Vascular Pathology Flashcards
1
Q
What characteristic of the vessels has the most influece on pressure within the vessel?
A
-the radius
2
Q
What is an arteriovenous malformation?
A
-a connection between arteries and veins w/o intervening capillaries
3
Q
What happens when there are large or multiple arteriovenous malformations (AVM’s) that are shunting blood from arterial to venous circulation?
A
–forces the heart to pump additional volume, which leads to high-output cardiac failure
4
Q
What are some injurious causes of AVM’s?
A
- rupture of an arterial aneurysm into an adjacent vein
- penetrating injury that pierce arteries and veins
- inflammatory necrosis or adjacent vessels
5
Q
In what population are AVM’s most commonly diagnosed?
A
- men
- late childhood or early adulthood
6
Q
When would an AVM be medically indicated and surgically created?
A
-an arteriovenous fistula to provide access for chronic hemodialysis or chemotherapy
7
Q
What is a Berry (Saccular) Aneurysm and where are they typically found?
A
- focal, abnormal arterial dilation d/t underlying media defect
- Circle of Willis near the branch of the Anterior Cerebral A. and the Anterior Communicating A. (40%)
8
Q
What are major risk factors of a Berry Aneurysm?
A
- HTN
- smoking
9
Q
What conditions are associated with Berry Aneurysms?
A
- AD PKD
- Marfan Syndrome
- Ehlers Danlos Syndrome
10
Q
What is the most common cause of subarachnoid hemorrhages?
A
-Berry Aneurysm rupture
11
Q
What causes Berry Aneurysm rupture?
A
- acute increases in intracranial pressure
ex: straining w/ BM’s or orgasms
12
Q
How would a patient present with a ruptured Berry Aneurysm?
A
- “worst headache of my life”
- neck pain
- vomiting
- double vision
- seizures
- loss of consciousness
13
Q
What are possible causes of a Mycotic Aneurysm?
A
- septic emboli (ex: from infective endocarditis)
- could be an extension of adjacent infectious process or from circulating organisms that directly infect the arterial wall
14
Q
What is Fibromuscular Dysplasia?
A
–focal, irregular thickening in medium and large muscular arteries (ex: RENAL, carotid, splanchnic, etc.)
–likely a developmental etiology (high incidence in first-degree relatives)
15
Q
What is the most common population to be affected by Fibromuscular Dysplasia?
A
-young women
16
Q
What does Fibromuscular Dysplasia look like on angiography and what would you find on physical exam?
A
- “string of beads”
- epigastric abdominal bruit d/t renovascular HTN caused by Fibromuscular Dysplasia (present in 50%)
17
Q
What level of blood vessels regulates peripheral vascular resistance?
A
- arterioles
- influenced by neural and hormonal factors
18
Q
What is the main cause of primary HTN?
A
–90-95% idiopathic (essential HTN)
19
Q
What are risk factors of HTN?
A
Unmodifiable Risk Factors: age, genetics (ex: blacks have increased risk)
Modifiable Risk Factors: stress, obesity, physical inactivity, high salt consumption
20
Q
What are some causes of secondary HTN?
A
- kidney (renovascular disease, renal A. stenosis)
- endocrine (pheochromocytoma)
- cardiovascular (coarctation of the aorta)
21
Q
How is the category of severity determined for HTN?
A
-whichever number is higher
ex: 144/86 would be Stage 2
S144 = Stage 2
D86 = Stage 1
22
Q
What are the categories of severity of HTN?
A
Normal S<120 and D<80 (ex: 116/76) Elevated S120-129 and D<80 (ex: 124/76) Stage 1 S130-139 or D80-89 (ex: 134/84) Stage 2 S140+ or D90+ (ex: 146/96) HTN Crisis S>180 and/or D>120 (ex: 184/124)
23
Q
What is Primary Hyperaldosteronism?
A
-HTN w/ hypokalemia
24
Q
What causes Cushing Syndrome (which is an endocrine-related cause of secondary HTN)?
A
- tumor secretes ACTH, which increases cortisol secretion (pituitary or adrenal tumor, lung cancer, etc.)
- iatrogenic (ex: steroids)
25
What are clinical characteristics of Cushing Syndrome?
- "moon face" and increased facial hair growth
- weight gain in neck, back, and belly
- weak muscles in upper arms and legs
- skin bruises easily and heals poorly
- stretch marks
26
What is Pheochromocytoma (an endocrine-related cause of secondary HTN)?
- tumor of chromaffin cells in the adrenal gland
- releases epi/norepi to act on B1 and alpha1 receptor
- increases cardiac output
- constricts blood vessels
- associated w/ MEN syndrome
27
What is the clinical presentation of Pheochromocytoma?
- HTN
- tachycardia, palpitations
- headache
- diaphoresis
- tremor
28
How do you test for Pheochromocytoma?
-elevated urinary or plasma metanephrines (breakdown product of catecholamines)
29
What are the characteristics of Renal A. Stenosis (a renal cause of secondary HTN)?
- could be d/t atherosclerosis
- could be d/t Fibromuscular Dysplasia
- HTN decreases GFR and causes chronic kidney Dz
- increased creatinine
- can hear an abdominal bruit
30
What are characteristics of Coarctation of the Aorta (a CV cause of secondary HTN)?
- associated w/ bicuspid aortic valves
- more common in men
- HTN in the upper extremities
- htn in the lower extremities
31
What are the end organ effects of HTN on the heart and aorta?
- cardiac hypertrophy
- chronic heart failure
- ischemic heart disease
- acute aortic dissection
32
What are the end organ effects of HTN on the kidney?
-renal dysfxn and failure
33
What are the end organ effects of HTN on the brain and eye?
- -multi-infarct dementia
- -cerebrovascular hemorrhage
- -stroke
- -increased intracranial pressure and papilledema
- -retinopathy
34
What are the most common causes of death in untreated HTN patients?
- 50% die of ischemic heart disease or heart failure
| - 33% die of stroke
35
What is Hyaline Arteriolosclerosis (a HTN Vascular Dz)?
-homogenous pink hyaline thickening of the vessel wall, leading to a narrow lumen; CHRONIC HTN
- increased smooth muscle matrix synthesis
- increased leakage of plasma proteins
36
What other factor besides HTN might cause hyaline arteriosclerosis?
-side effect of calcineurin inhibitors
37
What is hyaline nephrosclerosis?
-arteriolar narrowing leads to impaired renal blood supply and ischemic glomerulosclerosis
38
Is a HTN crisis the result of a slow or rapid rise in BP?
- rapid
| - systolic >180; diastolic >120
39
What is a HTN Emergency?
--HTN crisis w/ end organ damage (often superimposed on pre-existing benign HTN)
-renal failure, encephalopathy, acute heart failure, retinal hemorrhages/exudates +/- papilledema
40
What is Hyperplastic Arteriolosclerosis (a HTN Vascular Dz)?
- smooth muscle forms concentric lamellations ("onion skinning") that cause a narrow lumen
- occurs in SEVERE HTN
41
In malignant HTN, what else is seen besides lamellations that are seen in Hyperplastic Arteriolosclerosis?
-fibrinoid deposits and vessel wall necrosis (particularly in the kidney)
42
What is atherosclerosis?
- "gruel" and "hardening"
- atheromatous plaque formation
- stenosis/occlusion
- plaque rupture
- aneurysm
43
What is Monckeberg Medial Sclerosis?
- -age-related degenerative process
- -calcification of muscular arteries (internal elastic membrane)
--no narrowing of lumen; not clinically significant
44
True or False: MI's are responsible for almost 25% of all deaths in the US and is the number 1 cause of mortality
True
45
What are major non-modifiable risk factors for atherosclerosis?
- genetic abnormalities (multifactorial inheritance)
- family history
- increasing age (40-60's)
- male sex
46
True or False: premenopausal estrogenized women have an increased risk of atherosclerosis
False; there is a Protective Effect against atherosclerosis
47
What are major modifiable risk factors for atherosclerosis?
- hyperlipidemia
- HTN
- cigarette smoking
- diabetes
48
What increases LDL?
- animal products
| - trans fat (fried foods, snack foods)
49
What decreases LDL?
- soluble fiber
| - statins (inhibit HMG CoA reductase which makes LDL)
50
What increases HDL?
- exercise
| - moderate alcohol consumption
51
What decreases HDL?
- obesity
| - smoking
52
What is the physiological process behind how cigarette smoking increases risk of atherosclerosis?
- cigarette smoking increases free radicals and ROS
- ->causes endothelial dysfxn
- ->causes platelet activation
53
What is the physiological process behind how diabetes increases risk of atherosclerosis?
-increased glucose causes oxidative stress, which causes inflammation
54
How does the endothelium respond to turbulent flow, HTN, cigarette smoking, etc.?
- becomes activated (pro-thrombotic, pro-inflammatory)
- expresses procoagulants
- expresses adhesion molecules
55
What is the structure of plaque?
- rests against the internal elastic membrane
- necrotic ctr (cell debris, cholesterol crystals, calcium)
- fibrous cap (macrophages, lymphocytes, collagen)
56
Where do most atherosclerotic lesions forms?
- areas of flow disturbance or branch points
| - near endothelial injury/dysfxn
57
What growth factors cause smooth muscle cell proliferation and collagen deposition (ECM)?
- -PDGF (by platelets, macrophages, endothelial cells)
- -fibroblast GF
- -TGF-alpha
58
Which vessel in the body is the most heavily involved with atherosclerosis?
-abdominal aorta
59
What is the definition of an aneurysm?
-an excessive localized abnormal dilation of a blood vessel or ventricular wall
60
What is the difference between a true aneurysm and a false aneurysm?
A true aneurysm has an intact vessel wall
61
What causes Marfan Syndrome?
- mutation in the FBN1 fibrillin gene
| - increased TGF-B causes elastic tissue weakening
62
What are clinical features of Marfan Syndrome?
- aortic aneurysm and dissection
- flexible joints
- tall, thin, w/ disproportionately long legs, arms, digits
- intraocular dislocation
- pectus carinatum or excavatum
63
What are clinical features of Ehlers Danlos Syndrome?
- hyperelastic fragile skin
- joint hypermobility
- abnormal wound healing
- mitral valve prolapse
64
What causes Ehlers Danlos Syndrome?
-mutation in collagen
65
What are the clinical manifestations of tertiary syphillis caused by T. pallidum?
- can affect brain, skin, organs, and CV system
- obliterative endarteritis of vasa vasorum
- thoracic aneurysm
- aortic valve regurge (diastolic decrescendo murmur)
- aorta w/ rough, pitted, tree bark appearance
66
What is the primary risk factor of a AAA?
-atherosclerosis
67
What is the at-risk population for a AAA?
-male smokers >50yrs old
68
Where is the most typical location of a AAA?
- below the renal arteries
| - above the aortic bifurcation
69
What is the clinical presentation of a (symptomatic) AAA?
- pulsatile abdominal mass
- abdominal pain, back pain
-if ruptured ... severe acute pain and htn
70
At what size is a AAA considered for surgical repair?
--5 cm (3-15% risk of rupture)
71
What are significant features of the Inflammatory Type of AAA?
- IgG4
- T lymphocytes
- fibroinflammatory infiltrate weakens wall
- responds to steroids
- prominent fibrosis
72
What is the primary risk factor of a Thoracic Aortic Aneurysm?
-HTN
73
What is the clinical presentation of a Thoracic Aortic Aneurysm?
-symptoms are d/t compression of adjacent structures
- breathing difficulties (respiratory tree)
- dysphagia (esophagus)
- cough (recurrent laryngeal nerve)
74
What is an aortic dissection?
--intimal tear w/ blood-filled channel separating media
--can progress to rupture (excruciating anterior CP)
75
What is the clinical triad of an aortic dissection?
- thoracic pain
- pulse abnormalities
- mediastinal widening on CXR
76
What are the causes of an aortic dissection?
- HTN (especially in men ages 40-60)
| - connective tissue disorders (Marfan, Ehlers Danlos)
77
Where is the aortic dissection most common?
- proximal to the L common carotid A.
- -Debakey Type 1
- -Type A
78
What are the characteristics of Giant Cell (Temporal) Arteritis?
- -most common vasculitis in older adults (>50yrs) in US
- -affects temporal, vertebral, and opthalmic aa.
- -important to Dx b/c vision loss can occur
- -T-cell mediated autoimmune response
- -Dx by temporal A. biopsy (anti-endothelial, ASMA Ab's)
79
What is Takayasu Arteritis?
- granulomatous autoimmune vasculitis of large-to-medium arteries in certain HLA types
- more common in younger adults (<50yrs)
80
What is the clinical presentation of Takayasu Arteritis?
-thickened aorta and major branch vessels
(pulmonary, coronary, renal)
- weak upper extremity pulses
- ocular disturbances
81
What are the characteristics of Polyarteritis Nodosa?
- -systemic vasculitis of small-to-medium vessels
- -young adults (33% have Hep B)
- -immune-complex mediated
- -commonly involves renal vessels and the GI tract
- -classic presentation = rapidly accelerating HTN
82
What is Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)?
- -infancy or early childhood
- -large-to-medium vessels (prefers coronary A.)
- -infectious (viral) trigger w/activated T-cells
83
What is the clinical presentation of Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)?
- fever
- "strawberry tongue"
- conjunctivitis
- erythema of palms and soles
- cervical lymphadenopathy
84
What are the fatal complications of Kawasaki Disease (Mucocutaneous Lymph Node Syndrome)?
- MI
- coronary A. rupture
-must treat with IVIG within the first 10 days of symptoms
85
What is Churg-Strauss Syndrome (Allergic Granulomatosis and Angiitis)?
-small vessel necrotizing vasculitis associated w/ asthma, hypereosinophilia, and lung infiltrates
86
What does the inflammation of Churg-Strauss Syndrome resemble?
- Polyarteritis Nodosa or Microscopic Polyangiitis
| - -w/ the addition of eosinophils and granulomas
87
What disease marker is present in Churg-Strauss Syndrome (Allergic Granulomatosis and Angiitis)?
- -MPO-ANCA mostly
| - -less than half have ANCA
88
What is the clinical presentation of Churg-Strauss Syndrome (Allergic Granulomatosis and Angiitis)?
- palpable purpura
- GI tract bleeding
- renal disease (glomerulosclerosis)
-myocardial involvement (cardiomyopathy/myocarditis and infarction) in 60% of patients
89
What accounts for almost half of the deaths in Churg-Strauss Syndrome?
-cardiomyopathy/myocarditis and infarction
90
What is Granulomatosis w/ Polyangiitis (Wegner's Granulomatosis?
--small-to-medium vessel necrotizing granulomatous vasculitis of respiratory tract (pneumonitis, sinusitis)
91
What are the characteristics of Granulomatosis w/ Polyangiitis (Wegner's Granulomatosis)?
+/- necrotizing renal pathology
(necrotizing crescentic glomerulonephritis)
- -males, 40's, T-cell mediated hypersensitivity rxn
- -PR3-ANCA (c-ANCA)
92
What are the clinical symptoms of Granulomatosis w/ Polyangiitis (Wegner's Granulomatosis)?
- lungs: cavities, bleeds, lung infiltrates
- nose: congestion, nosebleeds, saddle nose
- kidneys: glomerulonephritis
93
What is Microscopic Polyangiitis?
-necrotizing vasculitis of small vessels (arterioles, capillaries, venules) of any organ system, especially the kidneys and lungs
94
What are the characteristics of Microscopic Polyangiitis?
- -uniform disease stage activity in all vessels
- -MPO-ANCA
- -no significant immunoglobulin deposition in lesions
95
What are the clinical symptoms of Microscopic Polyangiitis?
- hematuria, proteinuria
- hemoptysis
- cutaneous purpura
- muscle weakness
- bowel pain and bleeding
96
What are the characteristics of Behcet's Disease
- -small-to-medium vessel NEUTROPHILIC vasculitis
- -associated w/ HLA-B51
Tx: steroids
97
What is the classic clinical triad of Behcet's Disease?
- oral aphthous ulcers
- genital ulcers
- uveitis
-often presents w/ arthritis
98
What is Thromboangiitis Obliterans (Buerger Disease)?
- segmental, thrombosing, acute and chronic vasculitis of small and medium vessels (particularly tibial and radial arteries)
- luminal necrosis and granulomatous inflammation
99
What population is at risk for Thromboangiitis Obliterans (Buerger Disease)?
-heavy smokers, <35yrs
100
What are the characteristics of Thromboangiitis Obliterans (Buerger Disease)?
- -hypersensitivity or toxic rxn to cigarettes
- -anti-endothelial Ab's
--affects HLA haplotypes of certain ethnic groups (Israeli, Indian, Japanese)
101
What is the disease process of Thromboangiitis Obliterans (Buerger Disease) and the progression of symptoms?
- thrombosis ---> vascular insufficiency ---> tissue death
| - Raynaud's Phenomenon ---> intermittent claudication ---> severe pain at rest ---> ulceration ---> gangrene
102
What are the characteristics of Raynaud's Phenomenon?
- vasospasm of small arteries and arterioles (especially fingers and toes) induced by cold or emotion
- "red, white, and blue" (proximal vasodilation, central vasoconstriction, and distal cyanosis)
103
What are the characteristics of Primary Raynaud's Phenomenon?
- symmetric involvement of the digits
- young women
- episodic
- spontaneous remission
104
What are the characteristics of Secondary Raynaud's Phenomenon?
- asymmetric involvement of digits that worsens w/ time
| - a component of other arterial diseases (SLE, scleroderma, thromboangiitis obliterans)
105
What are some causes of myocardial vascular contraction?
- high levels of vasoactive mediators
- -exogenous (cocaine, caffeine)
- -endogenous (epinephrine)
- elevated thyroid hormones
- -increased sensitivity to catecholamines
- autoantibodies and T cells in scleroderma
106
What is Takotsubo Cardiomyopathy ("Broken Heart Syndrome")?
-sudden surge of catecholamines w/ emotional distress
---> stimulates cardiac muscle cells, triggers constriction and causes ischemic cardiomyopathy or cardiac death
107
What are the characteristics of varicose veins?
- sustained intraluminal pressure leads to valvular incompetence
- stasis, thrombus, edema, pain, ischemia of overlying skin (stasis dermatitis), poor wound healing, superimposed infection
108
What is the risk of thrombi from superficial veins vs. risk of thrombi from deep veins?
-risk of thrombi from superficial veins is rare
109
What are the characteristics of portal HTN?
- venous HTN, most commonly d/t cirrhosis
- esophageal varices, hemorrhoids, caput medusae
- splenomegaly
110
What are the clinical symptoms of Superior Vena Cava Syndrome?
-venous dilation in head, neck, chest wall, and arms (with cyanosis)
- facial swelling, neurologic manifestations
- respiratory distress if pulmonary vessels compressed
111
What could be causes of Superior Vena Cava Syndrome?
-neoplasms (lung carcinoma, lymphoma)
112
What could be causes of Inferior Vena Cava Syndrome?
-neoplasms (hepatocellular carcinoma, renal cell carcinoma, or thomosis such as a DVT)
113
What are the clinical symptoms of Inferior Vena Cava Syndrome?
- lower extremity edema
| - distention of superficial lower abdominal veins
114
What are the clinical characteristics of Thrombophlebitis?
- venous thrombosis and inflammation
- typically in deep veins of the leg
- edema, cyanosis, erythema, pain
- serious consequence: PE
115
What are the risk factors of Thrombophlebitis?
- prolonged inactivity/immobilization
- hypercoagulable states (factor mutations, estrogen)
-tumor (thrombotic paraneoplastic syndrome, migratory thrombophlebitis); pancreatic or lung carcinoma
116
What are the characteristics of Lymphangitis?
- -inflammation of lymphatic channels
- -common cause: Group A B-hemolytic strep
- -inflamed lymphatics (painful red streaks)
117
What is Lymphadenitis?
-painful enlargement of draining lymph nodes
118
What are the characteristics of Primary Lymphedema?
-congenital defect
| -familial Milroy Disease
lymphatic agenesis or hypoplasia
119
What are the characteristics of Secondary Lymphedema?
- -blockage of previously normal lymphatics
- -causes: tumor, surgery, post-irradiation fibrosis
--peau d'orange (draining lymphatics of skin overlying breast cancer are filled w/ tumor cells)
120
What are examples of vascular ectasias?
- -nevus simplex
- -port-wine stain
- -Sturge-Weber Syndrome
121
What are characteristics of a nevus simplex (a type of vascular ectasia)?
- the most common type of vascular ectasia
- simple birthmark (~50% of infants)
- common sites: forehead, eyelid, nose, upper lip
- ectatic vessels in upper dermis
- most regress
122
What are characteristics of a Port-Wine Stain (nevus flammeus)?
- progressive ectasia of vascular plexus
- rare (0.3% of newborns)
- persist into adulthood
123
What are characteristics of Sturge-Weber Syndrome?
- -trigeminal n. port-wine stain
- -mental retardation, seizures, hemiplegia
- -leptomeningeal capillary-venous malformation
- -skull radio-opacities
- -eye abnormalities (esp. glaucoma)
124
What is a telangectasia?
-a permanent dilation in small vessels and capillaries forming a discrete lesion
125
What are the characteristics of a spider telangectasia?
- central red papule w/ radial red lines
- face, neck, and upper chest
- can be induced by increased circulating estrogen
- -(pregnancy, liver disease)
126
What are the characteristics of Hereditary Hemorrhagic Telangectasia (Osler-Weber-Rendu Disease)?
- autosomal dominant
- mutation in TGF-B signaling pathway
- abnormal vessels in skin, mucus membranes, organs
- telangectasias and AVM's occur
- Sx depend on location (nosebleeds, hematuria, etc.)
127
What is a hemangioma?
- common benign vascular tumor of children and adults
- most common benign tumor in infants and children
- frequently found on the head and neck
- usually superficial, but may be internal (esp. liver)
128
What is a Capillary Hemangioma?
- -most common type
- -skin, mucus membranes, viscera
- -red spot
- -thin-walled capillaries, tightly packed together
129
What is a Congenital /Infantile/Juvenile Hemangioma ("Strawberry")?
- present at birth, usually regress
| - subtype of capillary hemangioma
130
What is a Cavernous Hemangioma?
- irregular, dilated vascular channel w/ indistinct border
- more likely to involve deep tissue
- more likely to bleed
- seen in VHL
131
What is a Pyogenic Granuloma (Lobular Capillary Hemangioma)?
- type of capillary hemangioma
- rapidly growing, often in oral mucosa or on finger
- may ulcerate
- 25% develop after a trauma
- gingiva of pregnant women
132
What is a Glomus Tumor?
-- well-circumscribed mesenchymal tumor (typically benign) of modified smooth muscle arising from glomus body responsible for thermoregulation
-bluish, painful, esp. w/ temperature changes
133
Where is a Glomus Tumor commonly seen?
- most commonly in upper extremity (esp. fingers)
| - subungual location is common
134
What is a Lymphangioma?
- benign lymphatic neoplasm
| - Two Types: Simple or Cavernous (Cystic Hygroma)
135
What are the characteristics of a Simple Lymphangioma?
- common in head and neck
| - predilection for axillary region
136
What are the characteristics of a Cavernous Lymphangioma (Cystic Hygroma)?
- neck or axilla of children
- large (up to 15 cm)
- massively dilated lymphatic spaces
- common in Turner Syndrome (also seen in Trisomy 21)
- can be difficult to resect
137
What is a Bacillary Angiomatosis
- reactive vascular proliferation to Bartonella bacilli
- -ex: B. henselae ... Cat Scratch Fever
- -ex: B. quintana ... Trench Fever
-bacteria seen on Warthin Starry stain (silver stain)
138
What are the characteristics of Bacillary Angiomatosis?
- benign lesion
- red papules
- occurs in immunocompromised (HIV, transplant pts)
- Tx: abx
139
What is Kaposi Sarcoma?
- -angioproliferative disorder caused by HHV-8
- -intermediate grade (borderline) vascular tumor
- -can affect lymph nodes, GI tract, and other organs
140
What is the clinical presentation of Kaposi Sarcoma?
--red-purple nodules or plaques on lower limbs, genitals, face, and back
141
What are the characteristics of Classic (Sporadic) Kaposi Sarcoma?
- Mediterranean, Eastern European, or Middle Easterns
- older men (3:1 M:F)
- distal lower extremities
- indolent
142
What are the characteristics of Endemic (African) Kaposi Sarcoma?
- -African children < 10 yrs
- -lymph nodes +/- cutaneous involvement
- -also cutaneous manifestations in adults
143
What are the characteristics of Iatrogenic Kaposi Sarcoma (related to immunosuppression)?
- -related to T-cell immunosuppression in transplant pts
| - -may be widespread
144
What are the characteristics of AIDS-associated Kaposi Sarcoma?
- -most common type in the US
- -most common type of AIDS-related malignancy
- -disseminates
- -widely aggressive course
145
What are the stages of Kaposi Sarcoma?
1) Patch Stage - dilated channels w/blood and small hyperchromatic nuclei
2) Plaque Stage - infiltrative proliferation of spindle cells and irregular vascular channels
3) Tumor Stage - nodular mass of spindle cells
146
What is angiosarcoma?
- malignant vascular tumor
- locally invasive
- frequently metastasizes
147
What are specific risk factors for angiosarcoma?
- Liver: arsenic, thorotrast, PVC production
- lymphedema s/p axillary LN dissection
- radiation for carcinoma
148
What are the characteristics of Balloon Angioplasty?
- compresses and can rupture the occluding plaque
| - abrupt reclosure can result from thrombosis or spasm
149
What devices are used concomitantly with balloon angioplasty?
--metallic stents or drug-eluting stents
150
What are the characteristics of metallic stents, which are an expandable metallic mesh?
--can cause endothelial injury and immediate thrombosis ---> thus, antithrombolytic drugs are given
--long-term: proliferative in-stent restenosis in 33% of pts within 9 mos.
151
What are the characteristics of drug-eluting stents?
--releases an anti-proliferative to block smooth muscle activation
--restenosis at 1yr is decreased by 65%
152
What are the characteristics of vascular grafts?
-synthetic or autologous replacement or bypass of vessel (synthetic is only used in large vessels)
--long-term patency of saphenous v. = 50% at 10yrs
--long-term patency of internal mammary a. = 90% at 10yrs
