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L7 (26th – 30th November 2016)

Histology of blood vessels
All humans and animals require a mechanism to distribute oxygen and nutrition to the
tissues and to collect CO2 and waste product of tissue metabolism to the secretory
system. This is done by the blood vascular system. The latter consist of (1). a heart
which is the muscular pump, (2). various types of blood vessels and (3). blood. The
blood vessels are the part of the circulatory system that transports blood throughout
the human body. There are 3 major types of blood vessels: the arteries, which carry
the blood away from the heart; the capillaries, which enable the actual exchange of
water and chemicals between the blood and the tissues; and the veins, which carry
blood from the capillaries back toward the heart. The meaning of the word vascular,
relating to the blood vessels, is derived from the Latin vas, means vessel (Fig.1).

(Fig.1): Distribution of blood vessels around the whole body.

Cellular (tissue) Structure of Blood vessels:

The arteries and veins have three layers, but the middle layer is thicker in the arteries
than it is in the veins (Fig. 2-4):
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(Fig. 2): A 3D diagram to demonstrate the layers of the artery.

(1). Tunica intima (the thinnest layer): is a single layer of simple squamous
endothelial cells glued by a polysaccharide intercellular matrix, surrounded by a thin
layer of sub-endothelial connective tissue interlaced with a number of circularly
arranged elastic bands called the internal elastic lamina.

(Fig 3): CS of artery and vein within a dipose CT where two autonomic nerve fascicles
are seen nearby. Note the difference in the thickness of these structures.

(2). Tunica media (the thickest layer in arteries): circularly arranged elastic fiber,
connective tissue, polysaccharide substances, the second and third layer are separated
by another thick elastic band called external elastic lamina. The tunica media may
(especially in arteries) be rich in vascular smooth muscle, which controls the caliber
of the vessel.

(3). Tunica adventitia: (the thickest layer in veins) entirely made of connective tissue.
It also contains nerves that supply the vessel as well as nutrient capillaries (vasa
vasorum) in the larger blood vessels. Nerve endings could well be seen in adventitia.
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There is a layer of muscle surrounding the arteries and the veins which help contract
and expand the vessels. This creates enough pressure for blood to be pumped around
the body.

(Fig. 4): 3D of artery, vein and capillary to demonstrate the difference between their
layers.

There are various kinds of blood vessels:

(1). Arteries: They are classified as:
(a). Elastic (large sized arteries) e.g. Aorta: During systole, the elastic artery expands
to accommodate increased amount of blood but at diastole of the heart, there is elastic
recoil of the artery, so there is continuous blood flow to the peripheral parts of the
body. Since these arteries have abundant elastic fibers in their walls, these are
named elastic arteries. The lumen of the artery is surrounded by 3 concentric coats
(i): Tunica intima; (ii) Tunica media, and (iii): Tunica adventitia (Fig.5).
(i). The tunica intima consists of an endothelium, sub-endothelium Co.T. and an
internal elastic lamina. The endothelium is a thin layer of flattened cells, lining the
luminal surface of the artery. These cells rest on a basement membrane. Sub-
endothelial CT is a loose narrow layer containing elastic and collagen fibers along
with nuclei of fibroblasts and macrophages. The internal elastic lamina is the limiting
layer of tunica intima and is made up of fenestrated elastic fibers. The internal elastic
lamina is not prominent as elastic fibers merge with the elastic laminae of the tunica
media.
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(Fig. 5): Cross section in an elastic artery shows details of the wall.
(ii). The tunica media or middle layer is the thickest and is dominated by Co.T. of
elastic fibers with smooth muscle fibers. It comprises two-third (2/3) of the arterial
wall. The outer layer of the tunica is the external elastic lamina, made up of elastic
fibers, which is not so conspicuous.
(iii). The tunica adventitia is a layer of collagen fibers, elastic fibers and fibroblasts. It
contains few arterioles called vasa vasorum which nourish the tunica adventitia and
outer two-third (2/3) of tunica media, the rest being nourished by blood flowing
through the lumen of the vessels. Tunica adventitia comprises one-third (1/3) of the
thickness of the arterial wall.

(Fig.6): The layers of artery (H&E).

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(b). Muscular (medium sized) arteries e.g. brachial, radial, politeal.: These arteries
control the amount of blood flowing through them according to the activity of the part
of the body. It consists of a lumen surrounded by the same three concentric coats.

(Fig. 7): A CS in a muscular artery shows the L- Lumen, IEL- Internal Elastic Lamina,
N- Nuclei, TI- Tunica intima, TM- Tunica media, EEL- External Elastic Lamina, TA-
Tunica adventitia.
(i): The tunica intima consists of an endothelium, sub-endothelium CT and an internal
elastic lamina. The endothelium is formed by lining of flattened cells, resting on
basement membrane. The sub-endothelium CT. consists of fine collagen and elastic
fibers as well as fibroblasts. The internal elastic lamina is well defined. The lamina of
elastic fibers stands out well (not prominent) as the media mainly consists of smooth
muscle fibers.
(ii). The tunica media forms of 2/3 of the thickness of the arterial wall. It is made up
of circularly or spirally running smooth muscle fibers. Among the muscle fibers are
elastic fibers. The external elastic lamina is made of elastic fibers and is better defined
than in elastic artery due to predominance of muscle fibers in the tunica media.
(iii). The tunica adventitia is a well defined layer comprising nearly 1/3 of the
thickness of the arterial wall. It contains collagen and elastic fibers. Arterioles in the
form of vasa vasorum are usually present in this layer.
(c). Arterioles (smallest divisions of arteries) with a diameter of 100 µm. These are
the smallest divisions of the arteries which acts as resistance vessels to maintain
peripheral blood pressure. The 3 conventional concentric coats surround the lumen
are:
(i). The tunica intima consists of endothelium closely applied to the internal elastic
lamina with a mere trace of sub-endothelial CT.
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(ii). The tunica media is made up of a layers of circularly arranged smooth muscle
fibers and an outer elastic lamina.
(iii). The tunica adventitia is made of collagen as well as elastic fibers and is usually
a thick layer.

(Fig. 8): A comparison between the layers of three blood vessels in CS.
Blood vessels do not actively engage in the transport of blood (they have no
appreciable peristalsis), but arteries, and veins to a degree, can regulate their inner
diameter by contraction of the muscular layer. This changes the blood flow to
downstream organs, and is determined by the autonomic nervous system. Vaso-
dilation and vaso-constriction are also used antagonistically as methods
of thermoregulation. Oxygen, bound to hemoglobin in RBC, is the most critical
nutrient carried by the blood. In all arteries, apart from the pulmonary artery,
hemoglobin is highly saturated (95-100%) with oxygen. In all veins apart from
the pulmonary vein, the hemoglobin is desaturated at about 75%.
Blood vessels play a huge role in virtually every medical condition. Cancer, for
example, cannot progress unless the tumor causes angiogenesis (formation of new
blood vessels) to supply the malignant cells' metabolic demand. Atherosclerosis, the
formation of lipid lumps (atheromas) in the blood vessel wall, is the most common
cardiovascular disease, the main cause of death in the Western world.
Blood vessel permeability is increased in inflammation. Damage, due to trauma or
spontaneously, may lead to hemorrhage due to mechanical damage to the vessel
endothelium. In contrast, occlusion of the blood vessel by atherosclerotic plaque, by
an embolised blood clot or a foreign body leads to downstream ischemia (insufficient
blood supply) and possibly necrosis. Vessel occlusion tends to be a positive feedback
system; an occluded vessel creates eddies in the normally laminar flow or plug
flow blood currents. These eddies create abnormal fluid velocity gradients which push
blood elements such as cholesterol or chylomicron bodies to the endothelium. These
deposit onto the arterial walls which are already partially occluded and build upon the
blockage.
Capillaries:
Form a link between the arterioles (small division of an artery) and the venules
(smallest tributary of a vein). The diameter of a capillary is about 8-10 um. Its lumen
larger than the diameter of an erythrocyte. One to three endothelial cells with
stretched out cytoplasm line the lumen and rest on the basement membrane. Outside
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the basement membrane is a fine layer of collagen and elastic fibers with occasional
perivascular cells or pericytes (Fig 9). Usually the edge of endothelial cells fuse
with those of adjacent cells, making the lining continuous. These capillaries are
termed as "continuous capillaries". The exchange occurs through the cytoplasm by the
formation of pinocytic vesicles.

. (Fig. 9): Pericyte arrangement around the capillaries as indicated in both 3D and 2D,
respectively.

(Fig. 10): A ruptured Capillary shown as a colored SEM in which RBC are filtrating out
to the connective tissue to cause edema. (Fig. 11): A TEM micrograph of a cappilary
with an RBC inside occupying almost all the lumen with a thin endothelial lining of a
single simple squamous epitheila cells.

Capillaries are the smallest type of blood vessel, often only just large enough for red
blood cells to pass through. Capillaries consist of little more than a layer
of endothelium and occasional connective tissue. When the wall of the capillary
ruptures, the RBC would easily leak into the injured tissue to cause edema (Fig. 10).
When blood vessels connect to form a region of diffuse vascular supply it is called
an anastomosis (pl. anastomoses) (Fig.4).
Anastomoses provide critical alternative routes for blood to flow in case of blockages.
In viscera like kidney, small intestine and endocrine glands the capillaries are
fenestrated i.e. have minute apertures/pores between the adjacent endothelial cells.
The pores may be closed by thin membrane either of the basal lamina or thinned out
cytoplasm of the endothelial cells. The greater exchange in fenestrated capillaries
occurs through these pores (Fig.12).
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(Fig. 12): The three types of capillaries in 3D showing the arrangement of the
endothelial cells in each for comparison purposes.
Shunt vessels or Arteriovenous Anastomoses (AV Anastomoses):
In many organs in the body, the arterioles and venules may also be connected to each
other through a direct channels called A-V anastomoses. Through these most of the
blood passes directly from arteriole to venule and bypasses the capillaries. These are
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present in skin of lips, nose, pinna, mucous membrane of gastrointestinal tract (GIT)
and are richly supplied by sympathetic nerves (Figs 13 a&b). These AV anastomoses
help to maintain body temperature by decreasing the flow of blood through capillaries
in cold weather and enhancing the flow in hot climate.

(Fig. 13): Shunt arrangement (structure and interconnection between arteries and veins)
(a&b).