VASCULAR PATHOLOGY

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VASCULAR PATHOLOGY

• ARTERIOSCLEROSIS.
  Is a general term that means hardening
  of the arteries and is applied to 3 different
  types of vascular disease, all with sclerosis and
  thickening.
  -Atherosclerosis
  
  -Arteriolosclerosis
  -Monckebergs
  medial calcific.

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS.
  In USA about
  50 or more of the annual mortality is due to
  atherosclerosis
  -Ischemic heart disease
  
  -Myocardial infarction
  -Stroke
  
  -Gangrene of lower limbs

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS...(cont.)
  Pathogenesis.
  Atherosclerotic
  lesions develop in the tunica intima of
  elastic/muscular arteries with proliferation of
  smooth cellsaccumulation of lipids?macrophages,
  lymphs.,connecti-
  ve tissue?endothelium breakdown?plats.
  deposited.

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VASCULAR PATHOLOGY
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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS...(cont.)
  Pathogenesis..
  
  -Chronic endothelial injury, usually subtle
  ?endothelial
  dysfunction?increased permeabilityleukocyte
  adhesionthrombo-
  tic potential.
  
  -Accumulation of lipoproteins(LDL)in the
  vessel wall

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS...
  Pathogenesis...(cont.)
  
  -Oxidation of lipoproteins
  
  -Adhesion of blood monocytes(and others WBCs)to
  the endothelium?migration into the
  intima?macrophages?foamy cells
  -Adhesion of platelets
  
  -Release of factors from activated platelets,
  macrophages and
  endothelial cells?migration of smooth muscle
  cells from media?intima

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS....
  Pathogenesis...(cont.)
  
  -Proliferation of smooth muscle cells
  in the intimaextracellular matrix?accumulation
  of collagenproteoglycans
  
  -Increased accumulation of lipids in cells
  
  (macrophages/smooth muscle cells) and
  extracellularly.
  

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS.... Risk factors
  Major
  Lesser,uncertain
  Age
  Obesity
  Male gender Physical
  inactivity
  Family history Type A
  person.
  Genetic abnormalities Postmenop.estrogen
  deficiency
  High carbohydrate intake
  
  
  NONMODIFIABLE

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS....Risk factors...
  POTENTIALLY CONTROLLABLE
  Major
  Lesser,uncertain
  Hyperlipidemia
  Alcohol
  Hypertension
  Lipoproteins
  Cigarette smoking Transunsatur.fat int.
  Diabetes
  Chlamydia pneumon

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VASCULAR PATHOLOGY

• CLINICAL HORIZON.
• Fatty dot(initial lesion) w/isolated macroph.
  foamy
  cells
• Fatty streak(intracellular lipid accumulation)
• Fibrous cap(fibrous tissue thicker less cell
  than intima)
• Atheromatous plaque(20-30 yrs later)necro
  tic mass of
  lipidsmacroph.fibroblasts

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VASCULAR PATHOLOGY

• CLINICAL HORIZON...(cont.)
• Complex plaque(50-60 yrs later)
  -Thrombosis
  within fibrous cap
  -Neovascularization
  
  -Thinning of tunica media
  -Calcification
  
  -Ulceration?thrombosis?vascular
  
  occlusion
  

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VASCULAR PATHOLOGY
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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS...(cont.)
  Complications.
  
  1. Acute vascular occlusion
  -Myocardial
  infarction(coronaries)
  -Stroke (CNS) -Gangrene(lower limbs/
  intestine)
  2. Chronic
  narrowing
  -Renal hypertension
  -Ischemic
  atrophy of skin(diabetics)
  -Kidney atrophy(unilateral)

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VASCULAR PATHOLOGY

• ATHEROSCLEROSIS...(cont.)
  Complications...
  3.
  Aneurysm?rupture?hemorrhage
  -Abdominal aorta -Thoracic
  aorta
  -Iliacs -Coronaries -Basilar
  -Middle
  cerebral arteries -Carotids
  -Popliteal
  
  4. Embolism
  
  -Apoplexy(carotids)
  -Limb
  gangrene(iliacs?popliteal)

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VASCULAR PATHOLOGY
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VASCULAR PATHOLOGY

• ARTERIOLOSCLEROSIS.
  A. Hyaline arteriolosclerosis.
  -Is a
  homogeneous thickening of the arteriolar wall
  with loss of structure narrowing of lumen.
  
  -Hyaline material contains plasma prots.
  thickened basement
  membrane
  -It seems that results from endothelial
  damage caused by hemodynamic stress in
  hypertension or metabolic disorder in diabetes.

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VASCULAR PATHOLOGY

• ARTERIOLOSCLEROSIS...(cont.)
  -There are progressive ischemic changes of
  affected organs
  -In kidneys?benign
  nephrosclerosis assoc.
  to hypertension
  
  B. Hyperplastic arteriolosclerosis.
  -Is associated with
  more acute or severe increase in blood pressure
  as seen in malignant hypertension.
  
  -It appears as onion skin
  concentric thickening of vessels w/narrowing of
  lumen

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VASCULAR PATHOLOGY

• Hyperplastic arteriolosclerosis...(cont.)
  -In advanced
  stages may be seen necrosis and deposits of
  fibrinoid material in the wall
  -In kidneys?malignant
  nephrosclerosis associated to hypertension
  
  -Other tissues frequently affectedperiadre--
  
  nal fat, gallbladder, peripancreatic and
  intestinal arterioles.

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VASCULAR PATHOLOGY

• MONCKEBERGS MEDIAL CALCIFIC.
  -Degenerative
  calcification of the media of large medium
  sized muscular arteries
  -Occurs mainly in the elderly, but
  usually does not lead to any clinical
  symptomatol. -Probably
  secondary to a prolonged vasotonic stimuli.
  Vessels of the upper lower lims frequently
  affected.
  -Macro affected arteries are hard
  dilated

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