vascular pathology ii
TRANSCRIPT
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Vascular Pathology I
William Bligh-Glover M.D.
Department of Anatomy
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Goals and Objectives
• Identify and differentiate the various forms of atherosclerosis
• Understand the inter-relationships of vascular injury, clotting, inflammation and repair
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Normal Anatomy
• Serosa
• Muscularis
• Intima
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Normal Muscular Artery
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Normal Vein
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Risk Factors for Atherosclerosis
• Diabetes
• Dyslipidemia
– High LDL
– High homocysteine
– Low HDL
– High Triglycerides
• Male
• Tobacco Smoking
• Hypertension
• Obesity
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Aorta Microscopic
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Atherosclerosis
• Lipid deposition in media
• Disruption of elastic fibres
• Weakening of vessels
• Calcification
– Hardening of the arteries
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Fatty Streak
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Multi-Factoral
• Fatty streaks seen in Korean War KIAs
• Genetics
• Diet
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Coronary Atherosclerosis-Mild
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Sequential Sections
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Coronary Atherosclerosis
• Focal disease
– Dissect every 5 mm
• Areas of turbulent flow
• Damage to endothelium
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Endothelial Damage
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Occlusive Disease
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Angina Pectoris
• Stable Angina
• Unstable angina
• Prinzmetal’s Angina
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Acute Thrombosis
• Lipid is thrombogenic
• Exposure of lipid causes blood to clot
• Further narrows a narrowed lumen
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Thrombosis
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Acute Infarction
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Infarction
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Acute Thrombosis
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Aneurysms
• Atherosclerotic
• Syphilitic
• Connective tissue diseases
• Berry
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Atherosclerotic Aneurysms
• Infra-renal aorta
• Fusiform dilations of artery
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Aorta Microscopic
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Atheroma
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Cholesterol Clefts
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Aorta and Disruption
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Fatty Streak
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Atherosclerotic aorta
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Atherosclerotic aneurysm
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Atherosclerotic aneurysms
• Systemic disease
• Associated with smoking
• Dependent on size
• Consequences
– Rupture
– 90% mortality emergent
– 1% mortality elective
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Consequences
• Dissection
• Rupture
• Impingement on other vessels
– Carotid arteries
– Coronary arteries
– Vertebral arteries
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Dissecting AAA
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Aortic Dissection
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Dissection
False Lumen
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AAA prognosis
• Under 5 cm watch and wait
• Over 5 cm observe
• Serial CT scans
• 5-10% rate of rupture/year
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Arteriolosclerosis-Gross
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Ateriolosclerosis
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Fibrinoid Necrosis