The antiphospholipid (Hughes) syndrome (APS) is characterized by recurrent arterial or venous thromboembolism, or pregnancy loss, in association with antiphospholipid antibodies. These antibodies may be associated with premature or accelerated atherosclerosis and emerging evidence supports the concept of a vasculopathy in the APS that may lead to arterial stenotic lesions, possibly contributing to vascular occlusions and pregnancy morbidity.