Al-Farabi University College ‫كـلية الفـــارابي الجامــعة‬

Department of Dentistry ‫قسم طـــب االسنان‬

Second Stage ‫المرحلة الثــانية‬

Subject:general histology ‫ االنسجة‬: ‫المــادة‬

‫العامة‬

Artery Histology and Disease

Prepared by
‫زهراء فاضل اجبير فعيل‬

Supervisor:
‫م انس عدنان ياسين‬.‫م‬
Abstract
The arteries are the blood vessels that deliver oxygen-rich blood from the heart to
the tissues of the body. Each artery is a muscular tube lined by smooth tissue and
has three layers:

 The intima
 The media
 The adventitia

Introduction

An artery (pulmonary arteries) is a blood vessel that takes blood away from the
human heart to all parts of the body (tissues, lungs, Brian etc.). Most arteries carry
oxygenated blood; the two exceptions are the pulmonary and the umbilical arteries,
which carry deoxygenated blood to the organs that oxygenate it (lungs)

The arteries are part of the circulatory system, which is responsible for the delivery
of oxygen and nutrients to all cells, as well as the removal of carbon dioxide and
waste products, the maintenance of optimum blood pH, and the circulation of
proteins and cells of the human immune system

All arterial vessels originate with either the pulmonary trunk (from the right
ventricle) or the aorta (from the left ventricle).

Arterial pressure varies between the peak pressure during heart contraction, called
the systolic pressure, and the minimum or diastolic pressure between contractions,
when the heart expands and refills. This pressure variation within the artery produces
the observable pulse that reflects heart activity. The pressure in the arterial system
decreases steadily, highest in the aorta and lowest in the venous system.
Arteries of the systemic circulation can be subdivided into muscular or elastic types
according to the the relative compositions of elastic and muscle tissue in their tunica
media. Larger arteries are typically elastic and smaller arteries are more likely to be
muscular. These arteries deliver blood to the arterioles, which in turn deliver blood
to the capillary networks associated with the body’s tissues
Histology of arteries
The artery wall consists of three layers:

 The tunica intima (also called the tunica interna) is composed of epithelial
and connective tissue layers. Lining the tunica intima is the specialized simple
squamous epithelium called the endothelium, which is continuous throughout
the entire vascular system, including the lining of the chambers of the heart.
Damage to this endothelial lining and exposure of blood to the collagenous
fibers beneath is one of the primary causes of clot formation. Until recently,
the endothelium was viewed simply as the boundary between the blood in the
lumen and the walls of the vessels. Recent studies, however, have shown that
it is physiologically critical to such activities as helping to regulate capillary
exchange and altering blood flow. The endothelium releases local chemicals
called endothelins that can constrict the smooth muscle within the walls of the
vessel to increase blood pressure. Uncompensated overproduction of
endothelins may contribute to hypertension (high blood pressure) and
cardiovascular disease.

Next to the endothelium is the basement membrane, or basal lamina, that

effectively binds the endothelium to the connective tissue. The basement
membrane provides strength while maintaining flexibility, and it is permeable,
allowing materials to pass through it. The thin outer layer of the tunica intima
contains a small amount of areolar connective tissue that consists primarily of
elastic fibers to provide the vessel with additional flexibility; it also contains
some collagenous fibers to provide additional strength. In larger arteries, there
is also a thick, distinct layer of elastic fibers known as the internal elastic
membrane (also called the internal elastic lamina) at the boundary with the
tunica media. Like the other components of the tunica intima, the internal
elastic membrane provides structure while allowing the vessel to stretch. It is
permeated with small openings that allow exchange of materials between the
tunics. The internal elastic membrane is not apparent in veins. Under the
microscope, the lumen and the entire tunica intima of a vein will appear
smooth, whereas those of an artery will normally appear wavy because of the
partial constriction of the smooth muscle in the tunica media, the next layer
of blood vessel walls.
 The tunica media is the substantial middle layer of the vessel wall .It is
generally the thickest layer in arteries, and it is much thicker in arteries than
it is in veins. The tunica media consists of layers of smooth muscle supported
by connective tissue that is primarily made up of elastic fibers, most of which
are arranged in circular sheets. Toward the outer portion of the tunic, there are
also layers of longitudinal muscle. Contraction and relaxation of the circular
muscles decrease and increase the diameter of the vessel lumen, respectively.
Specifically in arteries, vasoconstriction decreases blood flow as the smooth
muscle in the walls of the tunica media contracts, making the lumen narrower
and increasing blood pressure. Similarly, vasodilation increases blood flow
as the smooth muscle relaxes, allowing the lumen to widen and blood pressure
to drop. Both vasoconstriction and vasodilation are regulated in part by small
vascular nerves, known as nervi vasorum, or “nerves of the vessel,” that run
within the walls of blood vessels. These are generally all sympathetic fibers,
although some trigger vasodilation and others induce vasoconstriction,
depending upon the nature of the neurotransmitter and receptors located on
the target cell. Parasympathetic stimulation does trigger vasodilation as well
as erection during sexual arousal in the external genitalia of both sexes.
Nervous control over vessels tends to be more generalized than the specific
targeting of individual blood vessels. Local controls, discussed later, account
for this phenomenon. (Seek additionLarger arteries are typically elastic
Hormones and local chemicals also control blood vessels. Together, these
neural and chemical mechanisms reduce or increase blood flow in response to
changing body conditions, from exercise to hydration. Regulation of both
blood flow and blood pressure is discussed in detail later in this chapter.
 The smooth muscle layers of the tunica media are supported by a framework
of collagenous fibers that also binds the tunica media to the inner and outer
tunics. Along with the collagenous fibers are large numbers of elastic fibers
that appear as wavy lines in prepared slides. Separating the tunica media from
the outer tunica externa in larger arteries is the external elastic
membrane (also called the external elastic lamina), which also appears wavy
in slides. This structure is not usually seen in smaller arteries, nor is it seen in
veins.

 The outer tunic, the tunica externa (also called the tunica adventitia), is a
substantial sheath of connective tissue composed primarily of collagenous
fibers. Some bands of elastic fibers are found here as well. The tunica externa
in veins also contains groups of smooth muscle fibers. This is normally the
thickest tunic in veins and may be thicker than the tunica media in some larger
arteries. The outer layers of the tunica externa are not distinct but rather blend
with the surrounding connective tissue outside the vessel, helping to hold the
vessel in relative position. If you are able to palpate some of the superficial
veins on your upper limbs and try to move them, you will find that the tunica
externa prevents this. If the tunica externa did not hold the vessel in place, any
movement would likely result in disruption of blood flow.
Type of arteries vessels

All arteries have relatively thick walls that can withstand the high pressure of blood
ejected from the heart. However, those close to the heart have the thickest walls,
containing a high percentage of elastic fibers in all three of their tunics. This type of
artery is known as an elastic artery

Elastic arteries
Vessels larger than 10 mm in diameter are typically elastic. Their abundant elastic
fibers allow them to expand These arteries that receive blood directly from the heart
- the aorta and the pulmonary artery.

These need to be elastic because: They are relatively thin compared to their
diameter. When the heart contracts, and ejects blood into these arteries, the walls
need to stretch to accommodate the blood surge, storing energy. The arterial
hydrostatic pressure that results from ventricular contraction is the 'systolic blood
pressure. Between heart contractions, the elastic walls recoil, to maintain blood
pressure, continuing to move blood even when ventricles are relaxed. The arterial
hydrostatic pressure between contractions is the 'diastolic blood pressure'.The walls
of these arteries have lots of elastin.

The tunica intima of elastic arteries is thicker than in other arteries. has small 'vasa
vasorum' as the large arteries need their own blood supply. Smooth muscle cells and
collagen fibres are present between the layers of elastic fibres. Both fibre types are
produced by the smooth muscle cells. Each elastic lamella forms together with
interlamellar fibres and cells a lamellar unit. The external elastic lamina is difficult
to discern from other layers of elastic fibres in the tunica media.
The tunica adventitia of elastic arteries appears thinner than the tunica media and
contains collagen fibres and the cell types typically present in connective tissue.

Tunica intima of elastic arteries is made up of an epithelium, which is a single

layer of flattened endothelial cells, together with a supporting layer of elastin rich
collagen. This layer also has fibroblasts and 'myointimal cells' that accumulate lipid
with ageing, and the intima layer thickens, one of the first signs of atherosclerosis.

These arteries that receive blood directly from the heart - the aorta and the
pulmonary artery.:
 These need to be elastic because:
 They are relatively thin compared to their diameter.
When the heart contracts, and ejects blood into these arteries, the walls need to
stretch to accommodate the blood surge, storing energy. The arterial hydrostatic
pressure that results from ventricular contraction is the 'systolic blood pressure'

.
 The aortic wall histology
The aorta is an elastic artery which has a relatively thick tunica intima bounded by
endothelium and the internal elastic membrane
The aortic wall, like that of all elastic arteries, has a trilaminar structure consisting
of a tunica intima, media, and adventitia. Most of the mechanical properties of the
aorta can be attributed to the media (with the strong collagen component and the
stretchable elastin component)
Although, the adventitia is also recognized as a strong layer that maintains aortic
diameter and holds stitches when performing surgery on the vessel
The media comprises cellular elements (including smooth muscle cells) and
structural proteins (notably elastin and collagen) that form the extracellular
matrix (ECM). These components are arranged into lamellar units concentric layers
of elastin with interspersed cells and collagen.

This slide shows the wall of the aorta, a large elastic artery. The three layers
of the aortic wall are visible here.
 Muscular arteries
These arteries distribute blood to various parts of the body. These include arteries
such as the femoral and coronary arteries. The walls of these arteries have lots of
smooth muscle, which means that they are able to contract or relax (dilate) to change
the amount of blood delivered, as needed.
Comparing these arteries to the elastic arteries, the sheet of elastin is now much
reduced, and found at the border between the tunica intima and tunica media in a
layer called the internal elastic layer (IEL) which can be seen very clearly. Less well
defined is the external elastic layer (EEL), between the tunica media and tunica
adventitia. There is a well defined circular layer of smooth muscle in the tunica
media.
The tunica intima: has an endothelium of flattened endothelial cells.
The tunica media is primarily a layer of smooth muscle, with some elastin an
collagen. Muscle layer, and is sandwiched between the IEL and EEL.
The Tunica Adventitia is very broad, and mostly contains collagen and elastin.
The tunica intima is thinner than in elastic arteries. Subendothelial connective tissue
other than the internal elastic lamina is often difficult to discern. The internal elastic
lamina forms a well defined layer. The tunica media is dominated by numerous
concentric layers of smooth muscle cells. Fine elastic fibres and and a few collagen
fibres are also present. The external elastic lamina can be clearly distinguished
although it may be incomplete in places. The thickness and appearance of the tunica
adventitia is variable.

Muscular arteries
 Arterioles

Are arterial vessels with a diameter below 0.1 - 0.5 mm .Endothelial cells are smaller
than in larger arteries, and the nucleus and surrounding cytoplasm may 'bulge'
slightly into the lumen of the arteriole. The endothelium still rests on a internal
elastic lamina, which may be incomplete and which is not always well-defined in
histological sections.

The tunica media consists of 1-3 concentric layers of smooth muscle cells. It is
difficult to identify an external elastic lamina or to distinguish the tunica adventitia
from the connective tissue surrounding the vessel. Arterioles receive both
sympathetic and parasympathetic innervation. The final branching of the
arterioles finally gives rise to the capillary network (microcirculation).

The tunica intima is very thin, and mostly consists of a single layer of squamous
epithelium.The tunica media consists almost entirely of a single layer up to six layers
of smooth muscle cells, and there is no EEL. The Tunica adventitia is about the same
size as the tunica media layer, merges in with surrounding tissue.

The Tunica adventitia is about the same size as the tunica media layer, merges in
with surrounding tissue.

Arterioles
Comparison of Arteries and Veins

Comparison of Arteries and Veins

 Development of artery

The great vessels are a part of the vascular system that first appears in the mid-third
week of development from mesoderm/ectoderm-derived angiogenic cells. The
arteries arise from the combination of the ectoderm (cells from the neural crests) and
the mesoderm (pharyngeal mesoderm).

The first arteries that develop are the right and left primitive aortae, which are
a continuation of endocardial cardiac tubes. These primitive aortae curve posteriorly
in the first pharyngeal arch, around the anterior part of foregut and then continue
posteriorly as two dorsal aortae. These two aortae also fuse cranially close to the
heart, forming the aortic sac. The aortic sac continues caudally as truncus arteriosus
and lies ventral to the pharynx. The two dorsal aortae lie dorsal to the primitive gut
and pass caudally and fuse at the distal end to form a common aorta while the cranial
part remains separate.
 Arterial Disease

Arterial disease, sometimes called artery disease, is a vascular disease that affects
the arteries of the body, which are the vessels that carry oxygen-rich blood away
from your heart to the tissues of the body.

Arterial diseases include:

 Abdominal Aortic Aneurysm

 Thoracic Aortic Aneurysm
 Coronary Artery Disease
 Carotid Artery Disease
 Peripheral Arterial Disease
 Vertebrobasilar Disease
 Renal Vascular Disease
 Thoracic Outlet Syndrome
 Subclavian Steal Syndrome

Symptoms of Arterial Disease

Because diseases of the arteries can affect different parts of the body, from the heart
to the kidney to the legs, symptoms range widely. For instance, coronary artery
disease can cause chest pain or a feeling of pressure in your chest. Symptoms of
carotid artery disease may include dizziness, a loss of balance, or a severe headache.
And peripheral arterial disease (PAD), also called peripheral artery disease, can
cause foot or leg pain, and foot sores or ulcers that are slow to heal.
 Abdominal Aortic Aneurysm

An abdominal aortic aneurysm is an enlarged area in the lower part of the major
vessel that supplies blood to the body (aorta). The aorta runs from your heart through
the center of your chest and abdomen.

Causes:

 Hardening of the arteries (atherosclerosis). Atherosclerosis occurs when fat

and other substances build up on the lining of a blood vessel.
 High blood pressure. High blood pressure can damage and weaken the aorta's
walls.
 Blood vessel diseases. These are diseases that cause blood vessels to become
inflamed.
 Infection in the aorta. Rarely, a bacterial or fungal infection might cause an
abdominal aortic aneurysms.
 Trauma. For example, being in a car accident can cause an abdominal aortic
aneurysms.

Symptoms

 Deep, constant pain in the abdomen or on the side of your abdomen

 Back pain
 A pulse near the bellybutton
 Thoracic aortic aneurysm
A thoracic aortic aneurysm is a weakened area in the major blood vessel that feeds
blood to the body (aorta). When the aorta is weak, blood pushing against the vessel
wall can cause it to bulge like a balloon (aneurysm).
Causes:
 Changes caused by age
 Connective tissue disorders such as Marfan or Ehlers-Danlos syndrome
 Inflammation of the aorta
 Injury from falls or motor vehicle accidents
 Syphilis
Symptoms

 Tenderness or pain in the chest

 Back pain
 Hoarseness
 Cough
 Shortness of breath
 Coronary Artery Disease

Coronary artery disease is the narrowing or blockage of the coronary arteries,

usually caused by atherosclerosis. Atherosclerosis (sometimes called
"hardening" or "clogging" of the arteries) is the buildup of cholesterol and fatty
deposits (called plaques) on the inner walls of the arteries. These plaques can
restrict blood flow to the heart muscle by physically clogging the artery or by
causing abnormal artery tone and function.

Causes

 Smoking
 High blood pressure
 High cholesterol
 Diabetes or insulin resistance
 Not being active (sedentary lifestyle)

Symptoms

 Chest pain (angina)

 Shortness of breath
 Heart attack
 Carotid artery disease
Carotid artery disease occurs when fatty deposits (plaques) clog the blood vessels
that deliver blood to your brain and head (carotid arteries). The blockage increases
your risk of stroke, a medical emergency that occurs when the blood supply to the
brain is interrupted or seriously reduced.
Causes
Carotid artery disease is caused by a buildup of plaques in arteries that deliver blood
to your brain. Plaques are clumps of cholesterol, calcium, fibrous tissue and other
cellular debris that gather at microscopic injury sites within the artery. This process
is called atherosclerosis.
Symptom

 Sudden loss of vision, blurred vision, or difficulty in seeing out of one or

both eyes
 Weakness, tingling, or numbness on one side of the face, one side of the body,
or in one arm or leg
 Sudden difficulty in walking, loss of balance, lack of coordination
 Sudden dizziness and/or confusion
 Difficulty speaking (called aphasia)
 Confusion
 Sudden severe headache
 Problems with memory
 Difficulty swallowing (called dysphagia)
 Peripheral Arterial Disease

Peripheral artery disease is a narrowing of the peripheral arteries serving the legs,
stomach, arms and head. (“Peripheral” in this case means away from the heart, in
the outer regions of the body.) PAD most commonly affects arteries in the legs

Causes

Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty

deposits (plaques) build up on your artery walls and reduce blood flow.

Symptoms

 Painful cramping in one or both of your hips, thighs or calf muscles after
certain activities, such as walking or climbing stairs (claudication)
 Leg numbness or weakness
 Coldness in your lower leg or foot, especially when compared with the
other side
 Sores on your toes, feet or legs that won't heal
 A change in the color of your legs
 Hair loss or slower hair growth on your feet and legs
 Slower growth of your toenails
 Shiny skin on your legs
 No pulse or a weak pulse in your legs or feet
 Erectile dysfunction in men
 Vertebrobasilar Disease

Vertebrobasilar disease is a disease of the arterial system. It describes a variety of

conditions affecting blood flow to the back of the brain via the vertebral and/or
basilar arteries. Blood is delivered to several structures in the brain, particularly
those responsible for movement and balance, via the carotid arteries (large vessels
on each side of the neck) and vertebral arteries. The vertebral arteries are located at
the back of the neck and merge at the base of the brain to form the basilar artery.
Causes

 Diabetes
 Hypertension
 Obesity
 High cholesterol
 Smoking
 Advanced age
 Inactive lifestyle

Symptoms

 Vertigo (dizziness)
 Visual disturbances (blurring, graying, double vision)
 Sudden falls
 Numbness or tingling
 Slurred or lost speech
 Confusion
 Issues with swallowing
Discussion

Blood pumped by the heart flows through a series of vessels known as arteries,
arterioles, capillaries, venules, and veins before returning to the heart. Arteries
transport blood away from the heart and branch into smaller vessels, forming
arterioles. Arterioles distribute blood to capillary beds, the sites of exchange with
the body tissues. Capillaries lead back to small vessels known as venules that flow
into the larger veins and eventually back to the heart.

The arterial system is a relatively high-pressure system, so arteries have thick walls
that appear round in cross section. The venous system is a lower-pressure system,
containing veins that have larger lumens and thinner walls. They often appear
flattened. Arteries, arterioles, venules, and veins are composed of three tunics known
as the tunica intima, tunica media, and tunica externa. Capillaries have only a tunica
intima layer. The tunica intima is a thin layer composed of a simple squamous
epithelium known as endothelium and a small amount of connective tissue. The
tunica media is a thicker area composed of variable amounts of smooth muscle and
connective tissue. It is the thickest layer in all but the largest arteries. The tunica
externa is primarily a layer of connective tissue, although in veins, it also contains
some smooth muscle. Blood flow through vessels can be dramatically influenced by
vasoconstriction and vasodilation in their walls.
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