INFLAMMATORY CONDITIONS OF VESSELS & DISEASES OF VEINS

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Inflammatory Diseases of Vessels

I. INFLAMMATORY DISEASES OF ARTERIES
II. INFLAMMATORY DISEASES OF VEINS

KEY WORDS:

Vasculitis, arteritis, polyarteritis nodosa, Wegener's granulomatosis, Buerger's disease, Rayneaud's phenomenon, phlebothrombosis, thrombophlebitis, migratory thrombophlebitis, varicose veins, varicocele.

OBJECTIVES:

You should be able to:

• Briefly define the key words.
  
• Describe in general terms the major complications of arteritis.
  
• Describe the complications of deep leg vein thrombosis.
  
• Your patient has recurrent venous thrombosis. List the diseases or conditions commonly associated with or predisposing to venous thrombosis.

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Inflammatory Diseases of Vessels

I. INFLAMMATORY DISEASES OF ARTERIES

• Diseases of arteries vary in manifestations many possible arterial sites of localization;
  
• Arteritis
  
  • may present with involvement of any organ system, and
  • commonly involves multiple organs.
    
• Inflammation of an arterial vessel may:
  
  • Weaken vessel walls, causing aneurysm or rupture
  • Narrow the lumen, causing ischemia
  • Damage the endothelium, resulting in thrombosis
  • Be complicated by arteriosclerosis (syphilitic aortitis with secondary atherosclerosis)
    
• Idiopathic Necrotizing Arteritis:
  
  • Often has allergic or autoimmune basis
  • Affects muscular arteries, arterioles, and capillaries (many types)
  • Classical example is polyarteritis nodosa
  • Typical lesion: necrosis of wall, marked inflammation
  • Complications: microaneurysms, rupture, occlusion, infarction
  • Patterns of distribution vary
  • Immunoglobulin and complement alterations vary
  • Some cases associated with Hepatitis B infection
  • Kawasaki's disease: arteritis in children with skin and lymph node involvement, may involve coronary arteries causing myocardial infarction (MI)
    
• Giant Cell Arteritis
  
  • Temporal artery usually
  • Can cause blindness
  • Treated with steroids
    
• Wegener's granulomatosis--triad of vasculitis involving:
  
  • Midline granuloma (face, upper respiratory tract)
  • Lungs--infarct-like necrosis with granulomatous inflammation
  • Kidneys--same, with hematuria
    
• Thromboangiitis obliterans (Buerger's disease):
  
  • Pain and ischemia, legs and arms
  • Relatively young men
  • Leads to gangrene of extremities
  • Genetic predisposition possible
  • Almost exclusively in smokers
  • May improve if give up smoking
  • Lesion:
    • cellular thrombosis with inflammation
    • involves arteries and veins
    • fibrosis around nerves and lymphatics
  • No agent has been demonstrated

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II. INFLAMMATORY DISEASES OF VEINS

• Thrombophlebitis: Acute inflammation of veins
  
  • Caused by bacterial, parasitic, physical, chemical, allergic injury
  • Examples:
    • Pylephlebitis (portal vein) from abdominal infection (e.g., appendicitis)
    • Dural sinuses in infections of ear and face
    • Pulmonary veins in pneumonia
    • Iliofemoral veins in puerperal sepsis
    • Hepato-veno-occlusive disease from "bush-teas"
    • Migratory thrombophlebitis (Trousseau's syndrome)
      • Transient attacks, variable sites
      • Sign of internal cancers (e.g., pancreas)
    • Idiopathic Thrombophlebitis: same as phlebothrombosis (see below)
      
• Phlebothrombosis: Venous thrombosis without inflammation
  
  • Usually in legs or pelvic veins
  • Exact incidence uncertain, but high (autopsy patients, as high as 60%)
  • Pain, tenderness, swelling, or may be asymptomatic
  • Complication: Pulmonary embolus
    • up to 50% of patients
    • source usually deep veins in thigh
  • Clots usually form in relation to valve cusps (site of maximum stasis), propagate upward
    
• Varicose Veins (not primarily inflammatory)
  
  • Abnormally dilated, tortuous veins
  • Produced by prolonged increase in intraluminal pressure
  • Often in relation to injury or defect of the vein proximally
  • Sites:
    • Legs (estimated 20% of population)
    • Perianal (hemorrhoids)
    • Vulva (this and the two above may be related to pregnancy)
    • Testis (varicocele, dilatation of pampiniform plexus)
    • Esophagus (in cirrhosis of liver)
  • Clustering in families suggests a structural abnormality, such as defective valves
  • Complications:
    • Inflammation, thrombosis, stasis dermatitis, ulceration of the skin
    • Not pulmonary embolism
  • Varices in distal esophagus, in cardia of stomach, and in perianal region occur in cirrhosis of the liver with portal hypertension, as porto-systemic anastomoses

Complication: hemorrhage, when varices torn or eroded

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[ Atherosclerosis | Cardiac Anatomy | Cardiac Adaptations | Inflammatory Diseases of Vessels and Diseases of Veins | Aneurysms and Vascular Tumors | Ischemic Heart Disease | Peri- and Myocardial Diseases | Valvular Disease ]

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Questions? Comments? Send a message to the CATS guru: jkessler@salus.uvm.edu