Abstract
In an attempt to elucidate the causes of occlusion of radial arteries used for coronary artery bypass grafts and to improve the results of these procedures, we studied the biometry and histology of the coronary, radial and left internal thoracic arteries. These arteries were harvested from 20 cadavers (13 males, 7 females). The specimens were calibrated to the various bypass graft sites using coronary calibrators, and were then submitted to histological examination to determine the structure and innervation of the vessel wall. No correlation was observed between the internal calibers of these various arteries, with the exception of the anterior interventricular and right coronary arteries. Intimal changes and the presence of atheromatous plaque were observed in coronary and radial arteries, but never in the internal thoracic artery. Like the coronary arteries and their branches, the radial artery is a muscular artery. Aging of muscular arteries results in thickening of the intima, which becomes fibrotic due to migration of myocytes from the media and duplication of the internal elastic lamina. The media becomes fibrous, hypertrophic or atrophic. The walls of the radial and coronary arteries contain several adventitial nerves (sympathetic and parasympathetic nerve fibers), but these nerve fibers were not observed in the wall of the left internal thoracic artery. In contrast, the internal thoracic artery, like the aorta, is an elastic artery. Aging of elastic arteries is first observed between the ages of 20 and 29 years and is characterized by loss of one or several elastic laminae of the media and more marked intimal thickening, over a variable length. Even if a radial artery's caliber is similar to that of the coronary artery, histological evolution and graft patency depend on its muscular identity.
Résumé
Pour tenter de comprendre les causes d'occlusion des artères radiales utilisées comme greffons dans les pontages aorto-coronariens et améliorer les résultats, la biométrie et l'histologie des artères coronaires, radiales et thoracique interne gauche ont été étudiées. Nous avons prélevé ces trois types d'artères chez 20 cadavres (13 hommes et 7 femmes). Ces prélèvements ont été calibrés aux différents sites de pontages avec des calibreurs coronaires, puis analysés en histologie afin de déterminer la structure et l'innervation de la paroi. Nous n'avons pas trouvé de corrélation entre les calibres internes de ces différentes artères, à l'exception des artères interventriculaire antérieure et coronaire droite. Le remaniement de l'intima et la présence de plaques d'athéromes ont été observés dans les artères coronaires et radiales, jamais dans l'artère thoracique interne. Comme les artères coronaires et leurs branches, l'artère radiale est de type musculaire. Leur vieillissement se traduit par un épaississement de l'intima qui se fibrose, par une migration myocytaire de la média et par un dédoublement de la limitante élastique interne. La média devient fibreuse, hypertrophique ou atrophique. A l'opposé l'artère thoracique interne est une artère élastique comme l'aorte. Le vieillissement se caractérise par la disparition, sur une étendue variable, d'une ou de plusieurs lames élastiques de la média et un épaississement intimal plus marqué. Même si, anatomiquement, le calibre reste adapté entre artère radiale et artère coronaire, le devenir histologique et donc la perméabilité des artères radiales est en relation avec sa nature musculaire.
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Barry, M.M., Foulon, P., Touati, G. et al. Comparative histological and biometric study of the coronary, radial and left internal thoracic arteries. Surg Radiol Anat 25, 284–289 (2003). https://doi.org/10.1007/s00276-003-0142-x
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DOI: https://doi.org/10.1007/s00276-003-0142-x