Path_11.txt

• Narrowing and obstructing the lumen, slowly by athrosclerosis or quickly by thrombotic embolus
• weakening the vessel wall; can lead to dissection dilation , and rupture
• causing thrombosis deposits, have the ability to embolize

• anomalous vessels
• interest to surgeons

• vascular outpouching resulting from congenital vascular wall weakness
• Mostly found in cerebral vessels

• arteriovenous fistula
• can be secondary to trauma, inflammation, or a healed ruptured aneurysm
• causes a left to right shunt, leads to increased venous return predisposing to high output heart failure

arterial wall thickening and loss of elasticity

• atherosclerosis
• arteriolosclerosis, associated with HTN
• Monckeberg medial calcific sclerosis; medial calcification to small and medium sized muscular arteries. after age 50. non obstructive and clinically insignificant

• elastic and large to medium sized vessels
• abdominal aorta, coronary arteries, popliteal, descending thoracic aorta, internal carotid, circle of willis

• elevated intimal based fibrofatty plaques composed of lipids
• proliferating smooth muscle
• increased extra cellular matrix

• white yellow intimal based lesion protruding into the vessel
• composed of a superficial fibrous cap containing SMC. leukocytes, and dense connective tissue ECM overlying a necrotic zone
• necrotic core contains dead cells, lipid, cholesterol, foam cells, proteins

• early lesion composed of intimal lipid laden macrophages and SMCs
• no real relationship between fatty streaks and plaques

• calcified, hemorrhagic, fissured, or ulcerated atheroma
• predisposed to local thrombus, cholesterol microemboli, and aneurysmal dilation

• age
• smoking
• hypercholestrol
• diabetes

• obesity
• sedentary life style
• high stress life
• type A personality

• an indicator of systemic inflammation and is correlated with atherosclerosis risk
• acute phase reactant synthesized in the liver
• downstream of many inflammatory triggers
• opsonizes bacteria and activates compliment
• withing intimal cells it can activate local endothelial cells and induce a prothrombotic state, increasing leukocyte adhesion

• hyperlipidemia
• hemodynamic disturbances
• smoking,
• HTN
• toxins and infections

• increased permeability
• white blood cell and platelet adhesion
• coagulation activation

considered to be a chronic inflammatory response to arterial wall injury

• EC injury, endothelial dysfunction causes increased permeability, and increased expression of adhesion molecules
• blood monocytes and leukocytes adhere
• monocytes migrate into intima and become macrophages that ingest lipids to form foam cells
• LDL and VLDL enter the vessel wall at site of injury
• macrophages oxidize lipoproteins
• platelets adhere
• PDGF is released which causes SMCs to migrate to the intima
• SMCs proliferate in the intima and secretes ECM leading to collagen and proteoglycan accumulation
• Lipids accumulate in the SMC and macrophages
• inflammation mediates lesion progression, initially foam cell formation is protective by removing lipids but then activated macrophages secrete cytokines that recruit more monocytes and T cells, and produce oxygen radicals that oxidize LDLs. The t cell macrophage cross talk initiates chronic inflammation

gangrene in the lower leg

• plaque rupture
• superficial erosion followed by superimposed thrombus formation
• embolism

• hypertension
• can also be a leading cause of congestive heart failure, renal failure, and aortic dissection

• systolic above 140
• diastolic above 90

no known cause

• renal disease
• renal artery stenosis
• endocrine abnormality
• vascular malformation
• neurologic disorders

• acute glomerulonephritis
• chronic renal disease
• polycystic disease
• renal artery stenosis
• renal artery fibromuscular dysplasia
• renal vasculitis
• renin producing tumor

• adrenocortical hyperfunction; cushings, primary aldosteronism, adrenal hyperplasia, licorice ingestion
• exogenous hormones; pregnancy and oral contracetives,
• pheochromatomas
• acromegly
• hypothyroidism
• hyperthyroidism
• pregnancy induced

• coarctation of the aorta
• vasculitis
• increased volume
• increased cardiac output
• rigid aorta

• psychogenic
• increased intercranial pressure
• sleep apnea
• acute stress; surgery

• sodium load
• mineralocroticoids
• naturetic factor

• angiotensin II
• catecholomines
• thromboxane
• leukotrienes
• endothelin

• kinins
• NO
• prostaglandins
• adenosine

increased blood flow leads to vasoconstriction

• increased blood volume; reduced renal sodium secretion
• increased peripheral resistance; increased vasoconstrictor agents, increased sensitivity of smooth muscle, neurologic factors

• renin angiotensin system
• sodium homeostasis

• arterioles
• small arteries, mainly in the kidney

• occurs in the elderly with mild hypertension and mild diabetes
• lesion reflects EC injury with plasma leakage into vessel wall and ECM synthesis by SMC
• diffuse pink, hyaline arteriolar thickening

• characteristic of malignant HTN; acute severe elevation in BP
• concentric lamina ( onion skin) arteriolar thickening
• associated with fibrin deposits and wall necrosis, necrotizing arteriolitis

focal abnormal vascular dilation

• true; bounded by all three layers
• false; extravascular hematoma that communicates with the intravascular space. part of the vessel wall is missing

• rupture
• impingement of adjacent structures
• occlusion of proximal vessel by extrinsic pressure or superimposed thrombus
• embolus from a mural thrombus

• cystic medial degeneration
• atherosclerosis
• syphilis
• trauma
• polyarteritis nodosa
• congenital defects
• infection

abdominal aorta, between the renal arteries and iliac bifurcation

true

aortic atherosclerosis is usually accompanied by coronary atherosclerosis

• syphilitic aortitis
• arises in the tertiary stage of syphilis
• confined to sac aorta and arch, may extend retrograde into the aortic valve
• starts in the adventicia as inflammation, results in aortic medial ischemia and patchy elastic fiber loss with wall thickening and scarring
• symptoms usually occur due to valvular insufficiency or impingement of surrounding organs

LV hypertrophy due to aortic insufficiency from tertiary syphilis

affected vaso vasorum with syphilis have a perivascular infiltrate of lymphocytes and plasma cells, with hyperplastic thickening of the walls

• a blood filled channel along the laminar plane of the aortic media
• it ofter ruptures
• not associated with previous dilation

• HTN
• nonspecific degenerative histologic changes including elastic fragmentation and excess ECM

connective tissue defects, marfan syndrome

• rupture
• extension into the great vessels and other aortic branches
• retrograde dissection of the aortic valve

• type A; ascending aorta. Usually an intimal tear within 10cm of aortic valve.
• Type B; distal to the subclavian artery

sudden onset of excruciating pain, beginning in the anterior chest and radiating to the back and moving downward as the dissection progresses

rupture of an intramural portion of the vasa vasorum is the likely cause of hemorrhage