Medial vascular calcification revisited: review and perspectives

Abstract

Vascular calcifications (VCs) are actively regulated biological processes associated with crystallization of hydroxyapatite in the extracellular matrix and in cells of the media (VCm) or intima (VCi) of the arterial wall. Both patterns of VC often coincide and occur in patients with type II diabetes, chronic kidney disease, and other less frequent disorders; VCs are also typical in senile degeneration. In this article, we review the current state of knowledge about the pathology, molecular biology, and nosology of VCm, expand on potential mechanisms responsible for poor prognosis, and expose some of the directions for future research in this area.

Malignant Mönckeberg medial calcific sclerosis

“…Then, calcifications may progress to involve up to three quadrants of the cross section (stage 2) or the entire vascular circumference (stage 3), distorting the architecture of the media. In stage 4, foci of bone formation may be found within the arterial media until they undergo osseous metaplasia giving rise to true bony trabeculae [3]. In our patient, MCS had a unique course because of the widespread distribution of vascular calcifications and the absence of classical risk factors for this complication, except for ESRD.…”

“…affected, other underlying disorders can be recognized (e.g., atherosclerosis, vasculitis) [3]. Our patient was only 50 years old and had no diabetes or atherosclerotic risk factors.…”

“…VCm is very common in CKD, and its incidence increases with renal function worsening, CKD duration, and especially time on hemodialysis [1,2]. Our patient was not yet on dialysis when ischemic lesions appeared; although we cannot date the onset of her kidney disease, such a widespread vascular calcification in the literature is usually associated with years of hemodialysis dependence [3]. A number of non-traditional risk factors are associated with vascular calcifications in CKD, in particular Ca-P metabolism abnormalities and high PTH levels.…”

“…The prevalence of vascular calcification of the media (VCm) of MCS type is estimated to be ~ 0.5% in adults, with the highest prevalence in type 2 diabetes patients. ESRD (end-stage renal disease) patients with VCm have less conventional risk factors for atherosclerosis, greater prevalence of Ca-P disorders, and a longer time on hemodialysis [3]. MCS is commonly observed in muscle-type conduit arteries, and is usually revealed in the arteries of the extremities, whereas a systemic distribution with involvement of visceral arteries appears uncommon [1].…”

Imaging Cardiovascular Calcification

“…Calcification of the arterial vessel's intimal and medial layer is presumed to have a different pathogenesis and clinical consequences 11. The intimal layer consists of endothelial cells that undergo a series of processes and eventually form atheromatous plaques that can cause plaque rupture and subsequent thromboembolic events,12 whereas the medial layer consists of smooth muscle cells and elastic fibers that can regulate blood flow and arterial pressure.…”