What diseases affect the arteries, veins, and capillaries?

Diseases Affecting Arteries, Veins, and Capillaries

Atherosclerosis is the most common disease affecting arteries worldwide, while venous diseases are primarily thrombotic and inflammatory in nature, and capillary diseases predominantly involve systemic inflammatory and autoimmune processes. 1

Arterial Diseases

Atherosclerotic Disease

• Atherosclerosis is the predominant arterial pathology globally, affecting all arterial beds including coronary, carotid, renal, mesenteric, and lower extremity arteries 1
• Risk factors include smoking, diabetes, hypertension, hyperlipidemia, family history, postmenopausal state, and hyperhomocysteinemia 1

Degenerative Arterial Disorders

• Marfan syndrome and Ehlers-Danlos syndrome cause collagen abnormalities leading to arterial wall structural integrity loss, aneurysm formation, and dissection 1
• Erdheim's cystic medial necrosis, arteriomegaly, and neurofibromatosis represent degenerative diseases with unclear vascular defects 1

Dysplastic Arterial Disease

• Fibromuscular dysplasia (FMD) is the most common dysplastic disease, characteristically affecting the middle and distal two-thirds of renal arteries, as well as carotid and iliac arteries 1
• Medial fibroplasia accounts for 80-85% of FMD cases, typically occurring in 25-50 year-old women with a characteristic "string of beads" angiographic appearance 1

Vasculitic Diseases (Arteritis) by Vessel Size

Large Vessel Arteritis (Aorta and First/Second-Order Branches):

• Giant cell arteritis (Takayasu's disease) affects large arteries, particularly the aortic arch and its branches 1, 2, 3
• Behçet's syndrome involves large vessels 1, 2
• Relapsing polychondritis and vasculitis associated with arthropathies affect large vessels 1

Medium Vessel Arteritis (Conduit Muscular Arteries):

• Polyarteritis nodosa classically targets medium-sized vessels 1, 2, 3
• Temporal arteritis (a form of giant cell arteritis) affects medium vessels 1
• Wegener's granulomatosis, Churg-Strauss syndrome, and Kawasaki disease also affect medium-sized vessels 1, 3
• Radiation-associated arteritis can affect vessels of any size 1

Small Vessel Disease (Arterioles and Microvessels):

• Rheumatoid arthritis, systemic lupus erythematosus, serum sickness, and other connective tissue/autoimmune diseases most frequently cause small-vessel arteritis 1, 2

Thrombotic and Embolic Arterial Disease

• Thromboangiitis obliterans (Buerger's disease) is an arterial obliterative and thrombotic process in young tobacco smokers, affecting arteries of all sizes (particularly smaller distal limb arteries) 1
• Primary prothrombotic diseases include protein C, protein S, or antithrombin III deficiencies; factor V Leiden; prothrombin mutations; lupus anticoagulant; anticardiolipin antibody; and malignancy-associated states 1
• Macroemboli originate from cardiac sources (left atrial appendage thrombus, atrial fibrillation, ventricular thrombus) 1
• Microemboli arise from cardiac valvular disease or arterial sources (ruptured cholesterol plaques causing atheroembolization) 1

Vasospastic Arterial Diseases

• Primary Raynaud's phenomenon represents primary vasospasm 1
• Secondary Raynaud's phenomenon occurs with scleroderma or systemic lupus erythematosus 1
• Other vasospastic syndromes include Prinzmetal's angina, migraine headache, and cerebral vasospasm 1

Other Arterial Pathologies

• Renal artery aneurysms may cause renovascular hypertension, with rupture risk greatest in noncalcified aneurysms >2 cm, particularly in premenopausal women 1
• Spontaneous renal artery dissection, arteriovenous malformations, trauma, and retroperitoneal fibrosis represent rare causes 1

Venous Diseases

Thromboangiitis obliterans (Buerger's disease) affects superficial veins in addition to arteries, behaving like a vasculitis in young tobacco smokers 1

Note: The provided evidence focuses predominantly on arterial pathology. Venous diseases such as deep vein thrombosis, chronic venous insufficiency, varicose veins, and superficial thrombophlebitis are not comprehensively covered in these guidelines.

Capillary (Microvascular) Diseases

Small-vessel disease affecting arterioles and microvessels occurs most frequently with systemic inflammatory and autoimmune disorders 1, 2:

• Rheumatoid arthritis causes small-vessel vasculitis 1
• Systemic lupus erythematosus affects microvessels 1
• ANCA-associated vasculitis (including granulomatosis with polyangiitis and microscopic polyangiitis) affects intraparenchymal vessels and microvessels 2
• Immune complex vasculitis involves small vessels 2

Clinical Pitfall

Do not assume all vascular disease is atherosclerotic—particularly in young patients, women under 50, or those with systemic symptoms (fever, weight loss, elevated inflammatory markers), consider vasculitis, dysplastic disorders, or thrombotic syndromes 1. The presence of disease in multiple vascular beds suggests systemic pathophysiological processes requiring comprehensive evaluation 1.