This document provides a comprehensive overview of vascular pathology, covering venous disorders such as varicose veins and deep vein thrombosis, a
This document provides a comprehensive overview of vascular pathology, covering venous disorders such as varicose veins and deep vein thrombosis, and lymphatic conditions including lymphangitis and lymphoedema. It thoroughly classifies and details various vascular tumors, from benign hemangiomas and lymphangiomas to intermediate-grade Kaposi Sarcoma and malignant angiosarcoma, highlighting their unique clinical features and associations. Furthermore, the notes address the pathology related to modern vascular interventions like endovascular stenting and different types of bypass grafts. Key Points Varicose veins are abnormally dilated, tortuous superficial veins caused by increased intraluminal pressure and incompetent valves, rarely leading to embolism unlike deep vein thrombosis (DVT). Lymphatic disorders encompass acute lymphangitis, often bacterial, and lymphoedema, which can be primary or secondary to lymphatic obstruction by tumors, surgery, or filariasis. Vascular tumors range from common benign hemangiomas, which often regress spontaneously, to aggressive malignant angiosarcomas and HHV8-associated Kaposi Sarcoma, particularly in immunocompromised individuals. Endovascular stenting effectively dilates arterial stenoses but carries risks of immediate thrombosis and long-term in-stent restenosis, with drug-eluting stents reducing restenosis but requiring prolonged anticoagulation. Vascular replacement for coronary bypass utilizes saphenous vein grafts with limited long-term patency due to atherosclerosis and intimal hyperplasia, while internal mammary artery grafts offer superior patency for specific applications. Detailed Notes OUTLINE Section 1: Venous Disorders Varicose Veins Phlebothrombosis and Thrombophlebitis Section 2: Lymphatic Disorders Lymphangitis Lymphoedema Section 3: Vascular Tumours Classification Overview Vascular Ectasias (Nevus Flammeus, Spider Telangiectasia, Osler-Weber-Rendu) Benign Tumours — Capillary Hemangioma · Cavernous Hemangioma · Pyogenic Granuloma · Lymphangioma · Glomus Tumour Reactive Proliferations — Bacillary Angiomatosis Intermediate-Grade — Kaposi Sarcoma Malignant — Angiosarcoma Section 4: Pathology of Vascular Intervention Endovascular Stenting and Restenosis Vascular Replacement and Bypass Grafts SECTION 1: VENOUS DISORDERS Varicose Veins Abnormally dilated, tortuous veins produced by prolonged increased intraluminal pressure with vessel dilation and incompetence of venous valves Superficial veins of the upper and lower leg most commonly involved — venous pressures in these sites can be elevated up to 10 times normal by prolonged dependent posture Affect up to 20% of men and one third of women Risk Factors: Obesity — increases risk Pregnancy — gravid uterus compresses inferior vena cava ↑ venous pressure; explains higher incidence in women Familial predilection — reflects defective venous wall development Clinical Features: Incompetence of venous valves → stasis, congestion, oedema, pain, thrombosis Secondary tissue ischaemia from chronic venous congestion and poor vessel drainage: Stasis dermatitis (also called "brawny induration") — brawny colour from haemolysis of extravasated red cells Ulcerations — poor wound healing; superimposed infections common Embolism from superficial varicose veins is very rare — in contrast to relatively frequent thromboembolism from deep vein thrombosis Two other important varicosity sites: Oesophageal varices — from portal hypertension (covered in GI pathology notes) Haemorrhoids — anal and perianal collaterals; from portal hypertension or straining Phlebothrombosis and Thrombophlebitis Phlebothrombosis — thrombosis of veins with only minimal inflammatory response Thrombophlebitis — venous thrombosis associated with prominent venous wall inflammation Together these account for at least 90% of clinical venous disease Deep Vein Thrombosis (DVT): Most often involves deep leg veins (popliteal, femoral, iliac) Major risk: pulmonary embolism — thrombi may propagate to involve larger veins, dislodge, and embolise Risk factors ( Virchow's triad ): stasis + hypercoagulability + endothelial injury Clinical: leg pain, swelling, warmth — but up to 50% are clinically silent Unlike superficial varicosities, deep vein thrombosis is a major source of pulmonary embolism Migratory Thrombophlebitis (Trousseau Syndrome): Repeated thrombophlebitis in different venous sites Associated with occult visceral malignancy (especially pancreatic, lung, GI carcinomas) Mechanism: tumour-derived mucins and other procoagulants activate clotting SECTION 2: LYMPHATIC DISORDERS Lymphangitis Acute inflammation from spread of bacterial infections into lymphatics Most common agent: group A β-haemolytic Streptococcus Morphology: affected lymphatics dilated and filled with exudate of neutrophils and monocytes; infiltrates can extend through vessel wall → cellulitis or focal abscesses Clinical features: Red, painful subcutaneous streaks (inflamed lymphatics tracking proxim