The Progression of Arteriosclerosis

This paper reports the results of a study made on 25 patients who have had two or more translumbar aortograms at intervals varying from one to four years. A technique was devised for the measurement of the diameter of the vessels from the radiographs and the type of atherosclerosis was also classified. The arterial tree, from the lower abdominal aorta to the division of the popliteal artery, was divided into nine anatomical segments. A total of 324 segments were studied.The results show that atherosclerosis must not be assumed to be a progressive and exclusively stenotic disease. In 30% the aorta and common iliac arteries became wider and in another third they showed no change. Fifty percent of the ilio-femoral segments became longer and most of these also became wider, which suggests that a considerable proportion of patients will ultimately develop arteriomegaly. In the superficial femoral arteries 50% of the cases developed further narrowing.Short narrow segments did not all progress to occlusion — 40% of the short stenoses in the aorta and iliac arteries became 2 to 5% wider. Long narrow segments more often became occluded, especially in the superficial femoral artery.It is concluded that arteriosclerotic degeneration is just as often a disease of dilatation as narrowing and that the only way to obtain evidence upon which to base a long-term prognosis is to repeat arteriograms over a period of years.