Vascular disease
The article covers vascular disease, i.e. diseases of blood vessels. Vasculitides are covered in a separate article called vasculitides.
Normal blood vessels
Comparing arteries and veins:[1]
| Feature | Artery | Vein |
| Internal elastic lamina | prominent/thick, usu. complete | thin & incomplete |
| External elastic lamina | present, thick | absent |
| Shape | circular / lumen wide open | collapsed |
| Wall thickness | thick | thin |
Great vessels
When things go wrong here, you see a cardiac surgeon.
Atherosclerosis
General
- A leading cause of death, esp. in the Western world.
- May have multi-system manifestations.
Location and associated pathology:
- Coronary artery atherosclerosis (AKA coronary artery disease) -> myocardial infarction +/-coronary thrombosis.
- Peripheral artery atherosclerosis -> peripheral vascular disease -> amputations.
- Carotid artery atherosclerosis -> thrombotic stroke.
- Superior mesenteric artery atherosclerosis -> ischemic enteritis or ischemic colitis or ischemic enterocolitis.
- Penile artery atherosclerosis -> impotence.
Clinical risk factors:
- Age.
- Blood pressure - modifiable (antihypertensives).
- Cholesterol - modifiable (statins, diet).
- Diabetes mellitus - modifiable (hypoglycemic medications, diet, lifestyle).
- Smoking - modifiable (cessation).
- Family history.
Microscopic
Features:
- Intimal hyperplasia.
- Lipid deposition.
- Foamy macrophages within intima & media.
- Cholesterol clefts
- Luminal narrowing.
Image:
Notes:
- Considered "complex" if any of the following are present:[2]
- Calcifications.
- Thrombosis.
- Haemorrhage.
Stains
- Elastic trichrome stain or Movat stain - highlights duplication of internal elastic lamina, allows on to identify with ease intimal thickening.
Aortic dissection
General
Classic risk factors:
Associations
Heritable:[4]
- Marfan's syndrome.
- Loeys-Dietz syndrome - a Marfan-like syndrome[5]
- Ehlers-Danlos syndrome.
- Bicuspid aortic valve.
Others:
- Tertiary syphilis.[6]
- Turner syndrome.[7]
Classification
Two classification exist:
- DeBakey.
- Stanford.
Stanford dissection classification:[8]
- Type A - aortic root to the left subclavian artery.
- Considered a surgical emergency.
- Type B - distal to (left) subclavian artery.
- Generally, treated conservatively.
Microscopic
Images:
Cystic medial degeneration
General
Microscopic
- Basophilic ground substance in the media (seen on Movat's stain).
- Disruption of the elastic lamina (seen on elastic trichrome stain).
- +/-Focal necrosis.
Images:
- www:
- WC:
Medial calcific sclerosis
- AKA Moenckeberg medial calcific sclerosis, calcific medial sclerosis of Monckeberg, and Monckeberg's arteriosclerosis.
General
- Usually of no clinical consequence.
Microscopic
Features:[12]
- Medial calcification (purple irregular stuff -- calcium phosphate).
Note:
- Lumen unaffected.
Images:
Hyperplastic arteriolosclerosis
General
- Hyperplasia = proliferation of cells.
- Associated with:[13]
- Malignant hypertension.
- Scleroderma.
Microscopic
Features:[12]
- Onion-skin appearance of intima & media due to:
- Intimal hyperplasia.
- Smooth muscle hyperplasia.
Image: Hyperplastic arteriolosclerosis (utah.edu).
Fibromuscular dysplasia
- Abbreviated FMD.
General
Etiology:
- Unknown, possibly genetic.
Gender:
- Women > men.
- May be seen in virtually any artery.
- Reported as a cause of sudden death with involvement of the artery supplying the AV node.[14]
Gross/radiologic
- Segmental - thinning and thickening.[15]
Classical locations:[15]
- Renal artery - leading to hypertension.
- Carotid artery.
Microscopic
Features:[15]
- Smooth muscle hyperplasia - key feature.
- Elastic fibre fragmentation.
- Luminal narrowing.
Images:
Stains
- Elastic trichrome or Movat stain - to demonstrate elastic fibre fragmentation.
Thromboangiitis obliterans
- AKA Buerger disease.
- Should not be confused with Berger disease (IgA nephropathy).
General
- Strong association with smoking.[16]
- Small and medium-sized vessels of the extremities.
Diagnosis - clinical:
- Corkscrew vessels on angiography.[17]
Treatment:
- Stop smoking.
Microscopic
Features:[18]
- Acute inflammation:
- Endarteritis - inner layers of blood vessels.
- Periarteritis.
Thrombosis
- See also: Cerebral venous thrombosis.
General
Definition:
- Blood clot formation within a vessel.
Complications:
- Embolism - see: Pulmonary thromboembolism.
Risk factors:
- The classic pimping question is what "Virchow's triad?"
- Stasis, hypercoagulability, endothelial injury.
- A long list is found in: risk factors for VTE.
Gross
Microscopic
Features:
- Lines of Zahn.
- Fibrin - pink acellular stuff on a H&E stain.
Image:
Cholesterol embolism
- Abbreviated CE.
General
- Strong association with atherosclerosis - found in ~3% of individuals in an autopsy series of 267 older individuals (mean age ~65 years).[19]
- Significant CEs are often iatrogenic.
- Known complication of coronary catherization (incidence ~ 1%).[20]
- May complicate any vascular surgery, CABG.
Microscopic
Features:[21]
- Intravascular cholesterol clefts (biconvex white spaces) - key feature.
- Typically ~ 100-500 micrometers (long axis) x 50-100 micrometers (short axis). (?)
- +/-Macrophages and giant cells.
- +/-Eosinophils.
Note:
- May be associated with ischemic changes and necrosis.
- Usually in the context of severe atherosclerosis.
Note (trivia):
- Cholesterol crystals dissolve with routine processing (paraffin embedding); this is why one talks of "cholesterol clefts".
Images:
Intracranial berry aneurysm
Main article: Berry aneurysm
See also
References
- ↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm. Accessed on: 13 January 2011.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 4. ISBN 978-1416002741.
- ↑ Braverman, AC. (Oct 2011). "Aortic dissection: prompt diagnosis and emergency treatment are critical.". Cleve Clin J Med 78 (10): 685-96. doi:10.3949/ccjm.78a.11053. PMID 21968475.
- ↑ Gleason TG (2005). "Heritable disorders predisposing to aortic dissection". Semin. Thorac. Cardiovasc. Surg. 17 (3): 274-81. doi:10.1053/j.semtcvs.2005.06.001. PMID 16253833.
- ↑ Loeys BL, Schwarze U, Holm T, et al (August 2006). "Aneurysm syndromes caused by mutations in the TGF-beta receptor". N. Engl. J. Med. 355 (8): 788-98. doi:10.1056/NEJMoa055695. PMID 16928994. http://content.nejm.org/cgi/content/full/355/8/788.
- ↑ Cruz, RP.; Marrone, LC.; Marrone, AC. (Nov 2010). "Chronic syphilitic aortic aneurysm complicated with chronic aortic dissection.". Am J Surg 200 (5): e64-6. doi:10.1016/j.amjsurg.2010.02.017. PMID 20864080.
- ↑ Carlson, M.; Silberbach, M. (2009). "Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the literature.". BMJ Case Rep 2009: bcr0620091998. doi:10.1136/bcr.06.2009.1998. PMID 21731587.
- ↑ Finkelmeier BA (September 1997). "Dissection of the aorta: a clinical update". J Vasc Nurs 15 (3): 88-93. PMID 9362838.
- ↑ URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
- ↑ URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
- ↑ Ha HI, Seo JB, Lee SH, et al. (2007). "Imaging of Marfan syndrome: multisystemic manifestations". Radiographics 27 (4): 989–1004. doi:10.1148/rg.274065171. PMID 17620463. http://radiographics.rsna.org/content/27/4/989.full.
- ↑ 12.0 12.1 Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 7. ISBN 978-1416002741.
- ↑ URL: http://library.med.utah.edu/WebPath/IMMHTML/IMM028.html. Accessed on: 11 May 2011.
- ↑ 14.0 14.1 Lee, S.; Chae, J.; Cho, Y. (Dec 2006). "Causes of sudden death related to sexual activity: results of a medicolegal postmortem study from 2001 to 2005.". J Korean Med Sci 21 (6): 995-9. PMID 17179675.
- ↑ 15.0 15.1 15.2 Hata, D. (Sep 2001). "Fibromuscular dysplasia.". Intern Med 40 (9): 978-9. PMID 11579971.
- ↑ Highlander, P.; Southerland, CC.; VonHerbulis, E.; Gonzalez, A. (Jan 2011). "Buerger disease (thromboangiitis obliterans): a clinical diagnosis.". Adv Skin Wound Care 24 (1): 15-7. doi:10.1097/01.ASW.0000392923.37852.43. PMID 21173586.
- ↑ Fujii, Y.; Soga, J.; Nakamura, S.; Hidaka, T.; Hata, T.; Idei, N.; Fujimura, N.; Nishioka, K. et al. (Aug 2010). "Classification of corkscrew collaterals in thromboangiitis obliterans (Buerger's disease): relationship between corkscrew type and prevalence of ischemic ulcers.". Circ J 74 (8): 1684-8. PMID 20534945.
- ↑ Kurata, A.; Schulz, A.; Franke, FE. (2004). "Reappraisal of thromboangiitis obliterans--a pathological contribution.". Verh Dtsch Ges Pathol 88: 231-6. PMID 16892557.
- ↑ Flory CM (1945). "Arterial occlusions produced by emboli from eroded aortic atheromatous plaques". Am J Pathol 21 (3): 549–565. PMC 1934118. PMID 19970827. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934118/.
- ↑ Fukumoto Y, Tsutsui H, Tsuchihashi M, Masumoto A, Takeshita A (July 2003). "The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study". J. Am. Coll. Cardiol. 42 (2): 211–6. doi:10.1016/S0735-1097(03)00579-5. PMID 12875753. http://linkinghub.elsevier.com/retrieve/pii/S0735109703005795.
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Reuter, Victor E; Stoler, Mark H (2009). Sternberg's Diagnostic Surgical Pathology (5th ed.). Lippincott Williams & Wilkins. pp. 1735-6. ISBN 978-0781779425.