title: Prevalence of nonatheromatous lesions in peripheral arterial disease.
abstract: OBJECTIVE
  The histopathology of peripheral arterial disease and the accompanying calcification are poorly defined, and it is not known whether this varies according to different risk factors.
  
  
  RESULTS
  Sections from 176 upper and lower leg arteries were examined histologically in specimens from amputations of 60 patients with peripheral arterial disease, of whom 58% had diabetes mellitus, 35% had end-stage renal disease, and 48% had a history of smoking. The most common findings were calcification of the media (72% of arteries) and intimal thickening without lipid (68% of arteries), with the presence of atheromas in only 23% of arteries. Intimal calcification occurred in 43% and was generally much less extensive than medial calcification. Nonatheromatous intimal thickening was frequently severe, resulting in complete occlusion in some vessels. The absence of lipid and macrophages was confirmed by staining with oil red O and staining for CD68. Other than a greater prevalence and severity of medial calcification in end-stage renal disease, the findings did not differ between diabetics, patients with end-stage renal disease, or smokers.
  
  
  CONCLUSIONS
  The results indicate that the majority of arteries in patients with peripheral arterial disease have a vascular lesion that is distinct from atherosclerosis, suggesting a different pathogenesis. This pattern does not differ substantially between patients with different risk factors for peripheral arterial disease. The bulk of vascular calcification in the lower extremities is medial rather than intimal.
authors.affiliation: From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.). woneill@emory.edu.
authors.forename: W Charles
authors.initials: WC
authors.lastname: O'Neill
authors.affiliation: From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
authors.forename: Kum Hyun
authors.initials: KH
authors.lastname: Han
authors.affiliation: From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Schneider
authors.affiliation: From the Renal Division, Department of Medicine (W.C.O., K.H.H.), and Department of Pathology (T.M.S., R.A.H.), Emory University School of Medicine, Atlanta, GA; and Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
authors.forename: Randolph A
authors.initials: RA
authors.lastname: Hennigar
mesh_terms: D000671:Amputation, Surgical; D001158:Arteries / Q000473:pathology; D050197:Atherosclerosis / Q000453:epidemiology / Q000473:pathology; D003920:Diabetes Mellitus / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply*; D058729:Peripheral Arterial Disease / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D058226:Plaque, Atherosclerotic; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology*; D061205:Vascular Calcification / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery
keywords: arteriosclerosis; atherosclerosis; pathology; peripheral vascular diseases; vascular calcification