Arteriosclerose, aterosclerose, arteriolosclerose e esclerose calcificante da média de Monckeberg: qual a diferença? / Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis: what is the difference?

Resumo A principal causa de óbito na contemporaneidade são as doenças cardiovasculares. Arteriosclerose, aterosclerose, arteriolosclerose e arteriosclerose de Monckeberg são termos frequentemente utilizados como sinônimos, mas traduzem alterações distintas. O objetivo desta revisão foi discutir os conceitos de arteriosclerose, aterosclerose, arteriolosclerose e esclerose calcificante da média de Monckeberg. O termo arteriosclerose é considerado mais genérico, significando o enrijecimento e a consequente perda de elasticidade da parede arterial, abarcando os demais tipos. A aterosclerose é uma doença inflamatória secundária a lesões na camada íntima, que tem como principal complicação obstrução crônica e aguda do lúmen arterial. A arteriolosclerose se refere ao espessamento das arteríolas, particularmente relacionada à hipertensão arterial sistêmica. Já a esclerose calcificante da média de Monckeberg designa a calcificação, não obstrutiva, da lâmina elástica interna ou da túnica média de artérias musculares. As calcificações vasculares, que incluem lesões ateroscleróticas e a esclerose calcificante da média de Monckeberg, vêm sendo estudadas como um fator de risco para a morbimortalidade cardiovascular.

Abstract Cardiovascular diseases are the main cause of death in contemporary times. Arteriosclerosis, atherosclerosis, arteriolosclerosis, and Monckeberg's arteriosclerosis are terms that are often used interchangeably, but they refer to different vascular pathologies. The objective of this study is to review the concepts of atherosclerosis, atherosclerosis, arteriosclerosis and Monckeberg medial calcific sclerosis (MMCS). The term arteriosclerosis is more generic, meaning the stiffening and consequent loss of elasticity of the arterial wall, and encompasses the other terms. Atherosclerosis is an inflammatory disease secondary to lesions in the intimal layer and whose main complication is acute and chronic obstruction of the arterial lumen. Arteriolosclerosis refers to thickening of arterioles, particularly in association with systemic arterial hypertension. MMCS refers to non-obstructive calcification in the internal elastic lamina or the tunica media of muscular arteries. Vascular calcifications, which include atherosclerotic lesions and MMCS, have been studied as a risk factor for cardiovascular morbidity and mortality.

Arterioesclerosis de Monckeberg en vasos uterinos: un interesante hallazgo incidental / Arteriosclerose de Monckeberg nos vasos uterinos: um achado incidental interessante / Monckeberg arteriosclerosis in uterine vessels: an interesting incidental finding

Se realizó la comunicación de un caso clínico-patológico, diagnosticado en el Hospital Docente Clínico Quirúrgico "Joaquín Albarrán" de La Habana. En dicha entidad se presentó en una paciente femenina de 85 años de edad con antecedentes de diabetes mellitus tipo 2, ingresada por cuadro de insuficiencia arterial de miembro inferior izquierdo por lo cual se le realizan amputación supracondilia y al tercer día de su estadía hospitalaria, fallece. En la autopsia se arribó al diagnóstico anatomopatológico de arterioesclerosis de Mönckeberg de vasos del útero. Esta es una forma de arterioesclerosis muy relacionada con la senectud, pero factores de riesgo como diabetes mellitus y la enfermedad renal crónica pueden contribuir de forma directa en su desarrollo y progresión. Su diagnóstico es un hallazgo incidental en muestras histopatológicas(AU)

A clinical-pathological case was reported, diagnosed at the Joaquín Albarrán Clinical Surgical Teaching Hospital in Havana. In this entity, an 85-year-old female patient with a history of type 2 diabetes mellitus was presented, admitted due to arterial insufficiency of the lower left limb, for which she underwent supracondylar amputation and died on the third day of her hospital stay. At the autopsy, the pathological diagnosis of Mönckeberg arteriosclerosis of vessels of the uterus was reached. This is a form of arteriosclerosis closely related to old age, but risk factors such as diabetes mellitus and chronic kidney disease can directly contribute to its development and progression. Its diagnosis is an incidental finding in histopathological samples(AU)

Um caso clínico-patológico foi relatado, diagnosticado no Hospital de Clínica Cirúrgica "Joaquín Albarrán" em Havana. Nessa entidade, apresentou-se uma paciente de 85 anos, com história de diabetes mellitus tipo 2, internada por insuficiência arterial do membro inferior esquerdo, para a qual sofreu amputação aupracondiliana e faleceu no terceiro dia de internação. Na autopsia, o diagnóstico patológico da arteriosclerose de Mönckeberg de navios do útero foi conseguido. Essa é uma forma de arteriosclerose intimamente relacionada à velhice, mas fatores de risco como diabetes mellitus e doença renal crônica podem contribuir diretamente para seu desenvolvimento e progressão. Seu diagnóstico é um achado incidental em amostras histopatológicas(AU)

Manifestaciones clínicas de la esclerosis de Monckeberg. Reporte de caso y revisión de la literatura / Clinical manifestations of Monckeberg's sclerosis. Report of case and literature review

Resumen La esclerosis de Monckeberg es una enfermedad de baja prevalencia y causa desconocida, en la cual arterias de mediano y pequeño calibre sufren calcificación de la capa media generándose una reducción de la luz. Suele manifestarse por la aparición de úlceras de tipo arterial en la piel de extremidades superiores e inferiores. Su diagnóstico requiere de estudios histopatológicos, con diagnósticos diferenciales como la poliarteritis nodosa y la arteritis de células gigantes. No existen guías de tratamiento, se han propuesto quelantes de calcio como el tiosulfato de sodio, pero los pocos estudios disponibles no han logrado demostrar resultados significativos.

Abstract Monckeberg's sclerosis is a rare and low prevalence disease of unknown cause in which small and medium size arteries suffer calcification of the middle layer, leading to a reduction in calibre. Clinically, the disease manifests by the appearance of arterial type ulcers on the skin of upper and lower extremities. Its diagnosis is difficult, and requires histopathological studies. Some rheumatic conditions, such as polyarteritis nodosa and giant cell arteritis may mimic this process. Treatment of the disease is not well established. Although the use of calcium chelators such as sodium thiosulfate has been proposed, the few available studies have failed to show significant results.

Radiographic manifestations of Mönckeberg arteriosclerosis in the head and neck region

Mönckeberg sclerosis is a disease of unknown etiology, characterized by dystrophic calcification within the arterial tunica media of the lower extremities leading to reduced arterial compliance. Medial calcinosis does not obstruct the lumina of the arteries, and therefore does not lead to symptoms or signs of limb or organ ischemia. Mönckeberg sclerosis most commonly occurs in aged and diabetic individuals and in patients on dialysis. Mönckeberg arteriosclerosis is frequently observed in the visceral arteries, and it can occur in the head and neck region as well. This report describes a remarkable case of Mönckeberg arteriosclerosis in the head and neck region as detected on dental imaging studies. To the best of our knowledge, this is the first case that has been reported in which this condition presented in the facial vasculature. The aim of this report was to define the radiographic characteristics of Mönckeberg arteriosclerosis in an effort to assist health care providers in diagnosing and managing this condition.

Aplicación del sistema aterométrico en fallecidos por muerte violenta con aterosclerosis coronaria / Application of atherosclerosis indexing system in deceased subjects by violent death with coronary aterosclerosis

INTRODUCCIÓN: la alta morbimortalidad de causa aterosclerótica ha motivado múltiples investigaciones y en Cuba, el Sistema Aterométrico, permite caracterizar las lesiones ateroscleróticas en cualquier sector vascular. OBJETIVO: estudiar la aterosclerosis de los tres vasos coronarios principales en fallecidos por muerte violenta y clínica, analizando comparativamente las lesiones, teniendo en cuenta sexo y grupo de nivel aterosclerótico. MÉTODOS: se aplicó el Sistema Aterométrico para estudiar comparativamente coronaria derecha y coronaria izquierda en sus ramas descendente anterior y circunfleja, en una población de 108 fallecidos por muerte violenta y 472 por muerte clínica, agrupados también según nivel aterosclerótico y sexo. RESULTADOS: la mayor diferencia se encontró en las placas fibrosas del grupo de alto nivel aterosclerótico para la coronaria derecha, que llegó a ser de un 22,3 % mayor en los clínicos, siendo solamente del 17,5 % para la descendente anterior y de 20,3 % en la circunfleja. En este mismo grupo las placas fibrosas fueron 2,59 veces más frecuentes en la descendente anterior que en la coronaria derecha. Las placas fibrosas entre los sexos tuvieron poca diferencia, en ambos grupos, solamente alrededor de 1 % para los tres vasos coronarios. CONCLUSIONES: es mayor la aterosclerosis en los fallecidos por muerte clínica que en los fallecidos por muerte violenta, tanto en la población en su totalidad, como subdividida en los grupos de alto y bajo nivel aterosclerótico así como en hombres y mujeres, resultando el Sistema Aterométrico muy útil en la evaluación del proceso aterosclerótico en fallecidos por muerte violenta.

INTRODUCTION: the high morbidity and mortality of atherosclerotic causes has motivated multiple investigations and in Cuba, the atherometric system to characterize atherosclerotic lesions in any vascular sector. OBJECTIVE: Study atherosclerosis of the three main coronary vessels in violent deaths from clinical death and comparatively analyzing the injury, considering sex and level of atherosclerosis. METHODS: Atherometric system was used to comparatively study right and left coronary artery in their anterior descending coronary artery branches and circumflex, in a population of 108 violently dead subjects and 472 clinical dead subjects, also grouped according to atherosclerotic level and sex. RESULTS: The main difference was found in fibrous plaques of the atherosclerotic high level group for the right coronary, which reached 22.3% higher in clinical, and only 17.5% for the descending left anterior and 20.3% in the circumflex. In this same group, fibrous plaques were 2.59 times more frequent in the anterior descending coronary right. Fibrous plaques according to genders had little difference in both groups, only about 1% for the three coronary vessels. CONCLUSIONS: the atherosclerosis is higher clinical dead subjects than violently dead subjects, as much in the overall population, as subdivided in the groups of high and low atherosclerotic level, as in men and women, proving to be the very useful Atherometric System for assessing the atherosclerotic process in violently dead subjects.

Are Vascular Aging and Atherosclerosis Synonymous?

The development of plaques along the inner layer of arterial walls is known as atherosclerosis. Atherosclerotic plaques can become hardened by calcium deposition and fibrous tissue of the arterial wall may proliferate leading to arteriosclerosis. In a typical textbook, arteriosclerosis only has three categories-atherosclerosis, Monckeberg medial calcific sclerosis, and arteriolosclerosis, leaving out vascular aging when in fact, aging is the strongest risk factor for atherosclerosis. Thus, vascular aging is often confused with atherosclerosis. Up to now, there has been no appropriate pathological term for vascular aging. And arteriosclerosis is different from vascular aging, as atherosclerosis includes some components of pathologic aging. But in actuality, physiological aging and pathological aging can not be clearly distinguished. Therefore, in terms of aging, arteriosclerosis is included in vascular aging. More research is required to define vascular aging.

Arteriosclerose de Monckeberg como causa de isquemia crítica de membros inferiores: relato de caso / Monckeberg's arteriosclerosis as a cause of lower limb critical ischemia: case report

A arteriosclerose de Monckeberg pode ser uma causa rara de isquemia grave dos membros inferiores. Relatamos o caso de um paciente com isquemia crítica do membro inferior, sem condições de revascularização, que evoluiu para amputação. O paciente não apresentava os fatores de risco clássicos para aterosclerose. O diagnóstico anatomopatológico foi de arteriosclerose por calcificação da média de Monckeberg.

Efeito do paricalcitol e do calcitriol sobre a doença cardiovascular em camundongos uninefectomizados ApoE -/- / Effect of paricalcitol and calcitriol on cardiovascular disease in uninephrectomized ApoE -/- mice

O estudo investigou a influência do tratamento de 10 semanas com paricalcitol (0,1µg/kg 5x/semana) e calcitriol (0,03µg/kg 5x/semana) em modelo de aterosclerose espontânea utilizando camundongos ApoE -/- sham e uninefrectomizados (UNX). Resultados: a densidade capilar por comprimento no tecido cardíaco foi significativamente mais baixa nos animais UNX Controle quando comparados aos shams, o que não ocorreu nos animais UNX tratados com paricalcitol e calcitriol. Nas aortas, a relação parede/lúmen foi significativamente menor no grupo Sham Controle quando comparada à dos grupos UNX Controle e UNX Calcitriol, sendo que nesses últimos, foram evidenciadas calcificações vasculares acompanhadas por células positivas para Runx-2 (cbfa-1). Além disso, foi evidenciada uma menor expressão de TGFß nas aortas dos animais do grupo UNX Paricalcitol em relação aos grupos UNX Controle e UNX Calcitriol. Conclusões: Ambos os tratamentos preveniram alterações na capilarização cardíaca induzidas pela UNX. O tratamento com calcitriol na dose empregada induziu significativas calcificações vasculares, o que não ocorreu com o paricalcitol.

The study investigated the influence of a 10-week treatment with Paricalcitol (0.1µg/kg, 5x/week) or Calcitriol (0.03µg/kg, 5x/week) on cardiovascular disease in spontaneously atherosclerotic ApoE -/- mice submitted to uninephrectomy (UNX). Results: capillary length density of the heart was significantly lower in UNX Control, but not in UNX Paricalcitol and UNX Calcitriol animals, when compared to shams. In the aortas, a significantly lower wall/lumen ratio was observed in the Sham Control group when compared to UNX Control and UNX Calcitriol groups. In the latter, vascular calcifications accompanied by a significant presence of Runx-2 (cbfa-1) positive cells was observed. TGFß aorta expression was significantly higher in UNX Control and UNX Calciriol groups when compared to UNX Paricalcitol. Conclusions: Both treatments were able to prevent the reduction in heart capillarization induced by the UNX model. Treatment with Calcitriol at the employed dose and duration, though, induced significant vascular calcifications.