Arteriosclerosis in the lower limbs: a pathological study of fifty cases with no ischaemia

Abstract

INTRODUCTION:

In recent years there has been a greatly increased interest in peripheral arterial disease. This has come about as a result of improvements in diagnostic and surgical techniques which have led to extensive operative procedures by the vascular surgeon on both arteries and veins. Nevertheless, the treatment of obliterative arteriosclerosis and thromboangiitis obliterans remains mostly palliative and far from curative. Possibly this is because there has been very little advance knowledge in the initial pathology of these diseases in the lower limb within the last forty years.

After von Winiwarter (1879) gave his classic description of “endarteritis” as a cause of gangrene in the lower limb, there was obvious confusion between this disease and obliterative arteriosclerosis. Buerger (1908) more closely differentiated thromboangiitis obliterans but there is still (Luke, 1947) considerable clinical confusion between these two diseases. Thromboangiitis obliterans remains relatively rare but obliterative arteriosclerosis is becoming more common, doubtless because of the increase in age of the population.

There is a moderate number of published descriptions of the pathological changes in peripheral arteriosclerosis with gangrene which will be referred to subsequently. There are, however, very few accounts available which describe in any detail arterial disease in the lower limb in the absence of gangrene or other clinical manifestation of ischaemia. Most references are confined to incidental allusions or general statements. Indeed, with one or two exceptions, there have been no contributions to the literature along these lines since the extensive investigations by various German workers forty odd years ago.

Since then the knowledge of blood vessels in other parts of the body has been augmented by the use of newer injection techniques. This study has been undertaken using some of these methods to investigate arterial disease in the lower limbs when there is no ischaemia. Previously, no attempt has been made to approach the problem from this aspect.

There are no accounts available of any assessment of the degree of arterial disease in any of the extremities and it is hoped that the results of this study may provide a basis for the further investigation of arterial disease in the ischaemic limb.