Microangiopathy: Difference between revisions

| caption = A case of [[conjunctiva|conjunctival]]l microangiopathy (red dashed-square) secondary to [[diabetes]] demonstrating a [[Aneurysm|microaneurysm]] (orange arrow), vessel dilatation (blue arrows), and vascular tortuosity (yellow arrow).

{{bulleted list |Diabetic microangiopathy, mainly as [[diabetic retinopathy]], [[diabetic nephropathy|nephropathy]] and [[diabetic neuropathy|neuropathy]]. However, microvascular changes in diabetes are not confined to those, and are generalizable to a wide variety of organs including the skin, muscles, heart and brain.<ref>{{cite journal |last1=Sugimoto |first1=Kazuhiro |last2=Murakami |first2=Hiroshi |last3=Deguchi |first3=Takahisa |last4=Arimura |first4=Aiko |last5=Daimon |first5=Makoto |last6=Suzuki |first6=Susumu |last7=Shimbo |first7=Takuro |last8=Yagihashi |first8=Soroku |title=Cutaneous microangiopathy in patients with type 2 diabetes: Impaired vascular endothelial growth factor expression and its correlation with neuropathy, retinopathy and nephropathy |journal=Journal of Diabetes Investigation |date=2019 |volume=10 |issue=5 |pages=1318–1331 |doi=10.1111/jdi.13020 |pmid=30719863 |issn=2040-1116 |pmc=6717820}}</ref>|Coronary microvascular diseases (CMDs), which comprise multiple structural and functional abnormalities of the coronary microcirculation including [[microvascular angina]], previously known as '''cardiac syndrome X'''.<ref name="Camici">{{cite journal |last1=Camici |first1=Paolo G. |last2=Crea |first2=Filippo |title=Coronary microvascular dysfunction |journal=The New England Journal of Medicine |date=22 February 2007 |volume=356 |issue=8 |pages=830–840 |doi=10.1056/NEJMra061889 |pmid=17314342 |url=https://pubmed.ncbi.nlm.nih.gov/17314342/ |issn=1533-4406}}</ref>|Cerebral small vessel diseases (CSVDs), which include [[arteriosclerosis]]-related CSVD as in [[hypertension]], [[Cerebral amyloid angiopathy|amyloid]]-related CSVD as in [[Alzheimer's disease]] and other genetic, inflammatory-mediated and immune-mediated CSVDs.<ref name="CSVD">{{cite journal |last1=Litak |first1=Jakub |last2=Mazurek |first2=Marek |last3=Kulesza |first3=Bartłomiej |last4=Szmygin |first4=Paweł |last5=Litak |first5=Joanna |last6=Kamieniak |first6=Piotr |last7=Grochowski |first7=Cezary |title=Cerebral Small Vessel Disease |journal=International Journal of Molecular Sciences |date=20 December 2020 |volume=21 |issue=24 |pages=9729 |doi=10.3390/ijms21249729 |pmid=33419271 |issn=1422-0067 |pmc=7766314 |doi-access=free }}</ref>|[[Thrombotic microangiopathy|Thrombotic microangiopathies]], '''pseudo-thrombotic microangiopathy'''<ref>{{cite journal |last1=Pereira Fontes |first1=Carla |last2=Fonseca |first2=Samuel |title=Pseudothrombotic Microangiopathy as a Rare Presentation of Cobalamin Deficiency |journal=Cureus |date=2021 |volume=13 |issue=8 |pages=e17184 |doi=10.7759/cureus.17184 |pmid=34540418 |issn=2168-8184 |pmc=8439408}}</ref> and microangiopathies in a wide range of diseases including [[COVID-19|COVID-19 infection]],<ref name="NVC">{{cite journal |last1=Gualtierotti |first1=Roberta |last2=Fox |first2=Sharon E. |last3=Da Silva Lameira |first3=Fernanda |last4=Giachi |first4=Andrea |last5=Valenti |first5=Luca |last6=Borghi |first6=Maria Orietta |last7=Meroni |first7=Pier Luigi |last8=Cugno |first8=Massimo |last9=Peyvandi |first9=Flora |title=Nailfold Videocapillaroscopic Alterations as Markers of Microangiopathy in COVID-19 Patients |journal=Journal of Clinical Medicine |date=28 May 2023 |volume=12 |issue=11 |pages=3727 |doi=10.3390/jcm12113727 |pmid=37297922 |issn=2077-0383 |pmc=10253962 |doi-access=free }}</ref> [[chronic kidney disease]],<ref>{{cite journal |last1=Prommer |first1=Hans-Ulrich |last2=Maurer |first2=Johannes |last3=von Websky |first3=Karoline |last4=Freise |first4=Christian |last5=Sommer |first5=Kerstin |last6=Nasser |first6=Hamoud |last7=Samapati |first7=Rudi |last8=Reglin |first8=Bettina |last9=Guimarães |first9=Pedro |last10=Pries |first10=Axel Radlach |last11=Querfeld |first11=Uwe |title=Chronic kidney disease induces a systemic microangiopathy, tissue hypoxia and dysfunctional angiogenesis |journal=Scientific Reports |date=28 March 2018 |volume=8 |issue=1 |pages=5317 |doi=10.1038/s41598-018-23663-1 |pmid=29593228 |issn=2045-2322 |pmc=5871820|bibcode=2018NatSR...8.5317P }}</ref> [[chronic venous insufficiency]],<ref>{{cite journal |last1=Franzeck |first1=U. K. |last2=Haselbach |first2=P. |last3=Speiser |first3=D. |last4=Bollinger |first4=A. |title=Microangiopathy of cutaneous blood and lymphatic capillaries in chronic venous insufficiency (CVI). |journal=The Yale Journal of Biology and Medicine |date=1993 |volume=66 |issue=1 |pages=37–46 |pmid=8256463 |issn=0044-0086 |pmc=2588834}}</ref> [[systemic scleroderma]] and other [[connective tissue disease|connective tissue diseases]]s (CTDs) associated with peripheral vascular syndrome,<ref>{{cite journal |last1=Lambova |first1=Sevdalina Nikolova |title=Microangiopathy in Rheumatic Diseases |journal=Life |date=10 February 2023 |volume=13 |issue=2 |pages=491 |doi=10.3390/life13020491 |pmid=36836847 |issn=2075-1729 |pmc=9965541 |doi-access=free }}</ref> [[sarcoidosis]],<ref>{{cite journal |last1=Martinelli |first1=Anthony W. |last2=Dunn |first2=William |last3=McClure |first3=Mark E. |last4=Walker |first4=Ieuan |last5=Stewart |first5=Andrew |last6=Karia |first6=Sumit |last7=Preston |first7=Stephen D. |last8=Thiru |first8=Sathia |last9=Torpey |first9=Nicholas |last10=Ojha |first10=Sanjay |last11=Symington |first11=Emily |last12=Nathan |first12=James A. |title=A Case of Thrombotic Microangiopathy and Acute Sarcoidosis |journal=Chest |date=November 2022 |volume=162 |issue=5 |pages=e245–e248 |doi=10.1016/j.chest.2022.06.023 |pmid=36344132 |issn=0012-3692 |pmc=9752182}}</ref> [[amyloidosis]]<ref>{{cite journal |last1=Koike |first1=Haruki |last2=Katsuno |first2=Masahisa |title=Ultrastructure in Transthyretin Amyloidosis: From Pathophysiology to Therapeutic Insights |journal=Biomedicines |date=5 February 2019 |volume=7 |issue=1 |pages=11 |doi=10.3390/biomedicines7010011 |pmid=30764529 |issn=2227-9059 |pmc=6466231 |doi-access=free }}</ref> and even with [[Flight length#Short-haul and long-haul|long-haul]] flights.<ref>{{cite journal |last1=Cesarone |first1=M. R. |last2=Belcaro |first2=G. |last3=Geroulakos |first3=G. |last4=Griffin |first4=M. |last5=Ricci |first5=A. |last6=Brandolini |first6=R. |last7=Pellegrini |first7=L. |last8=Dugall |first8=M. |last9=Ippolito |first9=E. |last10=Candiani |first10=C. |last11=Simeone |first11=E. |last12=Errichi |first12=B. M. |last13=Di Renzo |first13=A. |title=Flight microangiopathy on long-haul flights: prevention of edema and microcirculation alterations with Venoruton |journal=Clinical and Applied Thrombosis/Hemostasis: Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis |date=April 2003 |volume=9 |issue=2 |pages=109–114 |doi=10.1177/107602960300900203 |pmid=12812378 |s2cid=1605773 |url=https://pubmed.ncbi.nlm.nih.gov/12812378/ |issn=1076-0296}}</ref>}}

Multiple authors have proposed that SVD may manifest as a multisystem disorder implying commonality between disorders of small vessels of the heart and brain (e.g. high incidence of brain hypoperfusion lesions in patients with myocardial defects and vice versa). <ref name="Sys" /><ref name="HB">{{cite journal |last1=Berry |first1=Colin |last2=Sidik |first2=Novalia |last3=Pereira |first3=Anthony C. |last4=Ford |first4=Thomas J. |last5=Touyz |first5=Rhian M. |last6=Kaski |first6=Juan‐Carlos |last7=Hainsworth |first7=Atticus H. |title=Small‐Vessel Disease in the Heart and Brain: Current Knowledge, Unmet Therapeutic Need, and Future Directions |journal=Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |date=2 February 2019 |volume=8 |issue=3 |pages=e011104 |doi=10.1161/JAHA.118.011104 |pmid=30712442 |issn=2047-9980 |pmc=6405580}}</ref>

{{bulleted list |Prevention (e.g. maintaining good [[Diabetes management#Glycemic control|glycaemic control]], screening for retinopathy and neuropathy and testing [[Albuminuria|urine albumin excretion]] annually).<ref name="Khalil" /> |Controlling symptoms and preventing worsening of the condition (e.g. [[tricyclic antidepressants]] and [[gabapentin]] for diabetic neuropathy).<ref name="Khalil" /> |Drug therapy (e.g. [[antiplatelets]] ([[Aspirin#Heart attacks and strokes|low-dose aspirin]]) and [[Lipid-lowering agent|lipid-lowering therapy]] ([[statins]]) for management of CMDs).<ref name="JACC" /> |Diet and lifestyle modification (e.g. restriction of dietary protein in diabetic nephropathy, smoking cessation, weight loss, improved nutrition, and regular exercise).<ref name="Khalil" /><ref name="JACC" /><ref name="Fabry">{{cite journal |last1=Chojdak-Łukasiewicz |first1=Justyna |last2=Dziadkowiak |first2=Edyta |last3=Zimny |first3=Anna |last4=Paradowski |first4=Bogusław |title=Cerebral small vessel disease: A review |journal=Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University |date=March 2021 |volume=30 |issue=3 |pages=349–356 |doi=10.17219/acem/131216 |pmid=33768739 |s2cid=232365709 |url=https://pubmed.ncbi.nlm.nih.gov/33768739/ |issn=1899-5276}}</ref> |Aggressive management of comorbidities and risk factors (e.g. adequate control of blood pressure, diabetes and related metabolic abnormalities and lipid management).<ref name="JACC" /><ref name="Fabry" /> |Other measures (e.g. [[Laser coagulation|photocoagulation]] in patients with severe proliferative diabetic retinopathy).<ref name="Khalil" /> |Genetic testing should be considered in young people with extensive CSVD in the absence of sufficient conventional vascular risk factors (For [[Fabry disease]], there is an [[Fabry disease #Therapies targeting enzyme activity|enzyme replacement therapy]]).<ref name="Fabry" />}}