Atherosclerosis is Exclusively an Arterial Disease
Yes, atherosclerotic disease occurs only in arteries, not in veins—this is a fundamental characteristic of the disease process related to the unique hemodynamic and structural properties of the arterial system. 1
Why Arteries Are Affected and Veins Are Spared
The selective involvement of arteries in atherosclerosis relates to critical differences in vessel wall structure and hemodynamic forces:
- High-pressure arterial systems are uniquely susceptible to atherosclerotic plaque formation, while veins and low-pressure arteries are typically spared from this disease process 1
- The large, high-pressure arteries (aorta, coronary, carotid, renal, and peripheral arteries) bear the mechanical stress and endothelial injury that initiates atherosclerotic changes 2
- Differences in macromolecular transport from blood into vessel walls between arteries and veins explain their different susceptibilities to atherosclerosis 1
Arterial Distribution of Atherosclerotic Disease
Atherosclerosis manifests as a systemic arterial disease affecting multiple vascular territories, but never venous structures:
- Coronary arteries are the most commonly affected, with fibrotic and lipid-rich plaque components 3
- Carotid and vertebral arteries develop primarily lipid-rich plaques that cause cerebrovascular disease 2, 3
- Lower extremity arteries (femoral, popliteal, tibial) develop predominantly fibrocalcific plaques causing peripheral arterial disease 2, 3
- Renal arteries are affected in approximately 90% of renovascular stenotic lesions, typically at the aorto-ostial segment 2
- Mesenteric arteries can develop atherosclerotic stenosis, though symptomatic disease is relatively rare 2
- Upper extremity arteries, particularly the subclavian artery, are affected less frequently than lower extremity vessels 2
Clinical Implications of Arterial-Only Disease
Understanding that atherosclerosis is exclusively arterial has important diagnostic and therapeutic implications:
- Polyvascular disease is common—the presence of atherosclerosis at one arterial site increases the likelihood of disease at other arterial sites, particularly in elderly patients 2
- When evaluating patients with known atherosclerotic disease in one vascular bed, clinicians must maintain heightened awareness for disease in other arterial territories 2
- The degree of overlap between coronary artery disease, cerebrovascular disease, and lower extremity arterial disease is particularly high in elderly populations 2
Common Pitfall to Avoid
Do not confuse venous thrombosis or venous insufficiency with atherosclerotic disease—these are entirely separate pathological processes. Deep vein thrombosis affects the venous system and has different risk factors, pathophysiology, and management compared to arterial atherosclerosis 2. While both may coexist in the same patient (particularly in those with multiple cardiovascular risk factors), they represent distinct disease entities affecting different vascular systems.