Pathology- Arteriosclerosis

Arteriosclerosis can be defined as a group of diseases that result in arterial wall thickening.

1. Monckeberg medial calcific sclerosis:

Medial calcification of medium sized arteries
Femoral, tibial, radial and ulnar arteries are affected mostly.
It is mostly asymptomatic and can be detected by X ray

2. Arteriosclerosis:

Occurs in diabetes, hypertension and aging
Affects small arteries and arterioles
Microscopic appearance-
Hyaline arteriosclerosis- pink, glossy arterial wall thickening with luminal narrowing is noted. Hyperplastic arteriosclerosis- Smooth muscle proliferation resulting in concentric (onion skin) wall thickening and luminal narrowing.

3. Atherosclerosis:

Def: Lipid deposition and intimal thickening of large and medium sized arteries, resulting in fatty streaks and atheromatous plaques.
Aorta, coronary arteries, carotid, cerebral, iliac and popliteal arteries
Fatty streak- flat, yellow intimal streak. Microscopically, lipid laden macrophages can be seen (also called foam cells).
Atheromatous plaque- Raised, yellow-white plaques, Microscopically-Fibrous cap is seen which contains smooth muscles, lymphocytes and foam cells. Necrotic core contains cholesterol clefts, foam cells and necrotic debris.

Major Risk Factors	Minor Risk Factors
Hyperlipidemia	Male gender
Hypertension	Obesity
Smoking	Sedentary life style
Diabetes	Stress (Type A personality)
	Elevated homocysteine
	Oral Contraceptives
	Increasing age
	Genetic factors

Clinical complications:

Ischemic heart disease
Cerebrovascular accidents
Atheroemboli (Transient ischemic attacks and renals infarcts)
peripheral vascular disease
Aneurysm formation
Mesenteric artery occlusion

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