Chapter 93: Vascular Calcification Dwight A. Towler and Linda L. Demer

Table 1. Histoanatomic Types of Vascular Calcification © 2008 American Society for Bone and Mineral Research From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.

Figure 1 Figure 1 Arterial calcification. In arterial cross-section, three layers—intima, media, and adventitia—are present from the lumen outward. In atherosclerosis, eccentric, subintimal atheroma formation, cholesterol deposition with inflammation, fibrosis, fragmented internal elastic lamina, apoptotic body formation, and calcium deposition demarcate the calcified atherosclerotic plaque. Atherosclerosis deforms the lumen and potentially provides a focus for thrombosis and acute arterial occlusion. In medial artery calcification, calcium deposition is concentric, thus compromising vascular compliance without lumen deformation. Low- grade adventitial inflammation, elastinolysis, and vascular smooth muscle cell matrix vesicle formation drive concentric disease processes. Myofibroblast proliferation, vascular monocyte-macrophage infiltration, and microvessel formation (angiogenesis) are key components of osteogenic vascular calcification responses. The vasa vasorum arises from the adventitia. CaPO4, apatitic calcium phosphate deposition. © 2008 American Society for Bone and Mineral Research From the Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7 th Edition.