🫀 Vasculitides
- Systemic inflammatory vessel disorders — heterogenous presentation
- Categorised by predominant vessel size (large / medium / small)
- Vasculitis may be primary or secondary to infection, drugs, or connective tissue disease
- Large vessel
- Takayasu arteritis – age <50, aortic arch involvement, granulomatous inflammation, blindness possible
- Giant cell (temporal) arteritis – older adults, headache, jaw claudication, vision loss; inner media granulomas; steroids & anti-TNF
- Medium vessel
- Kawasaki disease – children, mucocutaneous + cervical LAD; coronary aneurysms; IVIG therapy
- Polyarteritis nodosa – young adults (M>F), HBV association, renal involvement can be fatal; spares lungs
- Small vessel
- ANCA-associated
- Granulomatosis with polyangiitis (Wegener) – lung/upper airway granulomas, GN; PR3-ANCA (+)
- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) – asthma, eosinophilia, MPO-ANCA; cardiac death possible
- Immune complex–mediated – anti-GBM disease, IgA vasculitis (Henoch-Schönlein)
- ANCA-associated
- Thromboangiitis obliterans (Buerger) – thrombosis predominant, young male smokers, distal extremity ulcers
❄️ Raynaud phenomena
- Primary Raynaud – young women, episodic vasospasm (fingers/toes/nose/ears) triggered by cold/stress; blanching → cyanosis
- Secondary Raynaud – underlying arterial insufficiency (e.g. scleroderma/CREST)
- Secondary Raynaud often asymmetric, may progress to digital ulcers
🧬 Arteriosclerosis
- Monckeberg medial calcific sclerosis – media calcification of medium muscular arteries (femoral, radial), asymptomatic, x-ray finding
- Arteriolosclerosis (small arteries/arterioles)
- Hyaline – pink glassy thickening; benign HTN, diabetes, aging
- Hyperplastic – concentric “onion skin”; malignant HTN
- Atherosclerosis – large/medium elastic & muscular arteries; chronic inflammatory process
- Fatty streak (reversible) – lipid-laden macrophages (foam cells)
- Stable plaque – dense fibrous cap, small lipid core, chronic ischemia
- Vulnerable plaque – thin cap, large lipid core, dense inflammation → rupture/embolism
| Risk factor | Impact |
|---|---|
| Hyperlipidemia | ↑ LDL, ↑ oxidation |
| Hypertension | Endothelial injury |
| Smoking | Oxidative stress, vasospasm |
| Diabetes | Advanced glycation end products |
| Obesity / sedentary | Insulin resistance |
- Complications: MI, CVA, atheroemboli (TIA, renal infarcts), aneurysm, PVD, mesenteric occlusion
⬆️ Hypertension
- Persistent diastolic >80 or systolic >130 mmHg with end-organ damage
- Malignant (accelerated) – systolic >180 / diastolic >120; retinal hemorrhages, exudates, papilledema; medical emergency
- Epidemiology – 25% US adults; African Americans at higher risk; 95% essential (idiopathic)
- End-organ damage
- Hyaline arteriolosclerosis (arterioles)
- Concentric LV hypertrophy → CHF
- Accelerated atherosclerosis, MI, aneurysm, CVA, renal failure
- Malignant HTN: 2-year mortality >90% if untreated (renal failure, stroke, heart failure)
🫧 Aneurysms & AV fistulas
- Aneurysm – localised dilatation due to media weakness; complications: thrombosis, embolism, compression, rupture
- Atherosclerotic – abdominal aorta (below renal arteries), HTN association; >6 cm → 50% rupture in 10y; >5 cm surgical
- Syphilitic – ascending aorta, tertiary syphilis; obliterative endarteritis of vasa vasorum → aortic regurgitation
- Aortic dissection – intimal tear, media degeneration (cystic medial necrosis); severe tearing pain; Marfan / HTN
- Berry aneurysm – circle of Willis (congenital)
- Microaneurysms – HTN, diabetes
- Arteriovenous fistula – direct artery–vein connection (congenital/trauma); high-output failure, rupture risk
Intimal tear→
Blood enters media→
Dissection plane→
Compression / rupture
🩸 Venous disease
- Deep vein thrombosis – iliac/femoral/popliteal; unilateral swelling, warmth, erythema; Homan sign; Doppler ultrasound; PE risk
- Varicose veins – dilated tortuous veins; lower extremity (superficial), pregnancy; esophageal varices (portal HTN), hemorrhoids
- Venous insufficiency – edema, hyperpigmentation, ulcers (gaiter area); female > male, age-related
| Condition | Key feature |
|---|---|
| DVT | Unilateral leg pain/swelling, PE |
| Varicose veins | Superficial, pregnancy, hemorrhoids |
| Venous insufficiency | Edema, stasis dermatitis, ulcers |
🧫 Vascular neoplasms
- Benign
- Hemangioma – capillary/cavernous, most common infant tumour, may regress
- Hemangioblastoma – von Hippel-Lindau (cerebellum, retina, RCC)
- Glomus tumour – painful subungual nodule
- Malignant
- Kaposi sarcoma – HHV8; endothelial spindle cells, slit-like spaces, extravasated RBCs
- Classic (European) – lower extremity plaques in elderly
- Transplant-associated – immunosuppression, may regress
- African – children/young men, lymphatic spread
- AIDS-associated – aggressive, skin/GI/lungs, chemotherapy responsive
- Angiosarcoma – high mortality; skin, breast, liver; vinyl chloride / arsenic association (liver)
- Kaposi sarcoma – HHV8; endothelial spindle cells, slit-like spaces, extravasated RBCs
- Port‑wine stain (vascular malformation) does not regress; nevus flammeus nuchae (“stork bite”) regresses