Related Experiment Videos
Pattern of occlusive peripheral vascular disease in India. (clinicopathological study of 79 cases)
1Department of Pathology, King Edward VII Memorial Hospital, Bombay, India.
Insights
Peripheral vascular disease in India is primarily a thrombotic disorder, not distinctly separated by clinical types like Thromboangiitis Obliterans (TAO) and Atherosclerosis Obliterans (ASO). Angiitis is rare, suggesting thrombosis is the main issue.
Area of Science:
- Vascular Surgery
- Pathology
- Cardiovascular Research
Background:
- Peripheral vascular disease (PVD) significantly impacts patient health, necessitating a deeper understanding of its underlying pathology.
- Distinguishing between clinical presentations like Thromboangiitis Obliterans (TAO) and Atherosclerosis Obliterans (ASO) is crucial for effective treatment.
Purpose of the Study:
- To investigate the pathological patterns of peripheral vascular disease in Indian patients undergoing amputation.
- To compare the arterial involvement in TAO and ASO, and to determine the primary etiological factors.
Main Methods:
- Study included 89 patients with PVD requiring amputation and 26 control limbs.
- Clinical classification into TAO, ASO, and thrombo-embolic disease.
- Detailed angiographic, macroscopic, and microscopic examination of dissected arteries.
Main Results:
- No significant difference in arterial involvement frequency or extent between TAO and ASO.
- Primary thrombotic occlusion observed in a high percentage of both TAO (21/25) and ASO (23/54) cases.
- Atheromatous lesions were considered old thrombi, not primary degenerative causes, and were absent in controls.
Conclusions:
- Buerger's disease (TAO) is primarily a thrombotic disorder.
- TAO and ASO are not distinctly separable pathologically due to high rates of primary thrombosis in ASO.
- While thrombosis is key, the specific genesis may differ between TAO and ASO.
Abstract:
The pattern of peripheral vascular disease in India was studied in 89 patients undergoing amputation for vascular insufficiency. A control group of 26 limbs was studied for aging changes. Clinically, cases were classified into TAO (25), ASO (54) and thrombo-embolic disease (10). Angiographic, macroscopic and microscopic study of dissected vascular tree was done in view of clinical diagnosis. No significant difference was noted in the frequency and extent of involvement of limb arteries in TAO and ASO. Histologically angiitis was noted in 4 cases of TAO and one of ASO but these did not form a distinct clinical group. Primary thrombotic occlusion was seen in 21 cases of TAO and 23 cases of ASO. Atheroma with and without thrombosis was found in 26 cases. In 4 cases the arterial tree was normal. Atheromatous lesions were not seen in control group. In the groups under study they were thought to represent old thrombi rather than degenerative lesions predisposing to thrombosis. In view of these findings it was felt that Buerger's disease was primarily a thrombotic disorder. Angiitis was rare and was probably secondary. The two clinical groups TAO and ASO are not pathologically distinct as very high percentage of the latter showed primary thrombosis. The genesis of thrombosis in two groups however may be different.