Thrombo-embolic and vascular complications in vasculitis syndromes

The vasculitides are relatively rare diseases characterized by inflammation and necrosis of vessel walls and, hence, often complicated by vascular and thromboembolic manifestations. The causes and pathogenesis of most vasculitides are only partially known. However, in many there are strong implications of both immune-complex and cell-mediated pathogenetic mechanisms. Tissue ischaemia, thrombosis as well as mediators and end-products of vascular endothelial inflammation are thought to cause most of the vasculitic manifestations. Thrombo-embolic and cardiovascular manifestations and complications are most commonly found in the vasculitides with necrotizing vascular inflammation, i.e. Behçet's disease, Buerger's disease, Kawasaki's syndrome, polyarteritis nodosa and vasculitis of rheumatoid arteritis. The granulomatous vasculitides are less frequently complicated by thrombo-embolic manifestations. Vasculitis may also be an iatrogenic complication of a therapeutic intervention, such as an IC-mediated hypersensitivity vasculitis after streptokinase treatment or an anti-endothelial cell antibody-associated coronary vasculitis after heart transplantation.