Blood Vessels Frank A. Acevedo, PA-C

Vascular Abnormalities Narrowing of the lumen Thrombosis Weakening of the walls

Normal Intima - Endothelial Cells Media - Smooth Muscle Cells Adventitia - Connective Tissue

Arteries Elastic arteries Muscular arteries Arterioles

Endothelium Anticoagulant/Antithrombotic prostacyclin, thrombomodulin, plasminogen activator, heparin-like molecules Prothrombotic VonWillebrand Factor, tissue factor, plasminogen activator inhibitor

Vascular Smooth Muscle Vasoconstriction Dilatation Collagen, elastin synthesis Cellular proliferation in atherosclerosis

Vascular Diseases Congenital anomalies Atherosclerosis Hypertensive vascular disease The vasculitides Raynaud’s disease Aneurysms Vascular tumors

Congenital Anomalies Berry aneurysms AV fistulas

Atherosclerosis Elastic and medium sized arteries Atheroma is the basic lesion Age, male, genetic LDL, VLDL Monocytes - macrophages - foam cells Endothelial injury

Atherosclerosis

Risk Factors Major diet and hyperlipidemia, hypertension, cigarette smoking, diabetes Minor obesity, lack of exercise, age, male, family history, stress, BCP, High CHO intake, hyperhomocysteinemia

Hypertension Idiopathic, essential Renin - Angiotensin Accelerated atherogenesis Hyaline atherosclerosis

Vasculitides Giant cell arteritis Takayasu’s arteritis Polyarteritis nodosa Kawasaki disease Wegener’s granulomatosis Buerger’s disease

Giant Cell Arteritis Rare before age 50 Throbbing pain Visual disturbances Temporal artery Corticosteroids Polymyalgia rheumatica

Giant Cell Arteritis

Takayasu’s Arteritis Fibrous thickening of aortic arch Upper extremity pulselessness Females

Polyarteritis Nodosa Systemic involvement Fever, weight loss, hypertension Abdominal pain Melena Muscle aches Motor peripheral neuropathy

Polyarteritis Nodosa

Kawasaki Syndrome Young children and infants Fever, conjunctival and oral erythema and erosion, edema of the hands and feet, erythema of the palms and soles, desquamation, lymph node enlargement Leading cause of acquired heart disease in children

Wegener’s Granulomatosis Acute necrotizing granulomas of the upper and lower reap tract Focal necrotizing vasculitis Renal disease 5th decade of life Immunosuppressive therapy

Wegener’s Granulomatosis

Buerger’s Disease Thromboangitis obliterans Cigarette smoking “instep” claudication

Buerger’s Disease

Raynaud’s Disease Small artery, arteriole vasospasm White, blue, red

Raynaud’s Disease

Aneurysms Abdominal aorta frequently affected Natural history is to rupture Ischemic intima and media? Male caucasians Early detection

Dissection Type A Type B Hypertension Double lumen

DeBakey Classification

Dissection

Vascular Tumors Hemangiomas, Glomus tumor, Vascular ectasias ( nevus, spiders, Osler-Weber- Rendu disease) Angiosarcoma, Kaposi’s sarcoma

Hemangioma