Vascular_Disease_LECTURE_slides.pdf

Vascular Disease Learning Objectives  Classify vascular diseases  Describe the characteristics of atheroma and its complications  Define, classify and describe the types of aneurysm  Define varicose veins  Define vasculitis  Classify vascular tumours Vascular Disease  Arteries Arterioscle...

Vascular Disease Learning Objectives  Classify vascular diseases  Describe the characteristics of atheroma and its complications  Define, classify and describe the types of aneurysm  Define varicose veins  Define vasculitis  Classify vascular tumours Vascular Disease  Arteries Arteriosclerosis  Atherosclerosis  Veins Thrombosis  Phlebothrombosis vs Thrombophlebitis Formation of varicosities  All vessels • Vasculitis (inflammation) • Radiation damage  Tumours Age-related Vascular Changes  Fibrosis of intima and media  Accumulation of ground substance  Fragmentation of elastic lamellae Atherosclerosis  Also known as atheroma  Affects large and medium-sized elastic and muscular arteries  Characterised by lipid deposition, fibrosis and chronic inflammation Risk Factors  Age  Sex  Hypertension  Hyperlipidaemia (particularly LDL)  Diabetes     Smoking Obesity Sedentary lifestyle Low socio-economic status  Low birth-weight Morphology • Atheromatous (fibro-fatty, fibro-lipid) plaque •– Patchy and raised white to yellow 0.3-1.5cm •– Core of lipid •– Fibrous cap Complications of Atherosclerosis Peripheral Vascular Disease  Atheroma of distal aorta / iliac / femoral arteries  Causes ischaemia of lower limbs  Effects     Intermittent claudication Pain Ulcers Gangrene Aneurysms  Localised, permanent, abnormal dilatation of •blood vessel or the heart  Types: •– Atherosclerotic •– Dissecting •– Berry •– Micro-aneurysms •– Syphilitic •– Mycotic Atherosclerotic aneurysms  Usually abdominal aorta, distal to renal arteries  Women<Men,  Smokers, age over 50  Morphology  saccular or fusiform  15 to25 cm in length  Wall diameter > 50%  frequently contains mural thrombus Atherosclerotic aneurysms  The clinical consequences  Thrombosis  Embolism  Rupture  Obstruction of a branch vessel  ischemic injury  Impingement on an adjacent structure  Presentation as an abdominal pulsating mass  Can be repaired Video Dissecting Aortic Aneurysms  Men x3 more than women aged 40 to 60 with hypertension  Younger patients with systemic or localized abnormalities of connective tissue  Morphology:  usually initiates with an intimal tear  1-2 cm from aortic valve  dissection can extend along the aorta retrograde toward the heart or  distally, sometimes into the iliac and femoral arteries Dissecting Aortic Aneurysms Dissecting Aortic Aneurysms Dissecting Aortic Aneurysms Dissecting Aortic Aneurysms  Clinical symptoms • The sudden onset of excruciating pain,  beginning in the anterior chest, radiating to the back •between the scapulae, and moving downward as the •dissection progresses; the pain can be confused with •that of myocardial infarction. • The most common cause of death is rupture of •the dissection outward into the pericardial, •pleural, or peritoneal cavities. Berry Aneurysms  Aneurysms of the circle of Willis  Young people  Often hypertensive  Associated with sub-arachnoid haemorrhage •Kumar et al: Robbins & Cotran Pathologic Basis of Disease, 8th Edition. •Copyright (02009 by Saunders, an imprint of Elsevier, Inc. All rights reserved. Video Capillary Micro-aneurysms  Associated with • Hypertension • Diabetes mellitus  Small aneurysms of branches of middle cerebral artery  Associated with intra-cerebral haemorrhage Syphilitic and Mycotic Aneurysms  Syphilitic • Usually affects thoracic aorta  Mycotic • Wall of artery weakened by infection • Bacteria or fungi • Often in brain, secondary to embolism Varicose veins Definition: Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support Risk factors: Age, sex, heredity, posture, obesity •Venous valves incompetent and leads to stasis, congestion, oedema, pain, and thrombosis • Lower limbs usually saphenous system • Oesophageal varices • Haemorrhoids • Varicocele Varicose veins • • • • Cosmetic problems Aching in legs Stasis dermatitis Skin ulceration and bleeding Vasculitis  Inflammation and necrosis of blood vessels  Pathogenesis: •Cell immune-mediated inflammation •Deposition of immune complexes •Direct attack by circulating antibodies •Direct invasion of vascular walls by infectious pathogens •Often part of multi-system disease Vasculitis types Giant-cell (temporal) arteritis • > age 50, average onset age 70, women > men • granulomatous inflammation of large to small-sized arteries (temporal, vertebral and ophthalmic) • Cord like nodular thickening Takayasu arteritis (pulseless disease)  granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta) women age <30 Polyarteritis nodosa (PAN)  Medium small size muscular arteries of the kidneys, heart, liver, and gastrointestinal tract are involved  Fibrinoid necrosis could be fatal without steroid treatment Kawasaki disease (children < age 4) •High fever, conjunctival and oral lesions. Self-limited Giant-cell (temporal) arteritis • • • • • • 6-12 months Could be self-limited Patchy lesion Throbbing temporal pain Malaise Fever Takayasu arteritis • • • • • Dizziness Visual disturbances Dyspnoea Intermittent claudication upper limbs Asymmetric BP • Steroid treatment Vascular Tumours  Benign Angioma Haemangioma  Juvenile (strawberry) Skin  Capillary (ruby spots) Skin, spleen, kidneys  Cavernous (port wine stains) Skin, spleen, liver, pancreas Lymphangioma  Capillary and Cavernous hjds Vascular Tumours • Malignant Angiosarcoma • Skin, soft tissue, breast, bone, liver and spleen • Kaposi’s sarcoma: associated with HIV / AIDS Angioproliferative tumour derived from endothelial cells Learning Objectives  Classify vascular diseases  Describe the characteristics of •atheroma and its complications  Define, classify and describe the types •of aneurysm  Define varicose veins  Define vasculitis  Classify vascular tumours