Prevalence and correlation of atherosclerosis in internal mammary artery and coronaries: an autopsy study
Keywords:
Atherosclerosis, Autopsy, Coronary Vessels, Mammary Arteries, American Heart Association classification.
Abstract
Background: Coronary Artery Bypass Grafting (CABG) is one of the standard surgical procedures for treatment of multivessel Coronary Artery Disease (CAD). Among the various arterial grafts, Internal Mammary Artery (IMA) has been preferred as conduit of choice to bypass the coronary occlusion. But now with the incremental utilization of IMA grafts in CABG, there is a need for reassessment of its histological structure and presence of atherosclerosis. A prospective study was taken up to assess and correlate the prevalence of atherosclerosis in IMA and coronaries on autopsy.Methods: Representative segments of bilateral IMA and all major coronaries were taken from 150 autopsy cases conducted at Victoria hospital, Bangalore. These were processed conventionally. H&E sections of all cases were studied microscopically for presence of atherosclerosis. Morphological assessment of atherosclerotic lesions was done according to American Heart Association (AHA) classification.Results: Study included 114 males and 36 females. Atherosclerosis in IMA was seen in 11 (7.3 %) cases and coronary atherosclerosis in 122 (81.3%) cases. Prevalence of Coronary Atherosclerosis in male cases was 85.9%, while in female cases was 66.6%. LAD was the most commonly involved among coronaries. All 11 cases with IMA atherosclerosis showed coronary atherosclerosis. Higher AHA types of atherosclerosis (type 4/5) were not seen in IMA. There was no other vascular pathology apart from atherosclerosis in IMA.Conclusion: The Prevalence of atherosclerosis in IMA is on a higher side suggesting a need to look for and evaluate other conduit vessels as alternate to IMA in CABG.References
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18) Julke M, von Segesser L, Schneider J, Turina M, Heitz PU. Degree of arteriosclerosis of the internal mammary artery and of the coronary arteries in 45-to-75-year-old men. An autopsy study. Schweiz Med Wochenschr, 1989, Sep; 119(36) :1219-23.
19) Sims FH. A comparison of coronary and internal mammary arteries and implications of the results in the etiology of arteriosclerosis. Am Heart J, 1983, 105 : 560-66.
20) Huddleston CB, Stoney WS, Alford WC Jr, Burrus GR, Glassford DM Jr, Lea JW et al. Internal mammary artery grafts: technical factors influencing patency. Ann Thorac Surg. 1986;42(5):543-9
21) Sims FH. Discontinuities in the internal elastic lamina: a comparison of coronary and internal mammary arteries. Artery, 1985, 13:237–243.
22) Sims FH, Gavin JB (1990) The early development of intimal thickening of human coronary arteries. Coronary Artery Dis 1:205–213.
23) Suma H, Isomura T, Horii T, Sato T. Late angiographic results of using the right gastroepiploic artery as a graft. J Thorac Cardiovasc Surg 2000;120:496–498.
24) Puig LB, Souza AHS, Cividanes GVL, et al. Eight years experience using the inferior epigastric for myocardial revascularization. Eur J Cardiothorac Surg 1997;11:243–247.
2) Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian Heart Journal. 2008:60;B4–B18.
3) Park K. Epidemiology of Chronic Non-communicable Diseases and Conditions in Park’s Textbook of Preventive and Social Medicine, 20th ed., Banarsidas Bhanot Publishers, 2009. Chapter 6:303-05.
4) WS Aronow. Total Arterial Revascularization in CABG. Artery Bypass, 1st Ed. InTech, 2013:119.
5) Seevanayagam S, Buxton B. Arterial Grafting for Coronary Artery Bypass Surgery, 2nd Edition. Guo-Wei He, editor. Springer, 2006:1-110.
6) Edwards WD. Cardiovascular system in Handbook of autopsy practice, Ludwig J (Editor). Totowa, NJ, Humana Press, 2002;21-43.
7) Stary HC, Chandler AB, Glagov S, Guyton JR, Insull W Jr, Rosenfeld ME, Schaffer SA, Schwartz CJ, Wagner WD, Wissler RW. A definition of initial, fatty streak, and intermediate lesions of atherosclerosis: a report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Arterioscler Thromb. 1994;14: 840–856.
8) Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, Rosenfeld ME, Schwartz CJ, Wagner WD, Wissler RW. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis. American Heart Association. Circulation. 1995;92:1355–1374.
9) Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685–95.
10) Fausto N. Atherosclerosis in young people: The value of the autopsy for studies of the epidemiology and pathobiology of disease. Am J Pathol 1998;153:1021-2.
11) Kinoshita T, T Asai, T Suzuki, DV Phung. Histomorphology of right versus left internal thoracic artery and risk factors for intimal hyperplasia. European Journal of Cardiothoracic surgery 2013.
12) Kneubil MC, Gomes WJ, Aquino MS, Mazzilli P, Gomes GN, Ribeiro MF, Benatti CD, Buffolo E. Sequential histomorphometric study of the left internal thoracic artery. Braz J Cardiovasc Surg 2006; 21(4): 371-376.
13) Puri N, Gupta PK, Sharma J, Puri D. Prevalence of atherosclerosis in coronary artery and internal thoracic artery and its correlation in North–West Indians. Indian Journal of Thoracic & Cardiovascular Surgery. 2010; 26:243–246.
14) Sons HJ, Godehardt E, Kunert J, Losse B, Bircks W. Internal thoracic artery: prevalence of atherosclerotic changes. Journal of Thoracic & Cardiovascular Surgery. 1993; 106:1192–5.
15) Singh RN. Atherosclerosis and internal mammary arteries. Cardiovascular Interventional Radiology. 1983; 6:72–7.
16) Kay HR, Korns ME, Flemma RJ, et al. Atherosclerosis of the internal mammary artery. Ann Thorac Surg 1976;21:504-7.
17) Markl B, S Raab, H Arnholdt, C Vicol. Morphological and histopathological comparison of left and right internal thoracic artery with implications on their use for coronary surgery. Interact CardioVasc Thorac Surg; 2003, 2:73-76.
18) Julke M, von Segesser L, Schneider J, Turina M, Heitz PU. Degree of arteriosclerosis of the internal mammary artery and of the coronary arteries in 45-to-75-year-old men. An autopsy study. Schweiz Med Wochenschr, 1989, Sep; 119(36) :1219-23.
19) Sims FH. A comparison of coronary and internal mammary arteries and implications of the results in the etiology of arteriosclerosis. Am Heart J, 1983, 105 : 560-66.
20) Huddleston CB, Stoney WS, Alford WC Jr, Burrus GR, Glassford DM Jr, Lea JW et al. Internal mammary artery grafts: technical factors influencing patency. Ann Thorac Surg. 1986;42(5):543-9
21) Sims FH. Discontinuities in the internal elastic lamina: a comparison of coronary and internal mammary arteries. Artery, 1985, 13:237–243.
22) Sims FH, Gavin JB (1990) The early development of intimal thickening of human coronary arteries. Coronary Artery Dis 1:205–213.
23) Suma H, Isomura T, Horii T, Sato T. Late angiographic results of using the right gastroepiploic artery as a graft. J Thorac Cardiovasc Surg 2000;120:496–498.
24) Puig LB, Souza AHS, Cividanes GVL, et al. Eight years experience using the inferior epigastric for myocardial revascularization. Eur J Cardiothorac Surg 1997;11:243–247.
Published
2015-04-29
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