Histologic atherosclerotic plaque characteristics are associated with restenosis rates after endarterectomy of the common and superficial femoral arteries

• Published in: Journal of vascular surgery Vol. 52; no. 3; pp. 592 - 599
• Main Authors: Derksen, Wouter J.M., MD, de Vries, Jean-Paul P.M., MD, PhD, Vink, Aryan, MD, PhD, Velema, Evelyn, MSc, Vos, Jan-Albert, MD, PhD, de Kleijn, Dominique, PhD, Moll, Frans L., MD, PhD, Pasterkamp, Gerard, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2010; Elsevier
• Subjects: Aged; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - pathology; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Chi-Square Distribution; Constriction, Pathologic; Endarterectomy - adverse effects; Female; Femoral Artery - diagnostic imaging; Femoral Artery - pathology; Femoral Artery - surgery; Humans; Logistic Models; Male; Medical sciences; Middle Aged; Netherlands; Neurology; Odds Ratio; Recurrence; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular diseases and vascular malformations of the nervous system; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular disease; Superficial femoral artery; Restenosis; Common femoral artery; Atherosclerotic plaque; Surgery; Atherosclerosis; Cardiovascular disease; Histology; Endarteriectomy
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2010.03.063

Objectives This study assessed the predictive value of histologic plaque characteristics for the occurrence of restenosis after femoral artery endarterectomy. Background It would be advantageous if patients at increased risk for restenosis after arterial endarterectomy could be identified by histologic characteristics of the dissected plaque. Differences in atherosclerotic plaque composition of the carotid artery have been associated with restenosis rates after surgical endarterectomy. However, whether atherosclerotic plaque characteristics are also predictive for restenosis in other vascular territories is unknown. Methods Atherosclerotic plaques of 217 patients who underwent a common femoral artery endarterectomy (CFAE; n = 124) or remote superficial femoral artery endarterectomy (RSFAE; n = 93) were examined and scored microscopically for the presence of collagen, macrophages, smooth muscle cells, lipid core, intraplaque hemorrhage, and calcifications. The 12-month restenosis rate was assessed using duplex ultrasound imaging (peak systolic velocity [PSV] ratio ≥2.5). Results The 1-year restenosis rate was 66% (61 of 93) after RSFAE compared to 21% (26 of 124) after CFAE. Plaque with characteristics of high collagen and smooth muscle cell content were positively associated with the occurrence of restenosis, with odds ratios (ORs) of 2.90 (95% confidence interval [CI], 1.82-4.68) and 2.20 (1.50-3.20) for superficial femoral artery (SFA) and common femoral artery (CFA), respectively. SFA plaques showed significantly heavier staining for collagen (69% vs 31% for CFA; P < .001) and smooth muscle cells (64% vs 36% for CFA; P < .001). After multivariate analysis, the operation type (CFAE or RSFAE), gender, and the presence of collagen were independent predictive variables for restenosis after endarterectomy of the CFA and SFA. Conclusion Plaque composition of the CFA and SFA differs. Furthermore, the dissection of a fibrous collagen-rich plaque is an independent predictive variable for restenosis after endarterectomy of the CFA and SFA.