Vascular Disease

Question 1

Age-related Vascular Changes

Answer 1

 Fibrosis of intima and media
 Accumulation of ground substance
 Fragmentation of elastic lamellae

Question 2

Atherosclerosis

Answer 2

 Also known as atheroma
 Affects large and medium-sized elastic and muscular arteries
 Characterised by lipid deposition, fibrosis and chronic inflammation

Question 3

Risk Factors

Answer 3

 Age
 Sex
 Hypertension
Hyperlipidaemia(particularlyLDL)  Diabetes
 Smoking
 Obesity
 Sedentarylifestyle
 Lowsocio-economicstatus  Lowbirth-weight

Question 4

Morphology

Answer 4

• Atheromatous (fibro-fatty, fibro-lipid) plaque •– Patchy and raised white to yellow 0.3-1.5cm
• – Core of lipid

Question 5

Peripheral Vascular Disease

Answer 5

Atheroma of distal aorta/iliac/femoral arteries
 Causes ischaemia of lower limbs
 Effects
 Intermittent claudication
 Pain
 Ulcers
 Gangrene

Question 6

Aneurysms

Answer 6

Localised, permanent, abnormal dilatation of
•blood vessel or the heart
 Types:
•– Atherosclerotic
•– Dissecting
•– Berry
•– Micro-aneurysms 
•– Syphilitic
•– Mycotic

Question 7

Atherosclerotic aneurysms

Answer 7

 Usually abdominal aorta, distal to renal arteries
 Women 50%
 frequently contains mural thrombus

Question 8

Atherosclerotic aneurysms, the clinical consequences

Answer 8

 Thrombosis
 Embolism
 Rupture
 Obstruction of a branch vessel
 ischemic injury
 Impingement on an adjacent structure
 Presentation as an abdominal pulsating mass
 Can be repaired

Question 9

Dissecting Aortic Aneurysms

Answer 9

 Men x3 more than women aged 40 to 60 with hypertension

 Younger patients with systemic or localized abnormalities of connective tissue

Question 10

Dissecting Aortic Aneurysms morphology

Answer 10

 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

Question 11

Dissecting Aortic Aneurysms - clinical symptoms

Answer 11

• 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.

Question 12

Berry Aneurysms

Answer 12

 Aneurysms of the circle of Willis
 Young people
 Often hypertensive
 Associated with
sub-arachnoid haemorrhage

Question 13

Capillary Micro-aneurysms

Answer 13

 Associatedwith
• Hypertension
• Diabetes mellitus
Small aneurysms of branches of middle cerebral artery
 Associated with intra-cerebral haemorrhage

Question 14

 Syphilitic

Answer 14

• Usually affects thoracic aorta

Question 15

 Mycotic

Answer 15

• Wall of artery weakened by infection
• Bacteria or fungi
• Often in brain, secondary to embolism

Question 16

Varicose veins

Answer 16

Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support

Question 17

Varicose veins - Risk factors

Answer 17

Age, sex, heredity, posture, obesity

Question 18

after effects of varicose veins

Answer 18

• Venous valves incompetent and leads to stasis, congestion, oedema, pain, and thrombosis
• Lower limbs usually saphenous system
• Oesophageal varices
• Haemorrhoids
• Varicocele

Question 19

Vasculitis

Answer 19

 Inflammation and necrosis of blood vessels

Question 20

pathogenesis of Vasculitis

Answer 20

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

Question 21

Giant-cell (temporal) arteritis

Answer 21

• > age 50, average onset age 70, women > men
• granulomatous inflammation of large to small-sized arteries
(temporal, vertebral and ophthalmic)
• Cord like nodular thickening

Question 22

Takayasu arteritis (pulseless disease)

Answer 22

granulomatous vasculitis of medium and larger arteries of upper limbs (+arch of aorta) women age <30

Question 23

Polyarteritis nodosa (PAN)

Answer 23

Medium small size muscular arteries of the kidneys, heart, liver, and gastrointestinal tract are involved
 Fibrinoid necrosis could be fatal without steroid treatment

Question 24

Kawasaki disease (children < age 4)

Answer 24

•High fever, conjunctival and oral lesions. Self-limited

Question 25

Giant-cell (temporal) arteritis

Answer 25

• 6-12 months
• Could be self-limited
• Patchy lesion
• Throbbing temporal pain
• Malaise
• Fever

Question 26

Takayasu arteritis

Answer 26

• Dizziness
• Visualdisturbances
• Dyspnoea
• Intermittent claudication upper limbs
• Asymmetric BP
• Steroidtreatment

Question 27

Vascular Tumours

Answer 27

Benign 
Angioma
Haemangioma
 Juvenile (strawberry) Skin
 Capillary (rubyspots) Skin, spleen, kidneys
 Cavernous (portwinestains) Skin, spleen, liver, pancreas
Lymphangioma
 Capillary and Cavernous

Question 28

Vascular Tumours

Answer 28

• Malignant
Angiosarcoma
• Skin, soft tissue, breast, bone, liver and spleen
• Kaposi’s sarcoma: associated with HIV / AIDS
Angioproliferative tumour derived from endothelial cells