Difference between revisions of "Vascular disease"
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The article covers '''vascular disease''', i.e. diseases of blood | 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== | ==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> | 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" | {| class="wikitable sortable" | ||
! Feature | ! Feature | ||
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! Vein | ! Vein | ||
|- | |- | ||
| Internal elastic lamina | | Internal elastic lamina (IEL) | ||
| prominent/thick, usu. complete | | prominent/thick, usu. complete | ||
| thin & incomplete | | thin & incomplete | ||
|- | |- | ||
| External elastic lamina | | External elastic lamina (EEL) | ||
| present, thick | | present, thick | ||
| absent | | absent | ||
Line 24: | Line 27: | ||
| thin | | 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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*Luminal narrowing. | *Luminal narrowing. | ||
Notes: | Notes: | ||
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**Haemorrhage. | **Haemorrhage. | ||
====Image==== | |||
<gallery> | |||
Image:RCA_atherosclerosis.jpg |Right coronary artery with atherosclerosis. (WC/Nephron) | |||
</gallery> | |||
===Stains=== | ===Stains=== | ||
*[[Elastic trichrome stain]] or [[Movat stain]] - highlights duplication of internal elastic lamina, allows on to identify with ease intimal thickening. | *[[Elastic trichrome stain]] or [[Movat stain]] - highlights duplication of internal elastic lamina, allows on to identify with ease intimal thickening. | ||
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==Aortic dissection== | ==Aortic dissection== | ||
*Abbreviated ''AoD''. | *Abbreviated ''AoD''. | ||
{{Main|Aortic dissection}} | |||
==Cystic medial degeneration== | ==Cystic medial degeneration== | ||
*[[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> | *[[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> | ||
{{Main|Cystic medial degeneration}} | |||
==Medial calcific sclerosis== | ==Medial calcific sclerosis== | ||
[[AKA]] ''Moenckeberg medial calcific sclerosis'', ''calcific medial sclerosis of Monckeberg'', and ''Monckeberg's arteriosclerosis''. | |||
{{Main|Medial calcific sclerosis}} | |||
==Hyperplastic arteriolosclerosis== | ==Hyperplastic arteriolosclerosis== | ||
Line 210: | Line 138: | ||
==Thromboangiitis obliterans== | ==Thromboangiitis obliterans== | ||
{{Main|Thromboangiitis obliterans}} | |||
==Thrombosis== | ==Thrombosis== | ||
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*Fibrin - pink acellular stuff on a [[H&E stain]]. | *Fibrin - pink acellular stuff on a [[H&E stain]]. | ||
Image | ====Image==== | ||
<gallery> | |||
Image:Fetal_thrombotic_vasculopathy_-_high_mag.jpg | Intravascular fibrin - high mag. (WC/Nephron) | |||
</gallery> | |||
==Cholesterol embolism== | ==Cholesterol embolism== | ||
*Abbreviated ''CE''. | *Abbreviated ''CE''. | ||
{{Main|Cholesterol embolism}} | |||
==Coarctation of the aorta== | ==Coarctation of the aorta== | ||
Line 301: | Line 191: | ||
*Narrowing (stenosis) of the aorta proximal or distal to the ductus arteriosis. | *Narrowing (stenosis) of the aorta proximal or distal to the ductus arteriosis. | ||
Image | ====Image==== | ||
<gallery> | |||
Image:Coarctation_and_PDA.png | Pre- and postductal coarctation of the aorta - schematic (WC) | |||
</gallery> | |||
==Intracranial berry aneurysm== | ==Intracranial berry aneurysm== | ||
{{Main|Berry aneurysm}} | {{Main|Berry aneurysm}} |
Latest revision as of 03:39, 7 March 2016
The article covers vascular disease, i.e. diseases of blood vessels. These keep vascular surgeons and cardiac surgeon busy.
Vasculitides are covered in a separate article called vasculitides.
Normal blood vessels
Comparing arteries and veins:[1]
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 |
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.
- Atherosclerotic peripheral vascular disease -> leg 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 (high) - 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.
Notes:
- Considered "complex" if any of the following are present:[2]
- Calcifications.
- Thrombosis.
- Haemorrhage.
Image
Stains
- Elastic trichrome stain or Movat stain - highlights duplication of internal elastic lamina, allows on to identify with ease intimal thickening.
Aortic dissection
- Abbreviated AoD.
Main article: Aortic dissection
Cystic medial degeneration
Main article: Cystic medial degeneration
Medial calcific sclerosis
AKA Moenckeberg medial calcific sclerosis, calcific medial sclerosis of Monckeberg, and Monckeberg's arteriosclerosis.
Main article: Medial calcific sclerosis
Hyperplastic arteriolosclerosis
General
- Associated with:[4]
- Malignant hypertension.
- Scleroderma.
- May be a consequence of thrombotic microangiopathy.[citation needed]
Note:
- Hyperplasia = proliferation of cells.
Microscopic
Features:[5]
- 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.[6]
Gross/radiologic
- Segmental - thinning and thickening.[7]
Classical locations:[7]
- Renal artery - leading to hypertension.
- Carotid artery.
Microscopic
Features:[7]
- Smooth muscle hyperplasia - key feature.
- Elastic fibre fragmentation.
- Luminal narrowing.
Images:
Stains
- Elastic trichrome or Movat stain - to demonstrate elastic fibre fragmentation.
Thromboangiitis obliterans
Main article: Thromboangiitis obliterans
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.
Main article: Cholesterol embolism
Coarctation of the aorta
- AKA aortic coarctation.
General
- Uncommon.
Classification:
- Preductal.
- Postductal.
Associations:
Clinical
Presentation:[10]
- Heart failure.
- Hypertension - esp. upper extremity vs. lower extremity.
Gross
- Narrowing (stenosis) of the aorta proximal or distal to the ductus arteriosis.
Image
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.
- ↑ URL: http://emedicine.medscape.com/article/756835-overview. Accessed on: 12 August 2010.
- ↑ URL: http://library.med.utah.edu/WebPath/IMMHTML/IMM028.html. Accessed on: 11 May 2011.
- ↑ Klatt, Edward C. (2006). Robbins and Cotran Atlas of Pathology (1st ed.). Saunders. pp. 7. ISBN 978-1416002741.
- ↑ 6.0 6.1 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.
- ↑ 7.0 7.1 7.2 Hata, D. (Sep 2001). "Fibromuscular dysplasia.". Intern Med 40 (9): 978-9. PMID 11579971.
- ↑ Braverman, AC.; Güven, H.; Beardslee, MA.; Makan, M.; Kates, AM.; Moon, MR. (Sep 2005). "The bicuspid aortic valve.". Curr Probl Cardiol 30 (9): 470-522. doi:10.1016/j.cpcardiol.2005.06.002. PMID 16129122.
- ↑ Hjerrild, BE.; Mortensen, KH.; Sørensen, KE.; Pedersen, EM.; Andersen, NH.; Lundorf, E.; Hansen, KW.; Hørlyck, A. et al. (2010). "Thoracic aortopathy in Turner syndrome and the influence of bicuspid aortic valves and blood pressure: a CMR study.". J Cardiovasc Magn Reson 12: 12. doi:10.1186/1532-429X-12-12. PMID 20222980.
- ↑ Peres, A.; Martins, JD.; Paramés, F.; Gil, R.; Matias, C.; Franco, J.; Freitas, I.; Trigo, C. et al. (Jan 2010). "Isolated aortic coarctation: experience in 100 consecutive patients.". Rev Port Cardiol 29 (1): 23-35. PMID 20391897.