Impact of Femoral Ossification on Local and Systemic Cardiovascular Patients' Condition

Ann Vasc Surg. 2019 Oct;60:335-345. doi: 10.1016/j.avsg.2019.03.035. Epub 2019 Jun 12.

Abstract

Background: Vascular calcifications are associated with a high cardiovascular morbi-mortality in the coronary territory. In parallel, femoral arteries are more calcified and develop osteoid metaplasia (OM). This study was conducted to assess the predictive value of OM and local inflammation on the occurrence of mid- and long-term adverse cardiovascular events.

Method: Between 2008 and 2015, 86 atheromatous samples were harvested during femoral endarterectomy on 81 patients and processed for histomorphological analyses of calcifications and inflammation (monocytes and B cells). Histological findings were compared with the long-term follow-up of patients, including major adverse cardiac event (MACE), major adverse limb event (MALE), and mortality. Frequencies were presented as percentage, and continuous data, as mean and standard deviation. A P-value < 0.05 was considered statistically significant.

Results: Median follow-up was 42.4 months (26.9-58.8). Twenty-eight percent of patients underwent a MACE; a MALE occurred in 18 (21%) limbs. Survival rate was 87.2% at 36 months. OM was found in 41 samples (51%), without any significant impact on the occurrence of MACE, MALE, or mortality. Preoperative white blood cell formulae revealed a higher rate of neutrophils associated with MACE (P = 0.04) and MALE (P = 0.0008), correlated with higher B cells counts in plaque samples.

Conclusions: OM is part of femoral calcifications in almost 50% of the cases but does not seem to be an independent predictive variable for MACE or MALE. However, a higher rate of B cell infiltration of the plaque and preoperative neutrophil blood count may be predictive of adverse events during follow-up.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Amputation
  • B-Lymphocytes / immunology
  • B-Lymphocytes / pathology
  • Disease Progression
  • Endarterectomy
  • Female
  • Femoral Artery / immunology
  • Femoral Artery / pathology*
  • Femoral Artery / surgery
  • France / epidemiology
  • Humans
  • Limb Salvage
  • Male
  • Middle Aged
  • Neutrophils / immunology
  • Neutrophils / pathology
  • Ossification, Heterotopic*
  • Peripheral Arterial Disease / immunology
  • Peripheral Arterial Disease / mortality
  • Peripheral Arterial Disease / pathology*
  • Peripheral Arterial Disease / surgery
  • Plaque, Atherosclerotic
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Calcification / immunology
  • Vascular Calcification / mortality
  • Vascular Calcification / pathology*
  • Vascular Calcification / surgery