Diseases of the Arterial Wall, Softcover reprint of the original 1st ed. 1989

This text combines extensive coverage of normal structure and function of the arterial wall with detailed accounts of the changes that occur in disease. These data are presented in a comprehensive way not found elsewhere, they are essential for the proper understanding of arterial disease and for its investigation using modern methodology. Development and the factors controlling vessel form and structure are first discussed, and the normal cellular populations, functions and interactions are then considered. Particular topics, such as pulmonary hypertension, the effects of trauma on vessels, and diabetic vascular disease, are reviewed in detail. This book will be of interest to all involved in the management of vascular disease.

I Cellular and Molecular Biology of the Normal Arterial Wall.- 1 Endothelial and Smooth-Muscle Cells.- Structure of the Normal Arterial Wall.- The Endothelial Cell.- Biological Behaviour and Morphology of Endothelial Cells.- Functional Properties of Vascular Endothelium.- The Smooth-Muscle Cell.- Biological Behaviour of Smooth-Muscle Cells.- Functional Morphology of Vascular Smooth Muscle.- Interactions Between Endothelial and Smooth-Muscle Cells.- Communication Between Endothelial and Smooth-Muscle Cells Mediated Via Humoral Mechanisms.- Communication Between Endothelial and Smooth-Muscle Cells Mediated Via Direct Cell-to-Cell Contacts.- References.- 2 Extracellular Matrix of the Arterial Vessel Wall.- Collagens.- Biochemistry.- Morphology.- Elastin.- Biochemistry.- Morphology.- Proteoglycans.- Biochemistry.- Morphology.- Structural Glycoproteins.- Biochemistry.- Morphology.- General Arrangement of Extracellular Matrix of the Vascular Wall.- References.- 3 Organogenesis of the Arterial Wall.- Structural Organization of Vessel Walls.- Early Development of the Circulation.- Structural Organization of the Arterial Wall.- Static Mechanics.- Scleroproteins in the Aortic Wall.- Developmental Implications.- Arterial Wall Nutrition.- Exceptional Areas in Vascular Development.- Ductus Arteriosus.- Coarctation.- Coronary Vessels and Vascular Cushions.- Conclusions.- References.- 4 Age-Related Morphological Changes of the Arterial Wall.- “Elastic”-Type Arteries.- “Muscular”-Type Arteries.- Assessment of Ageing of the Arterial Wall.- References.- 5 Effects of “Ageing” on Arterial Cells In Vitro.- Cell Culture Techniques.- Smooth-Muscle Cells.- Endothelial Cells.- Growth of Arterial Cells.- Smooth-Muscle Cells.- Endothelial Cells.- Growth Factors and the Proliferation of Arterial Cells.- Metabolic Activities of Arterial Cells.- Glycosaminoglycans and Proteoglycans.- Fibrous Proteins: Collagen and Elastin.- Low-Density Lipoproteins.- Conclusion.- References.- 6 Structural Modifications of the Arterial Wall in Hypertension.- Structural Modifications of the Arterial System as a Consequence of Hypertension.- Structural Modifications of the Arterial Wall as a Result of High Blood Pressure.- Complications: Lacunes and Atherosclerosis.- Effect of Treatment.- Similarity Between the Ageing Process and Hypertension in the Arterial Wall.- References.- 7 Adrenergic and Non-adrenergic Neural Control of the Arterial Wall.- Structure of the Vascular Neuroeffector Junction.- Pattern of Perivascular Innervation.- Development and Regeneration of Perivascular Innervation.- Adrenergic Nerves.- Cholinergic Nerves.- Non-adrenergic, Non-cholinergic Nerves.- Purinergic Nerves.- Aminergic Nerves.- Peptidergic Nerves.- Neuromodulation and Co-transmission.- Concluding Comments.- References.- 8 The Arterial Wall and the Haemostatic Process.- Thromboresistance of the Endothelium.- Thromboresistance in Relation to Primary Haemostasis.- Thromboresistance in Relation to Plasma Coagulation.- Thromboresistance in Relation to Fibrinolysis.- The Thrombogenicity of the Subendothelium.- Ex Vivo Study of the Thrombogenicity of the Subendothelium.- In Vitro Study of the Vascular Thrombogenic Macromolecules.- Structural Determinants of Collagen and Microfibrils Involved in the Thrombogenicity of Subendothelium.- In Vivo Studies on the Thrombogenicity of Subendothelium.- Mechanism of Platelet Activation.- Conclusion.- References.- 9 The Vascular Wall and Hormonal Control of Vasomotor Function.- Vasoactive Peptide Metabolism of the Vascular Endothelium.- Converting Enzyme or Kininase II.- Does a Complete Renin-Angiotensin System Exist in the Vascular Endothelium?.- Other Peptidases of the Vascular Endothelium.- Modulation by the Endothelium of the Physiological and Pharmacological Activity of Vasoactive Compounds.- Stimulation of Prostaglandin Formation by Vasoactive Agents in the Vascular Endothelium.- Vasomotor Reactions Depending on the Vascular Endothelium.- Physiological and Physiopathological Consequences of the Role of the Endothelium in Controlling Vasomotor Activity.- Endocrine Function of the Smooth-Muscle Cell: The Renin-Secreting Cell.- Morphology of Renin-Secreting Cells.- Renin Structure and Renin Precursor Maturation.- Role of Renin Secretion.- Note Added in Proof.- References.- II Pathophysiology of Experimental and Human Atherosclerosis.- 10 The Lesions of Atherosclerosis.- Early Changes, Fatty Streaks and Gellatinous Elevations.- The Fibroatheromatous Plaque and Early Established Lesion.- The Complicated Lesion.- The Pathogenesis of the Lesions.- The Role of Lipids.- References.- 11 Atherosclerosis: Cellular Aspects.- Role of Endothelium.- Modifications of the Endothelium in Pathological Conditions.- Endothelial Dysfunction as a Predisposing Factor for the Development of Atherosclerosis.- Role of Smooth-Muscle Cells.- The Arterial Smooth-Muscle Cell in Experimental Atherosclerosis.- Arterial Smooth-Muscle Cells in Human Atherosclerosis.- Growth Factors for Arterial Smooth-Muscle Cells.- Monoclonality of Atheromatous Smooth-Muscle Cells.- The Role of the Macrophage.- Conclusions.- References.- 12 Extracellular Matrix Changes in Atherosclerosis.- Collagens.- Proteoglycans.- Elastin.- Glycoproteins.- Summary.- References.- 13 Lipid Accumulation in the Vessel Wall.- Lesions Induced by Injury.- Injury from Indwelling Aortic Catheter.- Immunological Injury.- Inhibition of Lesion Development.- Balloon-Catheter Removal of the Endothelium.- Lipid Accumulation in Lesions.- Lipid-Containing Lesions Following Vascular Injury in Man.- Relationship of Injury to “Early” Human Atherosclerotic Lesions.- Mechanisms of Lipid Accumulation in Injury-Induced Lesions.- Proteoglycans and Lipid Accumulation.- Modification of Low-Density Lipoprotein.- Qualitative Change in Proteoglycans and Lipoprotein Binding.- Alterations of Lipoprotein and Vessel Wall Uptake.- Summary.- References.- 14 Role of Platelets in Atherosclerosis and its Complications.- Factors in Endothelial Injury.- Metabolic Factors.- Toxic Factors.- Immunological Factors.- Infectious and Viral Factors.- Role of Mononuclear Cells.- Role of Platelets in Atherosclerosis.- A Few Data on PDGF and its Role.- Progression of the Atherosclerotic Lesion.- Involvement of Haemostatic Factors in the Complication of the Arterial Lesions.- Thrombosis.- Thromboembolic Occlusion.- Arterial Spasm.- Conclusion.- References.- 15 Mechanical Factors in the Pathogenesis, Localization and Evolution of Atherosclerotic Plaques.- The Mechanical Forces.- Blood Flow.- Pressure and Wall Tension.- Pulsatile Flow.- The Physical State of the Plaque.- Mechanical Stresses and the Distribution of Intimal Plaques.- Methodological Problems.- Fluid Dynamic Characteristics.- Blood Pressure and Tensile Stress.- Proposed Mechanisms for Plaque Initiation.- Endothelial Disruption.- Wall Shear Stress.- Transport Through the Artery Wall.- Mechanical Factors in Lesion Progression.- Secondary Disruption.- Artery Adaptation.- Mechanical Factors in Plaque Complication.- Direct Interventions on Plaques.- References.- 16 Progression, Topographical Aspects and Regression of Atherosclerosis.- Natural History and Progression of Atherosclerosis.- Progression.- Complications.- Specific Findings.- Problems of Regression.- References.- III Management of Patients with Atherosclerosis.- 17 A Pharmacological Approach to Degenerative Alterations of Arterial Walls.- The Primary Effects of Drugs on Arteries.- Role of Exaggerated Constriction of Arteries in Vascular Disease.- Response of Arteries to Acute Pharmacological Interventions.- Differences in the Response of Large and Small Arteries to Pharmacological Interventions.- Arterial Consequences of the Physiological Counter-regulations Induced by Drugs.- Long-term Effects of Drugs on Arteries.- Secondary Effects of Drugs on the Function of Arteries.- Conducting Function.- Buffering Function.- Baroreflex Function.- References.- 18 The Arterial Wall: Relationships Between Haemodynamic and Structural Aspects in Man.- Methods of Studying the Vascular System in Man.- Linear Model of the Vascular System.- Measuring the Diameter of Arteries of Large Calibre.- Haemodynamic Consequences of Diseases of the Large Arterial Trunks.- Reduction of Arterial Compliance.- Increase in Systolic Pressure.- Reversibility and Aggravation of Haemodynamic Disorders.- Restructuring of the Vascular System in Permanent Essential Systolo-Diastolic Arterial Hypertension.- Arguments in Favour of Structural Modifications in the Cardiovascular System of the Hypertensive Subject.- Reversibility of Structural and Haemodynamic Alterations of the Cardiovascular System in Hypertensive Subjects.- References.- 19 The Epidemiology of Atherosclerosis.- Atherosclerosis in Human Populations.- Temporal Variations.- The Search for Associations.- Secular and Geographical Relationships.- Group Comparisons.- The Search for Causes.- The Classical Risk Factors.- Other Risk Factors.- Risk Factors of the Other Locations of Atherosclerosis.- Conclusions and Hypotheses.- Preventive Trials.- Treatment of Hypertension.- Nutritional Prevention.- Hypocholesterolaemic Treatments.- Multifactorial Prevention.- Prevention: A Public Health Strategy.- References.- 20 Risk Factors for Atherosclerosis: A Clinician’s Pragmatic Appraisal.- Ignorance and Concern.- Genesis of Risk Factors.- Definition and Nature of Risk Factors.- Meaning of Risk Factors.- Correlation and Causation.- Arterial Diseases and Atherosclerosis.- Triglycerides and Atherosclerosis.- Possible Mechanisms of Action for Risk Factors.- Development of Atherosclerotic Plaques.- Complications of Atherosclerotic Plaques.- Consequences of Arterial Obstructions due to Atherothrombosis.- Other Unsolved Issues.- Do Risk Factors Exert the Same Influence in all Populations?.- Are Risk Factors Similar for all Arterial Localizations of Atherosclerosis.- Is Amending Risk Factors Controlling Atherosclerosis?.- Hypercholesterolaemia: A Nearly Perfect Example of a Risk Factor.- Agreement.- Disagreement.- Conclusion.- References.- 21 Diagnostic Principles and Therapeutic Management of Patients with Atherosclerosis.- Lower Limb Arteriopathies.- Diagnosis.- Clinical Diagnosis.- Investigations.- The Strategy of Investigation.- Principles of Treatment.- Treatment of Atherosclerosis.- Treatment of Ischaemia.- References.- Arteriosclerotic Lesions of Carotid Arteries.- Haemodynamic Factors.- Pathophysiology of Cerebrovascular Thrombosis.- Mechanism of Vascular Occlusion.- The Diagnosis of Cerebral Ischaemia Due to Thrombosis.- Clinical Features.- Carotid Bruits.- The Role of Computerized Axial Tomography.- Differential Diagnosis.- Transient Ischaemic Attacks.- Initial Approach.- Clinical Aspects and the Limits of Classification: Prolonged Reversible Ischaemic Neurological Deficits (PRIND) and Lacunar Infarction.- Ancillary Investigations.- Treatment.- Cerebrovascular Infarction.- Diagnosis.- Clinical Course.- Initial Medical Therapy.- The Role of Surgery in Carotid Artery Stenosis.- Long-Term Medical Therapy.- References.- Atheromatous Stenosis of Renal Arteries.- Strategy of Diagnosis.- Diagnosis of Renovascular Hypertension.- Diagnosis of the Stenosis.- Renal Consequence of the Stenosis.- Diffusion of the Disease.- Therapeutic Approach.- References.- Coronary Arteries.- Diagnosis.- Clinical Findings.- Complementary Investigations.- Arguments in Favour of a Diagnosis of Coronary Atherosclerosis.- Treatment.- References.- IV The Arterial Wall in Diabetes.- 22 Clinical and Physiopathological Features in Diabetic Vascular Disease.- Links Between Diabetes and Arterial Disease.- Pathogenic Factors.- Epidemiological Factors and Prevention.- Specific Organic Involvement.- Coronary Heart Disease.- Diabetic Foot and Peripheral Arterial Disease.- Cerebrovascular Disease.- Sexual Impotence.- Conclusion.- References.- 23 Diabetic Retinopathy.- Predisposing Factors.- Metabolic Disturbance.- Genetic Considerations.- Arterial Disease.- Duration.- Pre-retinopathy.- Breakdown of the Blood-Retinal Barriers.- Increased Blood Flow.- Background Retinopathy.- Venous Dilatation.- Oedema.- Exudates.- Haemorrhages.- Microaneurysms.- Capillary Non-perfusion.- Pericyte Degeneration.- Basement Membrane Thickening.- Proliferative Retinopathy.- Intraretinal Vascular Proliferation.- Pre-retinal Fibrovascular Proliferation.- Conclusion.- References.- 24 Diabetic Nephropathy.- Anatomopathological Features.- Gross Anatomy.- Light Microscopy.- Electron Microscopy.- Immunohistochemistry.- Specificity of Diabetic Glomerulosclerosis.- Superimposed Renal Lesions.- Papillary Necrosis.- Clinical Manifestations.- Pre-clinical Phase.- Clinical Phase.- Pathogenesis.- Genetic Factors.- Role of Insulin Deficiency and Hyperglycaemia.- Haemodynamic Factors.- References.- 25 Vascular Connective Matrices and Haemostasis in Diabetic Angiopathy.- Glycoprotein Biosynthesis Modification.- Increase in the Biosynthesis of Glycoproteins.- Decrease of Glycoprotein Degradation.- Metabolic Deviation: The Polyalcohol Pathway.- Non-enzymatic Glycosylation: Molecular and Cellular Consequences.- Non-enzymatic Glycosylation (NEG) of Proteins.- Incidence in the Vascular Connective Matrix.- Endothelial Cells, Platelets and Haemostasis in Diabetic Angiopathy.- Endothelial Cells.- Platelet Function and Coagulation Factors in Diabetic Microangiopathy.- Conclusion.- References.- V Inflammatory Diseases of the Arterial Wall.- 26 Immunological Processes in the Vascular Wall.- Effector Mechanisms in Immunologically Mediated Vascular Damage.- Immune Complexes and Antibodies to Vascular Structures.- Complement.- Cellular Effector Mechanisms.- Endothelial Cells.- Interactions Between Immunological Effectors and the Coagulation and Fibrinolytic Systems.- Experimental Models of Immunologically Mediated Vascular Lesions.- Immunologically Mediated Vascular Lesions in Man.- Laboratory Assessment of Immunologically Mediated Vascular Lesions.- In Situ Analysis.- Assessment of Humoral Abnormalities Associated with Immunologically Mediated Vasculitis.- References.- 27 The Vasculitis Syndromes in Small- and Medium-Sized Vessels.- Lesions and Mechanisms.- Lesions.- Mechanisms.- Classification.- Clinical and Nosological Aspects.- The Vasculitis Syndrome.- Diagnostic Considerations.- “Primary” Vasculitis.- Angiitis Secondary to Known Aetiological Agents.- Necrotizing Angiitis in Connective Tissue Disease and in Malignant Disorders.- Localized Angiitis.- References.- 28 The Vasculitis Syndromes in Aorta and Large Arteries.- Pathological Aspects.- Takayasu’s Disease.- Pathological Features.- Sites of Involvement and Visceral Consequences.- Associated Findings.- Aetiological Factors.- Temporal Arteritis (Temporal Arteritis/Polymyalgia Rheumatica Syndrome).- Pathological Aspects.- Immunopathological Aspects.- Patterns of Arterial Involvement.- Thromboangiitis Obliterans (Von Winiwarter-Buerger’s Disease).- Pathological Features.- Pattern of Arterial Involvement.- Aetiological Factors.- Infectious Aortitis and Arteritis.- Syphilitic Aortitis.- Tuberculous Aortitis and Arteritis.- Aortitis and Arteritis in Systemic Diseases and Miscellaneous Conditions.- Behcet’s Syndrome.- Cogan’s Syndrome.- Kawasaki Disease.- Rheumatic Fever.- Rheumatoid Arthritis.- Ankylosing Spondylitis.- Reiter’s Syndrome.- Relapsing Polychondritis.- Periaortitis or Inflammatory Aneurysms of the Aorta.- Miscellaneous Conditions.- Non-specific Aortitis.- References.- Principles of Diagnosis and Therapeutic Approach.- Takayasu’s Disease.- Principles of Diagnosis.- Therapeutic Approach.- Temporal Arteritis.- Clinical Diagnosis.- Other Investigations.- Strategy of Exploration.- Treatment.- Buerger’s Disease.- Clinical Features.- Special Investigations.- Strategy of Diagnosis.- Principles of Treatment.- References.- VI Arteriopathies of Diverse Origin.- 29 Fibromuscular Arterial Dysplasias Pathological Aspects and Current Concepts.- FMD of the Renal Artery.- Background Histopathology.- Complications.- FMD of the Renal Artery in Children.- FMD of the Renal Artery of Transplanted Kidney.- FMD of the Cervicoencephalic Arteries.- Other Sites of FMD.- Pathophysiology.- FMD is a Systemic Arterial Disease.- The Predilection for FMD to Occur in Elective Sites Suggests a Role for Local Factors.- FMD Affects Mainly the Media of Middle-Sized Muscular Arteries.- References.- Principles of Diagnosis and Therapeutic Approaches.- Internal Carotid Artery.- C.F. Degos.- Clinical Characterization.- Angiographic Characteristics.- Therapeutic Approach.- Renal Artery.- J.-B. Michel, P. Lagneau and J. Ménard.- Strategy of Diagnosis.- Therapeutic Approach.- References.- 30 Cardiovascular Alterations in Inherited Connective Tissue Disorders.- Fibrous Protein Diseases.- Marfan’s Syndrome.- Ehlers-Danlos Syndrome (EDS).- Cutis Laxa.- Osteogenesis Imperfecta (OI).- Pseudoxanthoma Elasticum (PXE).- Storage Diseases.- Polysaccharidoses.- Mucolipidoses.- Glycoproteinoses.- Lipidoses.- Inborn Metabolic Diseases with Secondary Effects on Fibrous Proteins.- Homocystinuria.- Alcaptonuria.- Menkes Syndrome.- Various Hereditary Disorders Affecting Connective Tissue and the Vascular Network.- References.- 31 Aneurysms and Arterial Dissections.- Aortic Aneurysms.- Extra-aortic Aneurysms.- Arterial Dissections/Dissecting Aneurysms.- Aortic Dissections.- Extra-aortic Dissecting Aneurysms.- References.- 32 Traumatic Arterial Disease.- Direct Trauma to Arteries.- Arterial Lesions.- Concomitant Lesions.- Results of Arterial Lesions.- Traumatic Mechanisms and Agents.- Arterial Injuries Due to Biological Effects of Certain Physical Agents.- Arterial Injuries Caused by Electromagnetic Radiation.- Effects of Vibration.- Effects of Cold.- Electrocution.- Injuries Caused by High Pressure.- References.- 33 Perioperative Arterial Changes.- Disorders of Operated Arteries Related to Surgical Procedures.- Arterial Exposure.- Arterial Clamping.- Arterial Ligation.- Arteriotomy.- Arterial Suture.- Arterial Anastomosis.- Pathology of the Operated Artery Due to Inclusion of a Foreign Body in the Wall of the Artery.- Pathological Changes in the Operated Artery Due to Interactions Between the Blood and the Artery Wall.- Thromboendarterectomy.- Arterial Embolectomy.- Transluminal Angioplasty.- Patch-Graft Angioplasty.- Bypass by Graft or Prosthesis.- References.- VII Pathology of the Pulmonary Arteries.- 34 Pulmonary Vasculitides.- Wegener’s Granulomatosis (WG).- Allergic Granulomatosis and Angiitis (Churg-Strauss Syndrome).- Necrotizing Sarcoid Granulomatosis (NSG).- Lymphomatoid Granulomatosis (LYG).- Bronchocentric Granulomatosis (BCG).- Pulmonary Hyalinizing Granuloma.- Conclusion.- References.- 35 Pulmonary Hypertension.- The Normal Pulmonary Artery and Circulation.- Normal Macroscopic Morphology and Morphometry.- Normal Microscopic Morphology and Morphometry.- Growth and Development.- Age-Related Changes.- Normal Physiology.- Pulmonary Hypertension and the Pulmonary Artery.- General Features and Morphological Grading.- Pulmonary Hypertension in Congenital Cardiac Left to Right Shunts.- Primary Plexogenic Pulmonary Arteriopathy.- Pulmonary Hypertension Due to Thromboembolic Disease.- Pulmonary Veno-Occlusive Disease and Capillary Haemangiomatosis.- Pulmonary Capillary Haemangiomatosis.- Pulmonary Hypertension Secondary to Pulmonary Venous Hypertension.- Hypoxic Pulmonary Hypertension.- Pulmonary Hypertension in Parenchymal Lung Disease.- References.- VIII Angiodysplasias, Tumours and Tumour-like Lesions of the Blood Vessels.- 36 Arteriovenous Malformations and Arterial Dysplasias.- Arteriovenous Malformations.- The Relationship Between Haemangiomas and Vascular Malformations.- Pathophysiology.- Arteriovenous Malformations in the CNS.- Arteriovenous Malformations of the Spinal Cord.- Cobb Syndrome.- Aneurysm of the Great Vein of Galen.- Some Specific Entities.- Arterial Dysplasias.- Idiopathic Arterial Calcification in Infancy.- Supravalvular Aortic Stenosis.- Macaroni Arteries.- Neurofibromatosis.- Angiodysplasia of the Colon.- Other Gastrointestinal Vascular Anomalies.- Intracranial Aneurysms.- References.- 37 Tumours and Tumour-like Lesions.- Tumour-like Lesions.- Pseudohaemangiomas.- Subadventitial Cystic Degeneration of the Popliteal Artery (Cystic Disease of the Popliteal Artery, Adventitial Mucoid Cyst).- Haemangiomas.- Capillary Haemangiomas.- Cavernous Haemangiomas.- Venous Haemangioma.- Specific Types.- Other Benign Tumours.- Miscellaneous Parietal Tumours.- Glomus Tumours and Glomangiomatosis.- Vascular Leiomyoma.- Tumours of the Juxtaglomerular Apparatus (J.-P. Camilleri).- Tumours with Malignant Potential.- Epithelioid Haemangioendothelioma.- Haemangiopericytoma.- Chemodectomas/Paragangliomas.- Malignant Tumours.- Angiosarcoma.- Angioendotheliosarcoma.- Leiomyosarcoma.- Glomangiosarcoma.- Kaposi’s Sarcoma (KS).- References.- 38 Diagnostic and Therapeutic Principles in Angiodysplasia.- Haemodynamic Categories.- Sequestrated Vascular Malformations.- Haemodynamically Venous Vascular Malformations.- Low-Flow Arteriovenous Malformations.- High-Flow Arteriovenous Malformations.- Ancillary Investigations.- Evolution.- Treatment.- References.