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Published on: February 11, 2017
Histopathology and morphometry of radial artery conduits: basic study and clinical application
Ujjwal K Chowdhury1, Balram Airan, Pankaj K Mishra
1Department of Cardiothoracic, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. ujjwalchow@rediffmail.com
Insights
The distal radial artery shows more intimal hyperplasia and arteriosclerosis than the proximal part, especially in older smokers and hypertensive patients. Distal segments should be discarded during radial artery harvesting for myocardial revascularization.
Area of Science:
- Vascular Biology
- Cardiovascular Surgery
- Pathology
Background:
- The radial artery is a common conduit for myocardial revascularization.
- Intimal hyperplasia, calcification, and arteriosclerosis can affect radial artery graft patency.
- Understanding the distribution and risk factors of these pathologies is crucial for optimal graft selection.
Purpose of the Study:
- To investigate the histopathology, morphometry, and risk factors of intimal hyperplasia, calcification, and arteriosclerosis in radial arteries.
- To compare morphometric differences between distal and proximal radial artery segments.
Main Methods:
- Histopathologic and morphometric analysis of 190 proximal and distal radial artery specimens.
- Evaluation of disease severity using luminal narrowing percentage, intimal thickness index, and intima-to-media ratio.
- Multivariate logistic regression to identify predictors of intimal hyperplasia, calcification, and arteriosclerosis.
Main Results:
- Distal radial artery segments exhibited significantly higher rates of intimal hyperplasia (76.3%) and luminal narrowing compared to proximal segments (32.6% normal).
- Age >50 years, smoking, and hypertension were significant predictors of intimal hyperplasia.
- Smoking, diabetes, hypercholesterolemia, peripheral arterial disease, and chronic renal failure were associated with medial calcification and arteriosclerosis.
Conclusions:
- Preexisting intimal hyperplasia is common in radial artery conduits, predominantly in the distal portion.
- Distal segments of the radial artery are more diseased and should be discarded during harvesting.
- Careful patient selection is advised, avoiding radial artery use in elderly males, smokers, diabetics, hypertensives, and those with peripheral vascular disease.
Background:
The purpose of this study was to determine the pathohistology, morphometry, and risk factors for the development of intimal hyperplasia, calcification, and arteriosclerosis in the radial artery and to compare the morphometry of the distal and proximal radial arteries.
Methods:
A total of 190 proximal and distal radial artery specimens obtained from patients who underwent myocardial revascularization were exposed to histopathologic and morphometric analysis. The severity of disease was evaluated on the basis of the percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio.
Results:
Sixty-two proximal (32.6%) and 22 distal (11.5%) radial artery segments were indicated as histologically normal. Morphometric analysis (Z test) revealed a lesser degree of intimal hyperplasia and luminal narrowing in the proximal segments compared with the distal segments (p < 0.001). The incidence of intimal hyperplasia, medial calcification, and arteriosclerosis in the distal radial arteries was 76.3%, 6.3%, and 5.78%, respectively. Using multivariate logistic regression, we have identified three significant predictors for intimal hyperplasia. Expressed as an odds ratio with a 95% confidence interval, these included (i) age greater than 50 years (1.052; 1.000-1.106, p = 0.052), (ii) smoking (14.073; 5.293-37.414, p = 0.000), and (iii) hypertension (2.777; 1.171-6.583, p = 0.020). Factors associated with an increased likelihood of medial calcification and arteriosclerosis included a history of smoking, diabetes, hypercholesterolemia, peripheral arterial disease, and chronic renal failure (p < 0.05).
Conclusions:
The great majority of radial artery conduits indicate preexisting intimal hyperplasia mostly affecting the distal portion. Therefore in cases of longer diseased segments of radial arteries, the discarded segments should be the distal end. Care should be taken when selecting radial artery as a conduit in myocardial revascularization, particularly in elderly males, diabetics, smokers, hypertensive patients, and in those with associated peripheral vascular disease.
