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)