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Vascular Remodeling in Atherosclerotic Femoral Arteries: Three-dimensional US Analysis¹

¹ From the Divs of Cardiology (M.G., C.S., P.W., W.S., D.G.) and Angiology (M.H., E.M.), Depts of Internal Medicine II and Medical Computer Sciences, Section of Clinical Biometrics (S.L.), Univ of Vienna, Wahringer Gurtel 18–20, A-1090 Vienna, Austria; and Heart Lung Institute, Utrecht, the Netherlands (G.P.). Received Jun 10, 2003; revision requested Aug 26; revision received Dec 10; accepted Jan 13, 2004. Address correspondence to M.G. (e-mail: mariann.gyongyosi@univie.ac.at).

PURPOSE: To investigate the various modes of vascular remodeling of atherosclerotic femoral arteries and determine the associations between type of arterial remodeling and clinical data (age, sex, and medical history) and inflammatory parameters.

MATERIALS AND METHODS: Intravascular ultrasonography (US) of the femoral arteries was performed in 50 patients with clinical symptoms of peripheral vascular disease. To determine the arterial remodeling mode (expansive remodeling [ER], involving compensatory enlargement of the artery, or constrictive remodeling [CR], involving vessel constriction during progression of atherosclerosis), the cross-sectional areas (CSAs) of the external elastic membrane (EEM), lumen, and plaque-plus-media were measured every 0.1 mm by using three-dimensional reconstruction. Clinical, laboratory, and intravascular US data were compared in the different remodeling groups (dominant ER, dominant CR, or mixed remodeling) by using analysis of variance supplemented by Tukey-Kramer tests. Multivariate analysis was performed to test independent variables predicting dominant ER.

RESULTS: Intravascular US revealed the parallel existence of ER and CR in all patients: Increases and decreases in EEM in response to plaque growth could be observed within the same artery. ER dominated in 13 (26%) patients, and CR dominated in 11 (22%) patients: At least 80% of EEM CSAs were higher or lower than the mean of the EEM CSAs of the segments proximal and distal to the lesion. Patients with dominant ER had higher levels of serum C-reactive protein (CRP) compared with levels in patients with dominant CR and patients with mixed remodeling (1.62 mg/dL ± 2.05 [standard deviation] vs 0.19 mg/dL ± 0.33 and 0.21 mg/dL ± 0.39, respectively, P < .005). Multivariate analysis revealed high CRP level to be a significant independent predictor for dominant ER (P < .01).

CONCLUSION: The parallel existence of ER and CR was found in all patients with peripheral atherosclerosis, with a dominance of vessel expansion in 26% of patients. Higher plasma CRP level was associated with dominant ER.

© RSNA, 2004

Index terms: Arteries, femoral, 922.12989 • Arteries, stenosis or obstruction, 922.721 • Arteries, US, 922.12989 • Arteriosclerosis, 922.721 • Ultrasound (US), intravascular, 922.12989