大動脈瘤および閉塞性動脈硬化症における頸動脈超音波所見(II)

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  • Ultrasonographic findings of carotid arteries in aortic aneurysm and arteriosclerosis obliterans (Part II)

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Although both aortic aneurysm and arteriosclerosis obliterans have been clarified pathologically, we established a basis for the clinical estimation of arterial changes other than primary lesions and evaluated their significance. We examined ultrasonographic (US) findings of extra-cranial carotid arteries in 77 male patients with aortic aneurysm (AA group) and 88 male patients with arteriosclerosis obliterans (ASO group), who were diagnosed by computed tomography, angiography and/or surgery. Using a high-resolution, realtime, B-mode US instrument, the diameter and wall thickness of the common carotids were measured bilaterally in the end-diastolic phase, and occlusive changes and plaques were estimated. As risk factors for atherosclerosis, hypertension, diabetes, hyperlipidemia, and cigarette smoking were assessed, in addition to age, body height and weight. Mean ages of the AA and ASO groups were 72 and 70 years, respectively. There was no significant difference between the groups in body height or weight. Hypertension was frequently seen in the AA group, whereas diabetes and cigarette smoking were frequent observed in the ASO group. US findings revealed that the mean diameter of the carotids, even when adjusted for body height and body surface area, was significantly greater in the AA group than in the ASO group. The index of trans-sectional vessel wall area, calculated with diameter and wall thickness, was also greater in the AA group, but the mean wall thickness of the AA group did not differ from that of the ASO group. Carotid lesions, especially bilateral carotid lesions, were significantly more frequent in the ASO group. Stepwise regression analysis demonstrated that the diameter was strongly related to the wall thickness and the presence of hypertension as well as the type of vessel diseases (AA/ASO). The diameter was also positively correlated with the wall thickness (r=0.324). Pathological findings of resected specimens, obtained from 40 patients with aortic aneurysm by surgical therapy, revealed lesions to be compatible with atherosclerosis. These findings showed that the carotid arteries were significantly dilated in patients with atherosclerotic aortic aneurysm. Recent studies have reported that either destruction of elastic fibers in the media due to primary activation of elastase or medial metaboic change secondary to intimal thickening cause aortic aneurysm. Therefore, it considered that the carotid dilatation was primarily due to medial destruction since no difference in the wall thickness between the AA and ASO groups was found. This suggested that medial fragility and ectasia were markedly present in patients with AA. Furthermore, hypertension, which was frequently seen in the AA group and correlated with the diameter of the common carotids, may promote dilatation of these arteries and increase medial fragility.

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