Vascular Disease

As the heart beats, it pumps blood through a system of blood vessels, called the circulatory system. The vessels are elastic tubes that carry blood to every part of the body. Arteries carry blood away from the heart and veins return blood back to the heart. Vascular disease includes any condition that affects your circulatory system, such as peripheral artery disease. This ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation.

At least half of the people with vascular disorders have no symptoms. If you have vascular disease, your risk for developing heart disease is six times greater. So it is critical to diagnose disorders accurately and early, because they can lead to progressive discomfort, long-term disability or even sudden death. Vascular disease can reduce your life expectancy by causing:

  • Heart attacks
  • Strokes
  • Ruptured blood vessels
  • Blood clots
  • Kidney failure
  • Lack of blood flow to the limbs resulting in tissue damage


Symptoms of Vascular Disease
Since vascular disease can occur anywhere there are arteries in the body, there are a variety of symptoms to watch for, including:

 

Symptoms of Peripheral Artery Disease (PAD)
This is a vascular disease that occurs in the arteries of the arms and legs. Symptoms of PAD include:

  • Skin discoloration
  • Decreased or absent pulses
  • Pain (during exercise) which worsens as disease worsens
  • Rest pain (pain that occurs when lying down)
  • Tissue loss (ulceration and/or gangrene which can lead to limb loss)

 

Symptoms of Venous Disease
This refers to all conditions caused by veins that become diseased or abnormal, typically affecting the legs. Venous Disease symptoms include:

  • Sudden pain/swelling of one leg
  • Pain and swelling of extremity(s)
  • Ulcer(s) that don’t heal, especially in ankle area
  • Large, protruding veins


Symptoms of Cerebrovascular Disease
This occurs in arteries of the neck that supply blood to the brain. Symptoms for Cerebrovascular Disease include:

  • Vision changes
  • Abnormal speech Weakness, numbness or paralysis
  • Abnormal noise in artery of neck heard by doctor through stethoscope
  • Transient Ischemic Attack (TIA) is a temporary loss of function related to temporary interruption of normal blood flow
  • Stroke is a sudden death of brain cells in a localized area due to inadequate blood flow


Causes of Vascular Disease:
The following are causes and conditions that fall under the category of vascular disease:

 

Aneurysm

  • An aneurysm is an abnormal bulge or weakness in the wall of a blood vessel. Aneurysms can form in any blood vessel, but occur most commonly in the aorta (aortic aneurysm) which is the main blood vessel leaving the heart:
  • Thoracic aortic aneurysm (a part of the aorta in the chest)
  • Abdominal aortic aneurysm (AAA) involve arteries above or below the kidneys

A small aneurysm generally poses no threat. However, you’re at increased risk for: Atherosclerotic plaque (fatty deposits) formation at the site of the aneurysm, a clot (thrombus) formation at the site and dislodgement, an increase in the aneurysm size causing pain from pressing on other organs, or an aneurysm rupture. In this case the artery wall thins at this spot and may burst under stress. A sudden rupture of an aortic aneurysm may be life threatening.

 

Buerger's Disease
This disease typically affects the small and medium sized arteries, veins and nerves. While the cause is unknown, there’s a strong association with tobacco use or exposure. The arteries of the arms and legs become narrowed or blocked, causing lack of blood supply (ischemia) to the fingers, hands, toes and feet. Pain occurs in the arms, hands, and more frequently the legs and feet, even at rest. With severe blockages, the tissue may die, requiring amputation of the fingers and toes. Superficial vein inflammation and symptoms of Raynaud's occur commonly in patients with Buerger's Disease.

 

Lymphedema
The lymphatic system is a circulatory system that includes an extensive network of lymph vessels and lymph nodes. It helps the immune system protect the body from foreign substances. Lymphedema is an abnormal build-up of fluid that causes swelling, most often in the arms or legs. It develops when lymph vessels or lymph nodes are missing, impaired, damaged or removed. Primary lymphedema is rare and caused by the absence of certain lymph vessels at birth or by abnormalities in the lymphatic vessels. Secondary lymphedema occurs as a result of a blockage or interruption that alters the lymphatic system. It can develop from an infection, malignancy, surgery, scar tissue formation, trauma, deep vein thrombosis (DVT), radiation or other cancer treatment.

 

Peripheral Artery Disease (PAD)
Like the blood vessels of the heart (coronary arteries), your peripheral arteries (blood vessels outside your heart) may also develop atherosclerosis, the build-up of plaque (fatty deposits) on the inside walls. Over time, the build-up narrows the artery. Eventually the narrowed artery causes less blood to flow, and a condition called ischemia can occur. Ischemia is an inadequate blood flow to the body's tissue.

  • A blockage in the legs can lead to pain or cramps with activity, changes in skin color, sores or ulcers and feeling tired in the legs. Total loss of circulation can lead to gangrene and amputation.

 

Peripheral Venous Disease
Veins are flexible, hollow tubes with flaps inside, called valves. When your muscles contract, the valves open, and blood moves through the veins. When your muscles relax, the valves close, keeping blood flowing in one direction through the veins.

If the valves inside your veins become damaged, they may not close completely. This allows blood to flow in both directions. When your muscles relax, the valves inside the damaged vein(s) can’t hold the blood, which can cause pooling of blood or swelling in the veins. The veins bulge and appear as ropes under the skin. The blood begins to move more slowly through the veins, it may stick to the sides of the vessel walls and blood clots can form.

 

Varicose Veins
Varicose veins are bulging, swollen, purple, ropy veins, seen just under your skin, caused by damaged valves within the veins. They are more common in women than men and often run in the family. They can also be caused by pregnancy, obesity or standing for long periods of time. Symptoms include:

  • Bulging, swollen, purple, ropy, veins seen under the skin
  • Spider veins - small red or purple bursts on your knees, calves or thighs, caused by swollen capillaries (small blood vessels)
  • Aching, stinging or swelling of the legs at the end of the day

 

Venous Blood Clots
Blood clots in the veins are usually caused by:
• Long bedrest and/or immobility
• Damage to veins from injury or infection
• Damage to the valves in the vein, causing pooling near the valve flaps
• Pregnancy and hormones (such as estrogen or birth control pills)
• Genetic disorders
• Conditions causing slowed blood flow or thicker blood, such as inflammatory bowel disease, congestive heart failure (CHF), or certain tumors
• Deep vein thrombosis (DVT) - a blood clot occurring in a deep vein
• Pulmonary embolism - a blood clot breaks loose from a vein and travels to the lungs
• Chronic Venous Insufficiency - occurs when damaged vein valves or DVT causes long-term pooling of blood and swelling in the legs. If uncontrolled, fluid will leak into the surrounding tissues in the ankles and feet, and may eventually cause skin breakdown and ulceration.

 

Raynaud's Phenomenon
Also called Raynaud's Disease or Syndrome, is characterized by spasms of the small arteries in the fingers, and sometimes, the toes, brought on by exposure to cold or excitement. The episodes produce temporary lack of blood supply to the area, causing the skin to appear white or bluish and cold or numb. In some cases, this may be related to underlying connective tissue disorders.

 

Renal Artery Disease
It is most commonly caused by atherosclerosis of the renal arteries. Renal arteries supply blood to the kidneys, adrenal glands and ureters. A blockage in these arteries can cause renal artery disease (stenosis). The symptoms include uncontrolled hypertension (high blood pressure), congestive heart failure, and abnormal kidney function. It occurs in people with generalized vascular disease. Less often, renal artery disease can be caused by fibromuscular dysplasia, a congenital (present at birth) abnormal development of the tissue that makes up the renal arteries.


Diagnosis of Vascular Disease
If you have the following risk factors, see your doctor to determine if you should be tested. Risk factors for vascular disease can include:

  • Cigarette smoking
  • Age 50 or older
  • Obesity
  • Diabetes
  • Heart disease
  • High cholesterol
  • High-stress lifestyle
  • High blood pressure
  • Family history of aneurysms
  • Sedentary lifestyle

 

The following diagnostic tests are used to measure and evaluate vascular disease:

  • Abdominal Aortic Ultrasound – This is to test for abdominal aortic aneurysms (AAA). A weakening, bulging or ballooning of the major artery in the abdomen, AAA is the ninth most common cause of death in America. Patients may not know if they have AAA and often the first symptom is a rupture. An ultrasound is a safe, reliable method of determining its presence.
  • Ankle-brachial Index -. This is a safe, painless test where a blood pressure cuff is placed above the ankles and compared to blood pressure in the arm to determine the risk of cardiovascular events.
  • Arterial Duplex Scan -. An arterial duplex scan is painless and highly accurate study which uses sound waves to evaluate blockage in certain arteries.
  • Arteriogram - Also referred to as an angiogram, this is an invasive test that uses a catheter (flexible, hollow tube) inserted into the artery. Dye is then injected so any blockages can be seen with X-rays. If a blockage is found, and if it is suitable to endovascular therapy, the treatment may be performed at the same time.
  • Doppler - A noninvasive diagnostic tool that uses ultrasound to detect blood flow in arteries and veins.
  • Duplex scan - It combines Doppler and noninvasive ultrasound imaging.
  • Ultrasound – This noninvasive test produces images of arteries and veins. For AAA, ultrasound is a reliable method of determining the presence and size of the aneurysm.


Treatments for Vascular Disease
The kind of treatment(s) you receive depends on the severity of your condition. Lifestyle changes such as quitting smoking, exercise and a heart-healthy diet are some. Other possible treatments for Vascular Disease include:

  • Thrombolytic therapy
  • Angioplasty/stenting
  • Bypass surgery
  • Medications

 

Frequently Asked Questions

 

Who should be tested for vascular disease?
You should be screened if you are age 55 and older, have smoked, have high blood pressure, high cholesterol, coronary disease or diabetes. Anyone with a family history of aneurysms should also be screened with duplex ultrasound. Early detection can prevent stroke, disability or death.


How do I know if I have circulatory problems in my legs?
When you walk, do you have pain or cramping in your leg muscles that goes away when you rest? After you rest, can you walk the same distance again before the pain stops you and you must rest? If you answered “yes” to these questions, you may be exhibiting symptoms of intermittent claudication (pain in the legs when you walk). The pain can be due to a decrease in blood flow to the legs. This diminished blood flow is most often the result of atherosclerosis: buildup of fatty deposits (plaque) on the insides of the arteries.

 

When should I see a vascular specialist?
Do not ignore your leg pain. The severity of the disease and length of time it goes untreated can make a big difference in your treatment and recovery. If you think you have a problem, talk to your doctor. Remember, atherosclerosis can occur in any of your arteries. If you are having symptoms in your legs, it’s possible arteries in your heart or neck could also be narrowing, setting you up for a possible heart attack or stroke.


What will a vascular specialist do?
A thorough medical history and physical exam will give the doctor information needed to determine if further tests are required. Your doctor may order a segmental pressure check test, to analyze the blood flow in your leg arteries. Blood pressure cuffs are wrapped around both arms and at four places along your leg: the upper thigh, lower thigh, upper calf and ankle. The test measures the blood pressure at each location, and compares this to the blood pressures in the arms. A decrease in blood pressure in the legs indicates arterial blockage. You may also have an ultrasound scan of your legs.

If angioplasty or surgery is being considered as a possible treatment, your doctor may recommend an angiogram. During an angiogram, in an artery typically by your groin, dye is placed through a catheter (a hallow, flexible tube) while X-rays are taken. The dye “lights up” your arterial system, pinpointing the exact location and severity of your blockages.

 

How can vascular disease be treated?
The best treatment depends on a number of factors. In some cases, lifestyle changes are enough to slow the progress and manage the disease. Sometimes, procedures are necessary to open up clogged blood vessels. The goal of any treatment program to reduce the number of risk factors and usually includes:

  • Exercise program on a regular basis
  • Reduction of fat, salt and cholesterol in your diet
  • Controlling diabetes and hypertension
  • Stop smoking, if you are a smoker it is absolutely essential that you stop

After your diagnostic testing is completed, your doctor will determine if you would benefit from angioplasty or a bypass procedure to treat the disease.