Difference between revisions of "Vascular disease"

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Vascular disease (view source)

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The article covers '''vascular disease'''.  Vasculitides are covered in a separate article called ''[[vasculitides]]''.
The article covers '''vascular disease''', i.e. diseases of [[blood vessel]]s. These keep vascular surgeons and cardiac surgeon busy.   
 
Vasculitides are covered in a separate article called ''[[vasculitides]]''.
 
==Normal blood vessels==
Comparing arteries and veins:<ref>URL: [http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm http://www.lab.anhb.uwa.edu.au/mb140/corepages/vascular/vascular.htm]. Accessed on: 13 January 2011.</ref>
<center>
{| class="wikitable sortable"
! Feature
! Artery
! Vein
|-
| Internal elastic lamina (IEL)
| prominent/thick, usu. complete
| thin & incomplete
|-
| External elastic lamina (EEL)
| present, thick
| absent
|-
| Shape
| circular / lumen wide open
| collapsed
|-
| Wall thickness
| thick
| thin
|}
</center>
[[Image:2102 Comparison of Artery and Vein.jpg|thumb|400px|center|Artery and vein. (WC)]]


==Great vessels==
==Great vessels==
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==Atherosclerosis==
==Atherosclerosis==
===General===
===General===
*Cardiac atherosclerosis -> myocardial infarction, coronary thrombosis.
*A leading cause of death, esp. in the Western world.
*Peripheral atherosclerosis -> peripheral vascular disease -> amputations.
*May have multi-system manifestations.
*Carotid atherosclerosis -> thrombotic stroke.
 
Location and associated pathology:
*[[Coronary artery atherosclerosis]] ([[AKA]] ''[[coronary artery disease]]'') -> [[myocardial infarction]] +/-coronary thrombosis.
*[[Atherosclerotic peripheral vascular disease]] -> [[leg amputation]]s.
*Carotid artery atherosclerosis -> thrombotic [[stroke]].
*Superior mesenteric artery atherosclerosis -> [[ischemic enteritis]] or [[ischemic colitis]] or ischemic enterocolitis.
*Penile artery atherosclerosis -> impotence.


Clinical risk factors:
Clinical risk factors:
*Age.
*Age.
*Blood pressure - modifiable (antihypertensives).
*[[Hypertension|Blood pressure (high)]] - modifiable (antihypertensives).
*Cholesterol - modifiable (statins, diet).
*Cholesterol - modifiable (statins, diet).
*Diabetes mellitus - modifiable (hypoglycemic medications, diet, lifestyle).
*[[Diabetes mellitus]] - modifiable (hypoglycemic medications, diet, lifestyle).
*Smoking - modifiable (cessation).
*[[Smoking]] - modifiable (cessation).
*Family history.
*Family history.


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*Intimal hyperplasia.
*Intimal hyperplasia.
*Lipid deposition.
*Lipid deposition.
*Foam macrophages within intima & media.
*Foamy macrophages within intima & media.
*Cholesterol clefts
*Cholesterol clefts
*Luminal narrowing.
*Luminal narrowing.
Notes:
*Considered "complex" if any of the following are present:<ref name=Ref_Klatt4>{{Ref Klatt|4}}</ref>
**Calcifications.
**Thrombosis.
**Haemorrhage.
====Image====
<gallery>
Image:RCA_atherosclerosis.jpg |Right coronary artery with atherosclerosis. (WC/Nephron)
</gallery>
===Stains===
*[[Elastic trichrome stain]] or [[Movat stain]] - highlights duplication of internal elastic lamina, allows on to identify with ease intimal thickening.


==Aortic dissection==
==Aortic dissection==
===Associations===
*Abbreviated ''AoD''.
Heritable:<ref name=pmid16253833>{{cite journal |author=Gleason TG |title=Heritable disorders predisposing to aortic dissection |journal=Semin. Thorac. Cardiovasc. Surg. |volume=17 |issue=3 |pages=274-81 |year=2005 |pmid=16253833 |doi=10.1053/j.semtcvs.2005.06.001 |url=}}</ref>
{{Main|Aortic dissection}}
*[[Marfan's syndrome]].
 
*Loeys-Dietz syndrome.<ref name=pmid16928994>{{cite journal |author=Loeys BL, Schwarze U, Holm T, ''et al'' |title=Aneurysm syndromes caused by mutations in the TGF-beta receptor |journal=N. Engl. J. Med. |volume=355 |issue=8 |pages=788-98 |year=2006 |month=August |pmid=16928994 |doi=10.1056/NEJMoa055695 |url=http://content.nejm.org/cgi/content/full/355/8/788}}</ref>
==Cystic medial degeneration==
**Marfan-like syndrome.
*[[AKA]] ''cystic medial necrosis''.<ref>URL: [http://emedicine.medscape.com/article/756835-overview http://emedicine.medscape.com/article/756835-overview]. Accessed on: 12 August 2010.</ref>
*[[Ehlers-Danlos syndrome]].
{{Main|Cystic medial degeneration}}
*Bicuspid aortic valve.
 
==Medial calcific sclerosis==
[[AKA]] ''Moenckeberg medial calcific sclerosis'', ''calcific medial sclerosis of Monckeberg'', and ''Monckeberg's arteriosclerosis''.
{{Main|Medial calcific sclerosis}}
 
==Hyperplastic arteriolosclerosis==
===General===
*Associated with:<ref>URL: [http://library.med.utah.edu/WebPath/IMMHTML/IMM028.html http://library.med.utah.edu/WebPath/IMMHTML/IMM028.html]. Accessed on: 11 May 2011.</ref>
**''Malignant [[hypertension]]''.
**''[[Scleroderma]]''.
*May be a consequence of [[thrombotic microangiopathy]].{{fact}}
 
Note:
*Hyperplasia = proliferation of cells.
 
===Microscopic===
Features:<ref name=Ref_Klatt7>{{Ref Klatt|7}}</ref>
*Onion-skin appearance of intima & media due to:
**Intimal hyperplasia.
**Smooth muscle hyperplasia.


Others:
Image: [http://library.med.utah.edu/WebPath/ATHHTML/ATH022.html Hyperplastic arteriolosclerosis (utah.edu)].
*Tertiary syphilis.


==Cystic medial degeneration==
==Fibromuscular dysplasia==
*Abbreviated ''FMD''.
===General===
===General===
*[[AKA]] ''cystic medial necrosis''.<ref>URL: [http://emedicine.medscape.com/article/756835-overview http://emedicine.medscape.com/article/756835-overview]. Accessed on: 12 August 2010.</ref>
Etiology:
**Often ''not'' cystic and ''not'' necrotic.
*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.<ref name=pmid17179675>{{Cite journal  | last1 = Lee | first1 = S. | last2 = Chae | first2 = J. | last3 = Cho | first3 = Y. | title = Causes of sudden death related to sexual activity: results of a medicolegal postmortem study from 2001 to 2005. | journal = J Korean Med Sci | volume = 21 | issue = 6 | pages = 995-9 | month = Dec | year = 2006 | doi =  | PMID = 17179675 | URL = http://jkms.kams.or.kr/fulltext/html/jkms21995h.html }}</ref>
 
===Gross/radiologic===
*Segmental - thinning and thickening.<ref name=pmid11579971/>
 
Classical locations:<ref name=pmid11579971/>
*Renal artery - leading to [[hypertension]].
*Carotid artery.


===Microscopic===
===Microscopic===
Features:<ref>URL: [http://emedicine.medscape.com/article/756835-overview http://emedicine.medscape.com/article/756835-overview]. Accessed on: 12 August 2010.</ref><ref name=pmid17620463>{{cite journal |author=Ha HI, Seo JB, Lee SH, ''et al.'' |title=Imaging of Marfan syndrome: multisystemic manifestations |journal=Radiographics |volume=27 |issue=4 |pages=989–1004 |year=2007 |pmid=17620463 |doi=10.1148/rg.274065171 |url=http://radiographics.rsna.org/content/27/4/989.full}}</ref>
Features:<ref name=pmid11579971>{{Cite journal | last1 = Hata | first1 = D. | title = Fibromuscular dysplasia. | journal = Intern Med | volume = 40 | issue = 9 | pages = 978-9 | month = Sep | year = 2001 | doi = | PMID = 11579971 | URL = http://www.journalarchive.jst.go.jp/jnlpdf.php?cdjournal=internalmedicine1992&cdvol=40&noissue=9&startpage=978&lang=en&from=jnlabstract }}</ref>
*Basophilic ground substance in the media (seen on Movat's [[stain]]).  
*Smooth muscle hyperplasia - '''key feature'''.
*Disruption of the elastic lamina (seen on elastic trichrome stain).
*Elastic fibre fragmentation.
*+/-Focal necrosis.
*Luminal narrowing.
 
Images:
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/cardio/fibromuscular-dysplasia.html FMD (brown.edu)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2721953/figure/F3/ FMD of AV nodal artery (kams.or.kr)].<ref name=pmid17179675/>
 
===Stains===
*[[Elastic trichrome]] or [[Movat stain]] - to demonstrate elastic fibre fragmentation.


Images: [http://radiographics.rsna.org/content/27/4/989.full Marfan's syndrome (radiographics.rsna.org)].
==Thromboangiitis obliterans==
{{Main|Thromboangiitis obliterans}}


==Medial calcific sclerosis==
==Thrombosis==
*[[AKA]] Moenckeberg medial calcific sclerosis.
:See also: ''[[Cerebral venous thrombosis]]''.
===General===
===General===
*Usually of no clinical consequence.
Definition:
*Blood clot formation within a vessel.
 
Complications:
*Embolism - see: ''[[Pulmonary embolism|Pulmonary thromboembolism]]''.
 
Risk factors:
*The classic pimping question is what "Virchow's triad?"
**Stasis, hypercoagulability, endothelial injury.
*A long list is found in: ''[[Pulmonary_embolism#Risks_factors_.28VTE.29|risk factors for VTE]]''.
 
===Gross===
:See: ''[[Pulmonary_embolism#Gross_.28VTE.29|Pulmonary embolism - gross features]]''.


===Microscopic===
===Microscopic===
Features:<ref>{{Ref Klatt|7}}</ref>
Features:
*Medial calcification (purple irregular stuff -- calcium phosphate).
*Lines of Zahn.
*Fibrin - pink acellular stuff on a [[H&E stain]].


Note:
====Image====
*Lumen unaffected.
<gallery>
Image:Fetal_thrombotic_vasculopathy_-_high_mag.jpg | Intravascular fibrin - high mag. (WC/Nephron)
</gallery>
==Cholesterol embolism==
*Abbreviated ''CE''.
{{Main|Cholesterol embolism}}
 
==Coarctation of the aorta==
*[[AKA]] ''aortic coarctation''.
===General===
*Uncommon.
 
Classification:
*Preductal.
*Postductal.
 
Associations:
*[[Bicuspid aortic valve]].<ref name=pmid16129122>{{Cite journal  | last1 = Braverman | first1 = AC. | last2 = Güven | first2 = H. | last3 = Beardslee | first3 = MA. | last4 = Makan | first4 = M. | last5 = Kates | first5 = AM. | last6 = Moon | first6 = MR. | title = The bicuspid aortic valve. | journal = Curr Probl Cardiol | volume = 30 | issue = 9 | pages = 470-522 | month = Sep | year = 2005 | doi = 10.1016/j.cpcardiol.2005.06.002 | PMID = 16129122 }}</ref>
*[[Turner syndrome]].<ref name=pmid20222980>{{Cite journal  | last1 = Hjerrild | first1 = BE. | last2 = Mortensen | first2 = KH. | last3 = Sørensen | first3 = KE. | last4 = Pedersen | first4 = EM. | last5 = Andersen | first5 = NH. | last6 = Lundorf | first6 = E. | last7 = Hansen | first7 = KW. | last8 = Hørlyck | first8 = A. | last9 = Hager | first9 = A. | title = Thoracic aortopathy in Turner syndrome and the influence of bicuspid aortic valves and blood pressure: a CMR study. | journal = J Cardiovasc Magn Reson | volume = 12 | issue =  | pages = 12 | month =  | year = 2010 | doi = 10.1186/1532-429X-12-12 | PMID = 20222980 }}</ref>
 
====Clinical====
Presentation:<ref name=pmid20391897>{{Cite journal  | last1 = Peres | first1 = A. | last2 = Martins | first2 = JD. | last3 = Paramés | first3 = F. | last4 = Gil | first4 = R. | last5 = Matias | first5 = C. | last6 = Franco | first6 = J. | last7 = Freitas | first7 = I. | last8 = Trigo | first8 = C. | last9 = Fragata | first9 = J. | title = Isolated aortic coarctation: experience in 100 consecutive patients. | journal = Rev Port Cardiol | volume = 29 | issue = 1 | pages = 23-35 | month = Jan | year = 2010 | doi =  | PMID = 20391897 }}</ref>
*Heart failure.
*[[Hypertension]] - esp. upper extremity vs. lower extremity.
 
===Gross===
*Narrowing (stenosis) of the aorta proximal or distal to the ductus arteriosis.
 
====Image====
<gallery>
Image:Coarctation_and_PDA.png | Pre- and postductal coarctation of the aorta - schematic (WC)
</gallery>
==Intracranial berry aneurysm==
{{Main|Berry aneurysm}}


==See also==
==See also==
Michael
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