Three things that can happen to the vascular system
1. Dilatation/rupture
2. Ischemia
3. Thrombosis
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Blood supply of the vascular wall
inner 1/3 – diffusion
outer 2/3 – vaso vasorum
Remember: tunica intima, tunica media, tunica adventitia
Remember: cerebral arteries have no external elastic lamina
Arteriosclerosis: Read other devoted section on Athero-Arteriosclerosis for complementary information.
· Senile arteriosclerosis
· normal aging process
· thickened INTIMALlayer
· swelling and frag. of the internal elastic laminae
· relatively benign
· Hypertensive arteriosclerosis
· MEDIA AND INTIMA involved
· hypertrophy and hyperplasia of the smooth muscle fibers in both media and intimal layers
· Atherosclerosis
· fibrolipid plaques in INTIMA
· Monckeberg’s medial calcification
· MEDIA
· ring-like calcification in the media of MEDIUM AND LARGE arteries of the muscular type
· intima and adventitia usually not affected
· found incidently on x-rays
· Nicotine
· Primary concern – accelerated atherosclerosis
· Hyaline Arteriolosclerosis
· INTIMA
· homogeneous thickening of the arteriolar wall with loss of underlying structure and narrowing of vessel lumen
· causes: benign HTN, diabetes
· results in progressive ischemic changes in affected organs
· Hyperplastic arteriolosclerosis
· INTIMA
· malignant HTN
· “onion skin” appearance
· “flea-bitten” kidney
· Transplant Associated Arteriolosclerosis
· immunological injury
· medium and small arteries in the organ develop circumferential plaques
· INTIMAL/ENDOTHELIAL
Classification of Different types of Arteritis
1. Giant Cell Arteritis
· age > 50
· affects large vessels
· giant cells align along the internal elastic lamina
2. Takayasu’s arteritis
· MEDIA
· fibrous thickening of the aortic arch with encroachment on the lumina of the major branches
3. Polyarteritis nodosa
· medium vessel arteritis
· P-ANCA
· SLE, scleroderma, dermatomyositis, Sjorgren’s syndrome
· DNA-anti-DNA complexes found in the vessel walls
· heart, liver, and G.I. tract
4. Kawasaki disease
· mucocutaneous lymph syndrome
· large, medium, and small arteries
· aneurysms in coronary arteries
5. Wegener’s granulomatosis
· saddle nose deformity
· small vessels
· C-ANCA
· focal necrotizing vasculitis of lungs and upper airways
· focal or diffuse necrotizing glomerulonephritis
6. Thromboangiitis obliterans (Buerger’s disease)
· only in smokers
· occlusive peripheral vascular disease that occurs almost exclusively in males <35
· multi-nucleated Giant cells- IN LUMEN
REMEMBER…
Giant Cell arteritis – internal elastic lamina
Takayasu’s arteritis – media
Buerger’s disease – lumen
Microscopic classifications of aneurysms
Fusiform
· spindle shaped area of dilatation due to a long segment of the vessel wall being affected around the whole circumference
Saccular
· “Berry” aneurysm
· narrow neck
Dissecting
· BLOOD TRACKING ALONG A FALSE LUMEN WITHIN THE ARTERIAL WALL
Tumors of the Blood Vessels
Kaposi’s sarcoma
· AIDS patients
· really gross picture
· maybe a virus associated tumor
· remain localized to skin and subcutaneous tissue but widespread visceral involvement may occur
· high mortality rate
Pathology of Therapeutic Interventions in Vascular Disease
Thrombolysis
· TPA
Balloon angioplasty
Vascular Replacement
1. Autologous grafts
2. Synthetic grafts
· can’t do coronaries because of size < 6 mm
· teflon grafts (more preferred for hemostasis/thrombogenic)
· dacron grafts (most permeable and also allows for tissue ingrowth)