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Patologi
vaskuler
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Spesialisasi vaskularisasi
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Sel endotel
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Pengaturan
tekanan darah
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Arteriosklerosis
1. Arteriosklerosis Monckeberg(medial calcific sclerosis)
2. Arteriolosklerosis
3. Aterosklerosis
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Response to injury hypothesis
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Penebalan tunika intima
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Plak aterom
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Interaksi sel pada aterosklerosis
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11/02/16 10
Klasifikasi Aterosklerosis: American Heart Association
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Fatty streakmakroskopis, pada aorta
mikroskopis
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Plak ibrous
Plak ruptur dengan trombosis
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Plak ateromatosa a! "oronaria
#asson $lastin %alsiikasi dan
rekanalisasi
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Plak aterosklerotikruptur
&isertai trombosis 'superimposed(
I# atal
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)terosklerosis dan komplikasi klinisnya
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The complications of atherosclerosis
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11/02/16 1*
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HYPERTENSION
+ ESSENTIAL 95%
+SECONARY 5%
+ 10/-0
BP = CO x PR
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SECONARY+ Re!al+ )"ute glomerulonephritis
+ .hroni" renal disease+ Poly"ysti" disease+ enal artery stenosis+ enal artery ibromus"ular dysplasia+ enal vas"ulitis+ eninprodu"ing tumors
+ E!"o#ri!e+ )dreno"orti"al hyperun"tion+ '.ushing syndrome, primary aldosteronism, "ongenital adrenal hyperplasia, li"ori"e
ingestion(+ $ogenous hormones 'glu"o"orti"oids, estrogen in"luding pregnan"yindu"ed and
oral "ontra"eptives3, sympathomimeti"s and tyramine"ontaining oods, monoamine
oidase inhibitors(+ Pheo"hromo"ytoma, )"romegaly, 4ypothyroidism 'myedema(, 4yperthyroidism+ Pregnan"yindu"ed+ Car"iovas#ular$ .oar"tation o aorta, Polyarteritis nodosa 'or other vas"ulitis(+ In"reased intravas"ular volume+ ISC$In"reased "ardia" output, igidity o the aorta, eurologi", Psy"hogeni",
In"reased intra"ranial pressure, Sleep apnea, )"ute stress, in"luding, surgery
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)rteriolosklerosis hialin
)rteriolosklerosis hiperplastik
onion skin'P)S(
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ANEURISMA
1. Aneurisma aterosklerotik
2. Aneurisma karena cystic
medial sclerosis3. Aneurisma Berry
4. Aneurisma sifilitik / luetik
5. issecting aneurisma
!. "istula arterio#enosa
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)neurisma
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&egenerasi tunika
media
ormal 'elasti"a verhoe(
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)neurisma aorta abdominalis
ruptur
&ibuka trombus
berlapis
lapis
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! Aneurisma Aterosklerotik
Paling sering di aorta desenden 'terutama
aorta abdominalis
"! Aneurisma karena cysticme#ial sclerosis
)neurisma paling sering pada
per"abangan aorta
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2*
$! Aneurisma %erry
+ 7esi ke"il dan sakular, paling sering di arteri ke"il otak
terutama sirkulus 8illisi+ 9imbul sesudah lahir di daerah kelemahan tunika media
arteri kongenital di biurkatio arteriae serebri
+ 9idak berhubungan dengan aterosklerosis
+ Sering berhubungan dengan penyakit gin:al polikistik+ $tiologi paling sering dari hemoragi subarakhnoid
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2;
&! Aneurisma Sifilitik'(uetik
+ Sebagai maniestasi lues std! I tra"t
Manifestasi klinis&
+ 4eno"hS"honlein purpura+ Serum si"kness
h S h5 l i
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11/02/16 *
Henoch3Sch5nlein purpura'Easkulitis hipersensiti leukositoklastik(
Lesio terutama padapantat dan siku trauma
Mikros: netrofl didalam & sekitarvenula karioreksisdebris inti
Lesi berat
degenerasi fbrinoiddinding vasa,nekrosis, trombus
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;
4askulitis (eukositoklastik
Biosi kulit& fragmentasi netrofil di dalam dansekitar dinding embulu' dara'
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-
Throm6oan+itis o6literans-%uer+er7s #isease.
$ umen tersumbat trombus dengan 2 abses (ana')
$ inding arteri dengan infiltratleukosit
$ angren 0ari0ari kaki
/enyakit 4askular 8un+sional
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/enyakit 4askular 8un+sional
$ Raynau#7s #isease
Sianosis paroksismal u:ung ekstrimitas ':ari tangan,
kaki, u:ung hidung,telinga( disertai rasa tebal dan
panas
%arena vasospasme arteri ke"il / arteriolae
Idiopatik keadaan dingin dan stimulus emosional
dapat mendahului serangan
$ Raynau#7s phenomenon
Seperti aynaudHs disease,
&isebabkan penyakit lain Peny! @uerger, arterios"le
rosis oblit!, trauma 'tukang ketik, pianis(, S7$, poliar
teritis nodosa
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Fenomena aynaud
Pu"at berbatas tegas Sianosis u:ung :ari
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Penyakit Venosa
$ /hle6otrom6osis$ 4arikosis 9ena
-9arises.
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5anas hemangioendotelioma,
angiosarkoma, hemangioperisitoma,
%aposi sar"oma
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HEAN0IOA+ O1te! a ge!eri# ter' 1or ANY *e!ig! *loo"
vessel tu'or
+ CAPILLARY,s'all vas#ular s(a#es/A Also #alle" 2uve!ile3 o1te! #alle" *irt) 'arksA 4suall& regress it) age
+ CA6ERNO4S,LAR0E vas#ular
s(a#es/A Also #alle" a"ultA 4suall& "o NOT regress
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) hemangioma lidah, @ hemangioma kapilare, . hemangioma kavernosa,
& granuloma piogenikum
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LYPHAN0IOA
+ S'all 7.8 ''
+ 9% Hea" a!" !e#k regio! i! ki"s :8
+ 0e!erall&;;RARE+
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0LO4S T4OR
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0LO4S T4OR
0LOAN0IOA
+ 7 #'
+ ost #o''o!l& u!"er !ail
+ Pai!1ul
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)ngiomatosis basiler
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)ngiosarkoma
.&
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Sarkoma %aposi
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Sarkoma Kaposi
*1
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9erapi/intervensi Easkuler
+)ngioplasty
+Stent+>rat )utolog 'v! saphena, a! mammaria int(
Sintetik 'telon(
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AN0IOPLASTI+ Fraktur plak '"ra"kling sound(
+ &isse"tion
+ )rterial dilatation initially+ estenosis K 6 months
STENTS
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STENTS+ etalli# 'es)+ Per'a!e!tl& (la#e"
+ Sta&s (ate!t lo!ger t)a!
a!gio(last&+ O+TEN R40 COATE
+ 0oals$
A Preve!t t)ro'*osisA Preve!t s(as'
A ela& RE.ste!osis
)ngioplasti LballoonH
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)ngioplasti balloon
dan stent endovaskuler
0RA+TS
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0RA+TS+ ?3 CA@0 gra1ts (er &ear i! 4SA
+ Sa()e!ous v vs I!ter!al 'a''ar& a ,i!ter!al
t)ora#i# a/
+ 5% (ate!t a1ter 7 &ears3 1or sa()e!ous v+ 9% (ate!t a1ter 7 &ears3 1or 'a''ar& a
+ E!"ot)elial a!" s'oot) 'us#le 'igratio! a!"(roli1eratio! ke& 1a#tors 1or su##ess
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)nastomosis
)ngiogram
penyempitan di distal
Prolierasi t! intima dan
penyempitan lumen