Is There a Difference Between Diabetic and Non-Diabetic ITAs? Histomorphological and Immunohistochemical Examinations of Internal Thoracic Arteries[*]

Abstract

Background: The relative resistance to arteriosclerosis of the internal thoracic artery is clinically valid. The aim of this study was to evaluate the graduation of intima and media fibrosis in ITA parts and to determine the extent of atherosclerosis using immunohistochemical methods related to patients' risk factors. Methods: 227 distal ITA segments from 144 male and 83 female patients were examined. Mean age was 66.7 ± 9.03 years. HE and Elastica van Gieson staining was performed to detect intima-/mediafibrosis. Population: insulin-dependent diabetes mellitus (idDM; n = 35), non-insulin-dependent diabetes mellitus (nidDM; n = 32), irradiation of the chest due to cancer (n = 27), control group with isolated hyperlipidemia, hypertension, peripheral vascular disease (n = 133). 12 ITA segments of each group were examined immunohistochemically using CD34, CD68, Tenascin, Collagen III, Collagen IV. Results: Histomorphological examinations using HE and Elastica van Gieson stainings showed for idDM-ITAs no fibrosis in 57 %, slight fibrosis in 34 %, medium in 6 %, no severe, for nidDM-ITAs no fibrosis in 63 %, slight 31 %, medium 3 %, severe 3 %, for ITAs after irradiation: no fibrosis in 37 %, slight in 62 %, no medium or severe fibrosis. Compared to the control group there was no statistically significant difference in diabetic ITAs. Immunohistochemical examinations, scored on a 0 - 3 basis with 0 being the lowest (no reaction), 3 the highest (severe reaction), showed mostly no or slight reaction to CD34, CD68, Tenascin, and Collagen III for intima and media, with comparable results for diabetic or “irradiated” ITAs to those of the control group. The most distinct reaction (medium= 2), was detected for Collagen IV, a marker which outlines basement membranes of endothelia and smooth muscle cells of the vessel wall, but without differences between the four groups. No severe reactions were observed. Conclusions: The relative resistance of ITA to arteriosclerosis could be demonstrated in 227 ITA segments. Immunohistochemistry supports histomorphological findings. The influence of diabetes mellitus and irradiation remains irrelevant.

Diabetic ITAs - histomorphological findings

References

• 1 Kaufer E, Factor S M, Frame R, Brodmann R F. Pathology of the radial and internal thoracic arteries used as coronary artery bypass grafts.  Ann Thorac Surg. 1997;  63 1118-1122
• 2 van Son J AM, Smedts F, de Wilde P C. et al . Histological study of the internal mammary artery with emphasis on its suitability as a coronary artery bypass graft.  Ann Thorac Surg. 1993;  55 106-113
• 3 Gaber A J. Effective treatment of hypertension in patients with diabetes mellitus.  Clin Cardiol. 1992;  15 715
• 4 Levin M E, Sicard G A. Peripheral Vascular Disease in the Person with Diabetes. Rifkin H, Porte D Jr, Ellenberg and Rifkin's Diabetes Mellitus: Theory and Practice. 4th ed. New Hyde Park, NY; Elsevier Science 1990: 768-791
• 5 He G W. Contractility of the human internal mammary artery at the distal section increases toward the end. Emphasis on not using the end of the internal mammary artery for grafting.  J Thorac Cardiovasc Surg. 1993;  106 406-411
• 6 Marx R, Clahsen H, Schneider R, Sons H, Klein R M, Gülker H. Histomorphological studies of the distal internal thoracic artery which support its use for coronary artery bypass grafting.  Atherosclerosis. 2001;  159 43-48
• 7 van Son J AM, Smedt F, Vincent J G, van Lier H JJ, Kubat K. Comparative anatomic studies of various arterial conduits for myocardial revascularization.  J Thorac Cardiovasc Surg. 1990;  99 703
• 8 He G W, Acuff T E, Ryan W H, Yang C Q, Mack M J. Functional comparison between the human inferior epigastric artery and internal mammary artery. Similarities and differences.  Thorac Cardiovasc Surg. 1995;  109 13
• 9 Hsu S M, Raine L, Fanger H. A comperative study of the peroxidase - antiperoxidase method and an avidin-biotin complex method for studying polypeptide hormones with radioimmunoassay antibodies.  Am J Clin Pathol. 1981;  75 734-739
• 10 Cordell J L, Falini B, Erber W N. et al . Immunoenzymatic labeling of monoclonal antibodies using immune complexes of alkaline phosphatase and monoclonal antialkaline phosphatase (APAAP-complex).  J Histochem Cytochem. 1984;  32 219-229
• 11 Sims F H. A comparison of coronary and internal mammary arteries and implications of the results in the etiology of arteriosclerosis.  Am Heart J. 1983;  105 560-566
• 12 van Son J AM, Smedts F M, Yang C-Q, He G W. Morphometric study of the right gastroepiploic and inferior epigastric artery.  Ann Thorac Surg. 1997;  63 709-715
• 13 Gansera B, Schiller M, Kiask T, Angelis I, Nemaier-Prauser P, Kemkes B M. Internal thoracic artery vs. vein grafts - postoperative angiographic findings in symptomatic patients after 1000 days.  Thorac Cardiovasc Surg. 2003;  51 239-243
• 14 Lytle B W, Blackstone E H, Loop F D. et al . Two internal thoracic artery grafts are better than one.  J Thorac Cardiovasc Surg. 1999;  117 855-872
• 15 Buxton B F, Komeda M, Fuller J A, Gordon I. Bilateral internal thoracic artery grafting may improve late results of coronary artery surgery. (abstract).  Circulation. 1997;  96 (Suppl I) I-432
• 16 Gansera B, Günzinger R, Angelis I. et al . End of millennium - end of the single thoracic artery graft. Two thoracic arteries - standard for the next millennium? Early clinical results and analysis of risk factors in 1487 patients with bilateral internal thoracic artery grafts.  Thorac Cardiovasc Surg. 2001;  49 10-15
• 17 Gansera B, Hashemi A, Angelis I. et al . Cardiac surgery in patients with previous carcinoma of the breast and mediastinal irradiation: Is the internal thoracic artery graft obsolete?.  Thorac Cardiovasc Surg. 1999;  47 376-380
• 18 Sisto T. Atherosclerosis in internal mammary and related arteries.  Scand J Thorac Cardiovasc Surg. 1990;  24 7-11
• 19 Ribeau J CO, Hadcock S J, Teoh K, De Reske M, Richardson M. Endothelial adhesion molecule expression is enhanced in the aorta and internal mammary artery of diabetic patients.  J Surg Research. 1999;  85 225-233
• 20 van Son J AM, Falk V, Walther T, Smedts F M, Frank M, Mohr F W. Low-grade intimal hyperplasia in internal mammary and right gastroepiploic arteries as bypass grafts.  Ann Thorac Surg. 1997;  63 706-708

1 Presented at the 4th Joint Meeting of the German, Austrian, and Swiss Society for Thoracic and Cardiovascular Surgery, Hamburg, February 15 - 18, 2004