Carotid atherosclerosis in chronic renal failure-the central role of increased plaque burden.

Studies on carotid artery atherosclerosis have been performed in order to understand the high risk for cardiovascular disease in chronic renal failure (CRF). The purpose of this study was to evaluate the extent and nature of carotid artery atherosclerosis in patients with CRF. Of the 135 patients with CRF (52 +/- 11 years), 58 had moderate to severe predialysis CRF (PR), 36 were on dialysis treatment (DI), and 41 were renal transplant recipients (TR). In addition, 58 control subjects (CO) were examined. Common carotid artery intima-media thickness (IMT), plaque prevalence, plaque score, and stiffness index beta were determined. Furthermore, plaque calcification and internal carotid artery stenoses were classified. Plaque prevalence (PR 64%, DI 61%, TR 51%, CO 28%; P < 0.001) and plaque score (PR 3.3 +/- 4.3, DI 3.0 +/- 3.4, TR 2.5 +/- 3.2, CO 0.8 +/- 1.7 mm; P < 0.001) were significantly greater in the CRF patient groups compared to the controls, whereas no difference in IMT was noted between the study groups. The prevalences of plaque calcification and internal carotid artery stenoses were higher among the CRF patient groups. In addition, the stiffness index beta was higher in the CRF patient groups. The present study shows that the characteristic alterations of the carotid arteries in CRF include increased plaque burden, calcification and increased arterial stiffness.

Long-term outcome of surgical revascularization of supraaortic vessels.

The aim of this study was to evaluate long-term results of different surgical reconstructions of supraaortic vessels, particularly the subclavian and innominate arteries. It is a retrospective review of 33 years experience in a teaching hospital; 80 surgical revascularizations were performed in 76 patients who suffered occlusive disease of subclavian or innominate artery from 1965 to 1998. These included 38 bypass (BP) operations (28 carotid-subclavian, 4 aorto-subclavian, 3 aorto-innominate, and 3 subclavian transpositions) and 42 endarterectomies (EA). All available patients (34) were reassessed clinically, and by triplex scanning. The mean clinical follow-up was 9 months (range 1 to 116 months) for all patients and for control-examined patients 158 months (range 6 to 346 months). Four patients were lost to follow-up. The perioperative mortality was 2.5% (BP, 0%; EA, 5%). The overall patency rate for both the BP and the EA procedures was 95% at 1 and 5 years; 91% at 10 years (BP, 89%; EA, 93%) and 89% (BP, 87%; EA, 90%) at 15 years. Most of the patients (84%) were satisfied with the clinical result in the long term. We conclude that surgical revascularization of supraaortic vessels is an infrequent procedure, and all surgical techniques give good and durable long-term outcome.