Oral bacteria in the occluded arteries of patients with Buerger disease Takehisa Iwai, MD, PhD, Yoshinori Inoue, MD, PhD, Makoto Umeda, DDS, PhD, Yi Huang,

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Oral bacteria in the occluded arteries of patients with Buerger disease Takehisa Iwai, MD, PhD, Yoshinori Inoue, MD, PhD, Makoto Umeda, DDS, PhD, Yi Huang, DDS, PhD, Nobuhisa Kurihara, MD, Morio Koike, MD, PhD, Isao Ishikawa, DDS, PhD Journal of Vascular Surgery Volume 42, Issue 1, Pages 107-115 (July 2005) DOI: 10.1016/j.jvs.2005.03.016 Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, An angiogram of case 6, a 73-year-old man with a smoking history of 15 cigarettes per day for 53 years. Arterial changes typical of Buerger disease can be observed in the left leg and below the right knee. This patient developed gangrene on his left third and fourth toes at age 32 years. A minor amputation was performed at that time. An abdominal aortic aneurysm was diagnosed at age 73 years, and an aneurysmectomy with a bifurcated graft replacement was performed. A segment of his left femoral artery was obtained for this study during the operation. The patient quit smoking after abdominal aortic aneurysm surgery. B, The pathologic examination of the superficial femoral artery (SFA) of case 6. Intimal defects (may be artifacts) and internal elastic lamina are duplicated. Medial muscle fibers were replaced by collagenous fibers and fibroblasts. No inflammatory cells, such as giant cells or neutrophils, are seen. Atherosclerotic changes, such as foam cells, atheroma deposits, or cholesterol crystals, are absent (stain, elastica van Gieson stain; original magnification, ×40). Journal of Vascular Surgery 2005 42, 107-115DOI: (10.1016/j.jvs.2005.03.016) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 1 A, An angiogram of case 6, a 73-year-old man with a smoking history of 15 cigarettes per day for 53 years. Arterial changes typical of Buerger disease can be observed in the left leg and below the right knee. This patient developed gangrene on his left third and fourth toes at age 32 years. A minor amputation was performed at that time. An abdominal aortic aneurysm was diagnosed at age 73 years, and an aneurysmectomy with a bifurcated graft replacement was performed. A segment of his left femoral artery was obtained for this study during the operation. The patient quit smoking after abdominal aortic aneurysm surgery. B, The pathologic examination of the superficial femoral artery (SFA) of case 6. Intimal defects (may be artifacts) and internal elastic lamina are duplicated. Medial muscle fibers were replaced by collagenous fibers and fibroblasts. No inflammatory cells, such as giant cells or neutrophils, are seen. Atherosclerotic changes, such as foam cells, atheroma deposits, or cholesterol crystals, are absent (stain, elastica van Gieson stain; original magnification, ×40). Journal of Vascular Surgery 2005 42, 107-115DOI: (10.1016/j.jvs.2005.03.016) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 2 Pathologic pictures of different stages of Buerger disease. A, Intermediate-chronic phase of case 12 (aged 39 years) (inset: stain, hematoxylin and eosin; original magnification, ×600). B, Chronic phase of case 9 (aged 65 years). There is more cellular infiltration in the intermediate-chronic phase compared with the chronic phase, from which well-organized thrombi in the lumen can be observed, and cellular infiltration is not as apparent (stain, elastica van Gieson stain; original magnification, ×40). Journal of Vascular Surgery 2005 42, 107-115DOI: (10.1016/j.jvs.2005.03.016) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 3 A pathologic picture of a control arterial specimen. This is a common femoral arterial specimen from control patient 6 (aged 73 years; male), who underwent abdominal aortic reconstruction surgery. Macroscopically, the inner surface of the arterial specimen was smooth and shiny, and the arterial wall was soft and elastic. The microscopic view shows mild fibrous thickening in the intima. The media is almost intact, with a little disorder of the muscle fibers. No calcification or atheromatous degeneration was found. There was also no infiltration of any inflammatory cells in the adventitia (stain, elastica van Gieson stain; original magnification, ×40). Journal of Vascular Surgery 2005 42, 107-115DOI: (10.1016/j.jvs.2005.03.016) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions

Fig 4 Polymerase chain reaction results of artery samples from patients with Buerger disease. Lane 1, 1-Kilobase DNA ladder; lane 2, positive control; lane 3, negative control; lanes 4–17, arterial samples from patients with Buerger disease; lanes 18–24, arterial samples from control patients. Journal of Vascular Surgery 2005 42, 107-115DOI: (10.1016/j.jvs.2005.03.016) Copyright © 2005 The Society for Vascular Surgery Terms and Conditions