Degenerative and Inflammatory Artery Disease in South Africa

Degenerative and inflammatory artery diseases may be congenital or acquired.

Berry aneurysm

It is caused by focal weakness of the blood vessels walls. This may lead to subarachnoidal hemorrhage which may be fatal.

Arterio-venous fistula

It is the abnormal communication between the artery and vein. It may lead to left to right shunt with increased venous return. Fistulas may lead to heart failure and fatal hemorrhage.

Arteriosclerosis

This is a progressive disease of the arteries. It is characterized by a loss of elasticity and thickening of the arterial walls. It is caused by lipid deposition, synthesis of extracellular matrix and smooth muscle proliferation. It involves medium to large muscular arteries especially the aorta.

Arteriolosclerosis

It affects the smaller arteries, arterioles, and capillaries. It occurs in two variations which are hyaline arteriosclerosis and hyperplastic arteriosclerosis.

• Hyaline arteriosclerosis: This is characterized by diffuse pink hyaline thickening of the arterial wall. It affects the kidneys and may cause ischemic atrophy of the kidney.
• Hyperplastic arteriolosclerosis: It is characterized by smooth muscle proliferation and thickening of the arterial wall with reduplication of the basement membrane

Aneurysms

These are abnormal focal dilation of the veins and arteries. They develop whenever the walls of the blood vessels weaken. The most common causes are atherosclerosis and cystic radionecrosis. Other causes include syphilis, trauma, and intercranial arteries.

Polyarteriitis nodosa

This disease is characterized by necrotizing inflammation of the arteries throughout the body. In the early stages fibrinoid necrosis and heavy infiltration in the vessels. In the acute phase, vasculitis occurs and it is characterized by transmural inflammation. The lumen becomes thrombosed resulting in acute tissue ischemia. In the later stage, there is a proliferation of the nodular fibroblast and irregular aneurysm dilation of the blood vessels.

Wegener's granulomatosis

This is characterized by necrotizing glomerulonephritis, necrotizing granulomas of the upper respiratory tract and necrotizing or granulomatous vasculitis of small arteries and veins most commonly in the lungs. Diagnosis involves a biopsy of the upper respiratory tract lesions

Thrombangiitis obliterans (buerger’s disease)

This is a chronic inflammatory vascular disease which is characterized by acute and chronic vasculitis of the small and medium-sized arteries which is followed by thrombosis of the vessels affected. If the arteries of the lower extremities are affected it may lead to gangrene. Symptoms include colour and temperature changes of in the lower limbs, claudications, gangrene chronic ulcerations of the fingers toes and feet and severe pain even at rest.

Raynaud's disease

It is caused by intense spasms of the small arteries and arterioles and is characterized by cyanosis of acral parts or paroxysmal pallor.

Leukoclastic angiitis

It involves small vessels and is characterized by rich lekocytic infiltration and fibrinoid necrosis.

Risk factors

• Age
• Smoking
• Diabetes mellitus
• Acquired hyperlipemia
• High blood pressure
• Hypercholesterolemia

Symptoms include:

• Abdominal pain due to compression of mesenteric arteries
• Sudden decrease of blood pressure
• Fever
• Fatigue
• Severe chest pain
• Weight loss
• Vascular lesions
• Diarrhoea
• Peripheral neuropathy

Treatment

Treatment of degenerative and inflammatory artery disease involves the administration of medication such as hypertensive drugs anti-inflammatory drugs.

In severe cases, the affected part is replaced with a graft.