vasculopathy

Vasculopathy is a broad term for diseases that affect the structure or function of blood vessels, including arteries, veins, and capillaries. It denotes vessel pathology that disrupts perfusion or integrity, and is not limited to inflammatory conditions; vasculitis, by contrast, specifically refers to inflammation of vessel walls. Vasculopathies can be primary or secondary to other diseases or exposures.

Pathophysiology varies by bed and vessel type but commonly involves endothelial dysfunction, abnormal remodeling of vessel walls, smooth muscle proliferation, thrombosis, and, in the microvasculature, capillary loss or rarefaction. Macrovascular changes include atherosclerotic or arteriolosclerotic narrowing and occlusion, while microvascular vasculopathy may cause impaired autoregulation and tissue ischemia. Common etiologies include atherosclerosis, diabetes-related microangiopathy, hypertension, inflammatory or autoimmune processes, inherited connective tissue disorders, radiation, and certain drugs or toxins.

Clinical presentation depends on the vessels affected. Peripheral artery involvement can cause claudication or limb ischemia; cerebral or retinal microvascular disease may lead to staged cognitive impairment or vision changes; renal or gastrointestinal vasculopathy can cause organ-specific dysfunction; digital ulcers or edema may occur with venous or capillary involvement. Diagnosis relies on imaging and functional tests, such as duplex ultrasonography, computed tomography or magnetic resonance angiography, and, for microvascular disease, capillaroscopy or tissue biopsy when appropriate. Laboratory assessment focuses on risk factors and, if vasculitis is suspected, inflammatory markers and autoimmune testing.

Treatment targets underlying causes and risk factors, with antiplatelet therapy, statins, and strict control of blood pressure and glucose as common measures. Revascularization or endovascular interventions may be considered for critical limb or organ ischemia. Management is individualized and often multidisciplinary, with prognosis varying by extent, location, and response to therapy.