Obliterative foam-cell arteriopathy. A unifying concept embracing several entities previously described as radiation, decidual, transplant, and intratumoral-associated arteriopathy.

This review article aimed to postulate the existence of a specific arterial injury having as its histological hallmark a collection of macrophages loaded with lipids in the intima of small-sized and medium-sized arteries causing narrowing or complete obstruction. The proposal is made that a series of previously described entities, such as ionizing radiation arteriopathy, acute atherosis (foam-cell decidual arteriopathy), transplant chronic arteriopathy of solid organ allografts, and intratumoral-associated foam-cell arteriopathy constitute different manifestations of the same basic morphological process identified as obliterative foam-cell arteriopathy (OFCA). OFCA is a local (single-organ) lesion in the aforementioned diverse processes with variable etiopathogenesis but converges in a single morphological marker. This arteriopathy is essentially an intimal disease. The processes in which the OFCA appears are known under a variety of names partly dependent on the location of the lesion. The basic unifying mechanism of the different entities is endothelial activation and dysfunction (local arterial endotheliopathy), preferably in small-sized or medium-sized arteries (100 to 500 μm in external diameter).