Smooth muscle pattern is more reliable than the presence or absence of an internal elastic lamina in distinguishing an artery from a vein.
BACKGROUND
Major pathology textbooks suggest that the shape of the vessel and the presence or absence of an internal elastic lamina are the best means to distinguish an artery from a vein. Because the shape of the vessel is highly dependent upon the plane of section, the internal elastic lamina is often cited as a more reliable criterion. After evaluating a patient with superficial thrombophlebitis, in whom these conventional criteria had led to a misdiagnosis of polyarteritis nodosa, we sought to determine whether the pattern of smooth muscle in the media is a more sensitive discriminator between an artery and a vein.


METHODS
Anatomically identified arteries and veins were harvested from extremity amputation specimens and stored autopsy organ specimens and reviewed by two dermatopathologists who were blinded to the gross pathologist's impression. The biopsies were assessed for the smooth muscle pattern and the presence or absence of an internal elastic lamina.


RESULTS
Forty-seven of the 50 cases (94%) were concordant with the pathologist's gross impression using only the smooth muscle pattern to differentiate an artery from a vein. On the basis of the presence or absence of an internal elastic lamina, 41 of 50 cases (82%) were concordant with the prosector's designation of the vessel.


CONCLUSIONS
Vessels were harvested from a variety of sites, with lower extremity vessels predominating. There may be some regional variability not addressed in this study.


CONCLUSIONS
In this study, the pattern of muscle fibers within the vascular media discriminated between arteries and veins better than assessment of the presence or absence of an internal elastic lamina. Although no single criterion is 100% reliable, assessment of both these criteria may minimize the risk of misinterpreting vessels in the deep dermis and subcutis.
Dalton
Scott R
SR
Department of Pathology, Brooke Army Medical Center and Wilford Hall Medical Center, San Antonio, TX, USA.
Fillman
Eric P
EP
Ferringer
Tammie
T
Tyler
William
W
Elston
Dirk M
DM
D001158:Arteries / Q000033:anatomy & histology*; D004547:Elastic Tissue / Q000166:cytology*; D006801:Humans; D009131:Muscle, Smooth, Vascular / Q000166:cytology*; D015203:Reproducibility of Results; D017539:Tunica Intima / Q000166:cytology*; D014680:Veins / Q000033:anatomy & histology*