.

Cocaine abuse has been associated with sudden cardiac death with coronary artery thrombosis with or without underlying vessel disease. Additional vascular beds thus far implicated in cocaine-associated arteriopathy include thoracic and abdominal aorta, and pulmonary, cerebral, and placental vessels; abnormalities include vasospasm, thrombosis, and accelerated atherosclerosis. We report the case of an adult male cocaine user with severe arteriosclerosis of renal vessels, and suggest that cocaine may also affect the renal vasculature.

Adult↗
PubMed1997

Enhancement of nitric oxide production after arterial reconstruction in patients with arteriosclerosis obliterans.

PURPOSE: Nitric oxide (NO) not only relaxes vascular smooth muscles, but it also reduces platelet adhesion and is itself a potent antiaggregatory substance. Experimental studies have shown that the release of NO is modulated by the blood flow. However, little clinical information is available about the effects of hemodynamic changes after arterial reconstruction on NO production. We therefore examined whether the plasma levels of nitrite (NO2-) and nitrate (NO3-) ions increased after arterial reconstruction in patients with arteriosclerosis obliterans (ASO). METHODS: Blood samples were obtained from the femoral artery in seven patients who underwent arterial reconstruction and seven healthy individuals (control). NO2- and NO3- levels were measured using high-performance liquid chromatography before the operation and 1 hour and 14 days after the operation. In addition, the mean femoral artery blood flow and ankle-brachial pressure index (ABI) were also measured using a duplex and Doppler velocimeter both before and after the operations. RESULTS: In the control subjects, the mean plasma NO2-, NO3-, and NOx (NO2- plus NO3-) levels in the femoral artery were 0.37 +/- 0.15 mumol/L, 45.6 +/- 10.8 mumol/L, and 46.0 +/- 10.9 mumol/L, respectively. Before the operation in the patients with ASO, the mean plasma NO3- (23.8 +/- 2.2 mumol/L) and NOx levels (24.0 +/- 2.3 mumol/L) were significantly lower than those in the control subjects, whereas the plasma NO2- levels (0.27 +/- 0.04 mumol/L) were comparable between the two groups. At 14 days after operation, the mean plasma NO3- and NOx levels in the femoral artery were significantly increased to 42.8 +/- 5.6 mumol/L and 43.4 +/- 5.6 mumol/L compared with those before the operation, whereas the mean plasma NO2- levels (0.50 +/- 0.05 mumol/L) changed significantly. The mean ABI and the mean flow rate before the operation were 0.32 +/- 0.07 and 344 +/- 145 ml/min, respectively. Both the ABI and the mean flow rate significantly increased to 1.04 +/- 0.06 and 627 +/- 141 ml/min after the operation. CONCLUSIONS: In patients who have ASO, the mean plasma level of NO is significantly lower than that of healthy individuals. In patients with ASO, the mean blood flow increased significantly after arterial reconstruction. This hemodynamic improvement may thus enhance NO production and may also help to maintain the patency of the bypass graft or native artery.

Aged↗
PubMed1997

Dietary fatty acids and arteriosclerosis.

Dietary fatty acids show different molecular structures and thus physicochemical properties of importance regarding lipid metabolism and atherogenesis. Intake of dietary fatty acids is associated with several risk factors for arteriosclerosis including fasting and postprandial plasma lipids and lipoproteins, obesity and thrombosis. Consumption of saturated fatty acids is detrimental while that of monounsaturated and polyunsaturated fatty acids lowers the incidence of coronary heart disease, but the respective influence of the various unsaturated fatty acids ingested is still discussed. The importance of the interaction between the human gene pool and dietary fatty acids is emerging.

Arteriosclerosis↗
PubMed1988

Vein bypass surgery for femoro-popliteal arteriosclerosis: influence of different risk factors on patient survival and the importance of anticoagulant treatment.

For femoro-popliteal arteriosclerosis the autologous saphenous vein graft implanted in reverse has evolved as the standard procedure, but the impact of postoperative anticoagulant treatment upon patient survival in particular remains uncertain. Patients undergoing elective surgery during the years 1970-86 (n = 668) were analysed using Kaplan-Meier estimates. This demonstrated that the preoperative status of the patient exerted a significant influence on the probability of survival (P less than 0.0001 Mantel). Anticoagulants started postoperatively significantly prolonged the life of the patients (P less than 0.0001). Of the various risk factors the patient's age had the most important influence (P less than 0.0001), whereas the presence or absence of diabetes mellitus (P less than 0.064) and the duration of the operation (P less than 0.407), were not significant. Using the proportional hazards regression model to test the validity of a prognostic factor, while other variables were checked, we found preoperative clinical status (P less than 0.0001), the patient's age (P less than 0.0001) and anticoagulant treatment (P less than 0.0001) to be of statistical importance.

Age Factors↗
PubMed1988

Cost factors in limb-threatening ischaemia due to infrainguinal arteriosclerosis.

Cost factors are an increasingly important aspect of medical care. In the United States, more than 150,000 patients per year have limb-threatening ischaemia due to infrainguinal atherosclerosis. We studied the economic impact of this disease process and its treatment in 313 consecutive patients seen at our hospital between 1979 and 1981. Minimum follow-up was 3 years. Seventy-nine percent of our patients undergoing revascularisation attempts had limb salvage with full function at 1 year and 60% had full function at 3 years. Of the patients who died, 85% died with their limbs intact. The mean patient cost for all 289 arterial reconstructions was $26,194 +/- $876 S.E. ($23,026 +/- $1117 for 166 femoropopliteal bypasses; $30,380 +/- $1349 for 123 distal bypasses). The mean length of stay (LOS) for the reconstruction group was 50 days. In this patient population, the following adverse risk factors were present: Gangrene or necrosis in the foot (72%), age more than 70 (56%), and previous vascular surgery (21%). A significantly higher cost was associated with each of these factors (gangrene, $32,653 +/- $1534; age greater than 70, $28,089 +/- $1235; previous bypass, $29,666 +/- $1962). During the same time period, initial patient costs for 24 patients undergoing primary below-knee amputation and rehabilitation were $27,225 +/- $2896 S.E. Twenty-nine percent of the patients with below-knee amputations never walked again. The nonambulatory patients had a significant continuing expenditure for institutionalisation ($100/day) or home care ($270/week). These facts document the high cost of limb-threatening arteriosclerosis and its treatment by vascular reconstruction or primary below-knee amputation.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1999

Orthotopic aortic transplantation in mice: a new model of allograft arteriosclerosis.

BACKGROUND: Graft arteriosclerosis is a major cause of death after allotransplantation of organs such as the heart or the kidney. Aortic allotransplantation in mice is a useful experimental model to study the mechanisms of this pathology. However, the conventional heterotopic aortic model is limited by a high morbidity and is technically difficult to perform. We developed a new simple method for aortic transplantation in mice. METHODS: The infrarenal aorta from the donor mouse was anastomosed to the recipient's aorta at the same position using a sleeve technique. Orthotopic aortic transplantation was performed in 45 mice, 5 isografts and 40 allografts. No immunosuppression was given, and the mice were killed at day 15 or 30. The graft was examined macroscopically, and several histologic sections were made. RESULTS: The overall survival rate was 78%. The incidence of thrombosis was low (4 cases) compared with previously published series. Histology of aortas revealed typical aspects of rejection in the allografts with a chronic picture at day 30. No significant lesion was observed in isografts. CONCLUSIONS: We have developed a model of orthotopic aortic transplantation in mice. This new model is easy to carry out and has a low incidence of thrombosis, probably because there is no size discrepancy between donor and recipient aortic segment.

Anastomosis, Surgical↗
PubMed2003

Chronic transplant dysfunction and transplant arteriosclerosis: new insights into underlying mechanisms.

Although effective in the short-term, clinical solid-organ transplantation has not achieved its goals as a long-term treatment for patients with end-stage organ failure. Development of so-called chronic transplant dysfunction (CTD)is now recognised as the predominant cause of allograft loss long-term (after the first post-operative year) following transplantation. CTD has the remarkable histological feature that the luminal areas of intragraft arteries become obliterated, predominantly with vascular smooth muscle cells intermingled with some inflammatory cells. The development of this transplant vasculopathy,referred to as transplant arteriosclerosis (TA), is a multifactorial process and many risk factors have been identified. However, the precise pathogenetic mechanisms leading to TA are largely unknown and, as a result, current prevention and treatment protocols are inadequate. This review discusses the risk factors for TA and current views on the pathogenetic mechanisms leading to this vasculopathy. We argue here that host-derived cells contribute to the development of these vascular lesions, and propose that TA results from a normal vascular repair process that proceeds beyond the needs of functional repair. Guided by the proposed sequence of events, we finally discuss possible directions for future intervention strategies to prevent TA after solid-organ transplantation.

Arteriosclerosis↗
PubMed1997

Effects of prostaglandin E1 infusion on limb hemodynamics and vasodilatory response in patients with arteriosclerosis obliterans.

It is well known that prostaglandin E1 (PGE1) increases peripheral blood flow. The aim of this study was to investigate the effects of PGE1 infusion on the hemodynamics and vasodilatory response of the leg affected by intermittent claudication in patients with arteriosclerosis obliterans (ASO). Fourteen legs of 8 male patients with ASO were infused intravenously with PGE1 (120 microg/day) for 7 consecutive days. Before the infusion and 5 days after cessation of the infusion, resting skin and skeletal muscle blood flow in the calf and occlusion-induced reactive hyperemic flow were measured using plethysmography and a laser Doppler flowmeter. Clinical symptoms in the legs were assessed by treadmill exercise testing. Resting calf blood flow was found to have increased significantly (skin, from 2.6 +/- 0.1 ml/min/100 g tissue to 2.9 +/- 0.1 ml/min/100 g tissue, p < 0.02; skeletal muscle, from 3.1 +/- 0.2 ml/min/dl tissue to 4.0 +/- 0.5 ml/min/dl tissue, p < 0.02). There was also a significant reduction in the peripheral vascular resistance (-17.8 +/- 7.2%, p < 0.05) 5 days after the cessation of infusion. The time to the half-maximum post peak of hyperemia was significantly elongated (from 34.6 +/- 5.7 sec to 58.6 +/- 9.2 sec, p < 0.01). Borg's score of the legs on exercise testing was markedly reduced, and symptom-free walking distance was increased by an average of 70.9 + 15.6%. In conclusion, PGE1 infusion has vascular effects on not only resting calf blood flow but also hyperemic flow responses. These retentive effects may be due to alteration in vascular functions and/or rheological state as a result of PGE1-induced regular enhancement of blood flow, rather than the direct vasodilatory effect of the agent.

Aged↗
PubMed1999

Comparative effects of vitamin K2 and vitamin E on experimental arteriosclerosis.

The comparative effects of vitamin K2 and vitamin E on aortic calcium (Ca) and inorganic phosphorus (P) levels in the aorta and the elastin fraction (fr.) were investigated in male rats after experimental arteriosclerosis was induced by vitamin D2 with atherogenic diet. Both vitamin K2 (100 mg/kg b.w.) and vitamin E (40 mg/kg b.w.) inhibited the increase of Ca and P in the aorta and the elastin fr. from the arteriosclerotic rats. Vitamin K2 (50 mg/kg b.w.) also suppressed the deposition of Ca and P in the aorta, but there was no change due to vitamin K3 or geranylgeraniol (side chain of vitamin K2) administration. Both vitamin K2 and vitamin E showed lipid radical scavenging activity in the in vitro experiment. However, neither vitamin K3 nor geranylgeraniol exhibited anti-arteriosclerotic or radical scavenging activity under the above experimental conditions. It is suggested that vitamin K2 and vitamin E promoted an antiarteriosclerotic effect by radical scavenging activity. These actions of vitamin K2 are required in the structure of 2-methylnaphtoquinone and its side chain (geranylgeraniol).

Animals↗
PubMed2004

Relationships between arteriosclerosis, cerebral amyloid angiopathy and myelin loss from cerebral cortical white matter in Alzheimer's disease.

Pathological relationships between damage to the deep white matter of the cerebral cortex [as evidenced by myelin loss (ML)], cerebral amyloid angiopathy (CAA) and arteriosclerosis (ART) were investigated in the brains of 137 patients with autopsy-confirmed Alzheimer's disease (AD), in order to better understand the causes of white matter damage in AD, and the contribution of this to the pathogenesis of the disorder. All 137 patients had some degree of CAA in one or more brain regions although the occipital cortex was severely affected by CAA more frequently, and consequently mean CAA severity score was significantly greater, than other cortical regions. Eighty-seven patients (63.5%) were affected by ML, with more patients showing ML from occipital cortex than from other cortical regions leading to a significantly higher mean ML severity score in this region. One hundred and twenty-six patients (92%) were affected by ART, although the occipital cortex was not more frequently affected by ART than other cortical areas, the mean ART severity score in occipital cortex was nonetheless significantly greater than that of frontal and temporal cortex. Eighty-seven patients showed both CAA and ML, although there was only a weak correlation between degree of CAA and extent of ML (P = 0.035). Forty-seven patients showed ML and significant ART, 16 patients showed significant ART but no ML, 40 patients showed ML in the absence of significant ART and 34 patients showed neither significant ART nor ML. Overall, and for each of the four brain regions, the extent of ML correlated significantly (P < 0.001) with degree of ART. However, when only those 47 patients with ML and significant ART were considered, much stronger correlations between the extent of ML and the degree of ART were achieved both overall and within each of the four brain regions. The overall ART severity score (and overall scores for each pathological marker of ART) significantly correlated with that of CAA (P < 0.001). Pathological processes leading to white matter damage, in terms of ML at least, in AD are thus likely to be heterogeneous. Many patients suffer ML in association with ART, but in others ML cannot be explained by presence of ART or CAA. In such patients, autoregulatory changes in blood vessels might be responsible for ML. The association between the extent of CAA and ART suggests shared risk factors for each pathological change.

Age of Onset↗
PubMed2001

Different roles of arteriosclerosis in the rupture of intracranial dissecting aneurysms.

AIMS: Although intracranial dissecting aneurysm (IDA) is a newly described variant of the brain aneurysms that affects mainly the vertebrobasilar arterial system, its pathogenesis remains obscure. We aimed to clarify the role of arteriosclerosis in the pathogenesis of IDA based on histopathological findings in seven autopsy cases of IDA. METHODS AND RESULTS: All cases exhibited systemic hypertension or left ventricular hypertrophy. Macroscopically, all cases exhibited subarachnoid haemorrhage. Two types of dissection were recognized in the vertebral artery. Six of seven IDA cases showed a widespread disruption of the entire thickness of the arterial wall with the formation of a dilated pseudoaneurysm, which consisted of thin adventitia (arterial wall disruption type). Medial disruption of the arterial wall and subadventitial dissecting haemorrhage were also found, resulting in the formation of a false lumen and stenosis of the 'true' lumen of the artery. However, these lesions were connected to the site of rupture of the entire arterial wall. Within 1 day after onset of IDA, the autopsy cases showed formation of fibrin thrombus, marked leucocyte infiltration and necrosis of the arterial wall at the site of the lesion. Cases that survived more than 1 week showed smooth muscle cell proliferation, macrophage accumulation and lymphocytic infiltration in the lesions. These cases showed no atherosclerotic plaque, but non-atherosclerotic fibrocellular intima. The thickness of intima and media was significantly less in the vertebral artery of IDA patients than that of non-IDA patients with systemic hypertension. On the other hand, the remaining case showed severe atherosclerosis with haemorrhage into the lipid core without connection to the arterial lumen (intra-atheromatous plaque haemorrhage type). However, unusual arterioles and neovascularization of the intra-and peri-arterial walls were observed. CONCLUSIONS: Our results suggest that disruption of the entire arterial wall may be a critical event in the development of IDA and result in the medial disruption and subadventitial haemorrhage. Non-atheromatous intima might function as a protective factor in arterial wall disruption. On the other hand, atherosclerosis may predispose to intra-atheromatous plaque haemorrhage type of IDA through intramural haemorrhage originating from the newly formed vessels.

Adult↗