Vascular Erosion Classification and Risk Factors

Anatomical Classification by Vascular Territory

Deep territory erosion occurs in penetrating arterioles of the basal ganglia, thalamus, brainstem, and deep cerebellar nuclei, typically associated with arteriolosclerosis, and is characterized by concentric hyalinized vascular wall thickening in deep brain territories, driven by hypertension and diabetes, according to the American Heart Association 1
Lobar territory erosion affects arterioles in the leptomeninges, cerebral cortex, and cerebellar hemispheres, primarily linked to cerebral amyloid angiopathy (CAA), which is age-dependent with genetic predisposition, as stated by the American Stroke Association 1
Risk factors for vascular erosion include hypertension, diabetes, and age for arteriolosclerosis; age and apolipoprotein E ε2/ε4 alleles for CAA, as reported by the American Heart Association 1
Chronic contained rupture with vertebral body erosion (VBE) results from pulsatile trauma of thoracoabdominal aortic aneurysms causing progressive bone destruction, and is associated with arterial hypertension, osteoporosis, and advanced age, according to the American College of Cardiology 2
VBE occurs predominantly in thoracolumbar spine with average aneurysm diameter of 7.056 ± 3.39 cm, and is distinguished from infectious erosion by smooth, well-defined lytic margins, as stated by the American College of Cardiology 2

Symptomatic erosion presents with acute coronary syndromes, stroke/TIA, or critical limb ischemia depending on vascular bed, as reported by the American Heart Association 1, 3
Asymptomatic erosion is detected incidentally on imaging or at autopsy, and may be associated with underlying small vessel disease, according to the American Stroke Association 1
Intermittent claudication is characterized by exertional leg symptoms with reproducible walking distance, while critical limb ischemia is characterized by chronic ischemic rest pain, ulcers, or gangrene threatening limb viability, as stated by the American College of Cardiology 3, 4
Acute limb ischemia is characterized by sudden decrease in perfusion with the "5 Ps" (pain, pulselessness, pallor, paresthesias, paralysis), and requires urgent vascular surgery referral, according to the American College of Cardiology 3, 5

Diabetic patients have a 2-4 fold increased risk of peripheral arterial disease with more distal vessel involvement and medial arterial calcification, as reported by the European Society of Cardiology 4
Hypertensive patients have an increased risk of aortic erosion with vertebral body involvement, and elevated systolic blood pressure is strongly associated with upper extremity artery disease, according to the European Society of Cardiology 2, 7
Atherosclerotic disease patients have a worse prognosis with multi-site atherosclerosis, and smoking carries the highest odds ratio for upper extremity arterial disease, as stated by the European Society of Cardiology 4, 7
The American College of Cardiology recommends measuring ankle-brachial index (ABI) in all patients over 70 years, age 50-69 with smoking or diabetes, or any age with diabetes plus one atherosclerosis risk factor, to diagnose peripheral arterial disease 3
ABI <0.90 has 75% sensitivity and 86% specificity for PAD diagnosis, and ABI <0.5, ankle pressure <50 mmHg, or toe pressure <30 mmHg requires urgent vascular surgery referral, according to the American College of Cardiology 3, 6