Angiopathies

Angiopathy is a broad medical term describing disease of the blood vessels, including arteries, veins, and capillaries. It denotes structural or functional abnormalities of the vessel wall that can disrupt blood flow and tissue perfusion. Angiopathies may involve a single vascular bed or multiple organs and may occur without overt inflammation.

Clinically, angiopathies are commonly categorized into microangiopathies and macroangiopathies. Microangiopathies affect small vessels, capillaries and arterioles, and include diabetic microangiopathy, hypertensive small-vessel disease, retinal angioapathy, and thrombotic microangiopathies such as thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Macroangiopathies involve larger arteries and may accompany or overlap with atherosclerotic disease and other large-vessel vasculopathies, potentially contributing to stroke, limb ischemia, or other organ ischemia.

Pathophysiology is diverse but commonly involves endothelial dysfunction, abnormal remodeling of the vessel wall, and abnormal thrombotic or inflammatory processes. Changes may include basement membrane thickening, smooth muscle cell proliferation, luminal narrowing, and microthrombi. Etiologies are heterogeneous and include metabolic disorders (eg, diabetes, hypertension), autoimmune and inflammatory diseases, infections, genetic vascular disorders, and aging.

Clinical presentation varies with the vessels involved and may include ischemia, hemorrhage, edema, or organ dysfunction. Diagnosis uses clinical assessment, imaging such as Doppler ultrasound, CT or MR angiography, and sometimes tissue biopsy or laboratory testing for specific etiologies. Management focuses on treating the underlying cause and reducing vascular risk factors, with supportive care and disease-specific therapies such as plasma exchange for thrombotic microangiopathies, antiplatelet or anticoagulant therapy when indicated, and control of blood sugar and blood pressure.