Vascular disease explained

Vascular disease
Types:Peripheral artery disease, Renal artery stenosis
Diagnosis:Venography, Ultrasound
Treatment:Quit smoking, Lower cholesterol

Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood and lymph vessels can cause a range of health problems that can sometimes become severe, and fatal.[1] Coronary heart disease for example, is the leading cause of death for men and women in the United States.[2]

Types

There are several types of vascular disease, including venous diseases, and arterial diseases, and signs and symptoms vary depending on the disease. Those of the arterial system are associated with blood supply to tissues and its obstruction due to blockages or narrowing. In the venous system disorders are often caused by a slow return of blood due to insufficient valves, or to a blood clot.[3]

Venous disease

Most disorders of the veins involve obstruction such as a thrombus or insufficiency of the valves, or both of these.[4] [5] [6] Other conditions may be due to inflammation.

Phlebitis

Phlebitis is the inflammation of a vein. It is usually accompanied by a blood clot when it is known as thrombophlebitis. When the affected vein is a superficial vein in the leg, it is known as superficial thrombophlebitis, and unlike deep vein thrombosis there is little risk of the clot breaking off as an embolus.[7]

Venous insufficiency

See main article: article and Chronic venous insufficiency. Venous insufficiency is the most common disorder of the venous system, and is usually manifested as either spider veins or varicose veins. Several treatments are available including endovenous thermal ablation (using radiofrequency or laser energy), vein stripping, ambulatory phlebectomy, foam sclerotherapy, laser, or compression.

Postphlebitic syndrome is venous insufficiency that develops following deep vein thrombosis.[8]

Venous thrombosis

Venous thrombosis is the formation of a thrombus (blood clot) in a vein. This most commonly affects a deep vein known as deep vein thrombosis (DVT). DVT usually occurs in the veins of the legs, although it can also occur in the veins of the arms. Immobility, active cancer, obesity, traumatic damage and congenital disorders that make clots more likely are all risk factors for deep vein thrombosis. It can cause the affected limb to swell, and cause pain and an overlying skin rash. In the worst case, a deep vein thrombosis can extend, or a part of a clot can break off as an embolus and lodge in a pulmonary artery in the lungs, known as a pulmonary embolism.The decision to treat deep vein thrombosis depends on its size, a person's symptoms, and their risk factors. It generally involves anticoagulation to prevents clots or to reduce the size of the clot. Intermittent pneumatic compression is a method used to improve venous circulation in cases of edema or in those at risk from a deep vein thrombosis.

A clot can also form in a superficial vein (superficial venous thrombosis) which is normally not clinically significant, but the thrombus can migrate into the deep venous system where it can also give rise to a pulmonary embolism.[9]

Portal hypertension

The portal vein also known as the hepatic portal vein carries blood drained from most of the gastrointestinal tract to the liver. Portal hypertension is mainly caused by cirrhosis of the liver. Other causes can include an obstructing clot in a hepatic vein (Budd Chiari syndrome) or compression from tumors or tuberculosis lesions. When the pressure increases in the portal vein, a collateral circulation develops, causing visible veins such as esophageal varices.

Vascular anomalies

A vascular anomaly can be either a vascular tumor or a birthmark, or a vascular malformation.[10] In a tumor such as infantile hemangioma the mass is soft, and easily compressed, and their coloring is due to the dilated anomalous involved veins.[11] They are most commonly found in the head and neck. Venous malformations are the type of vascular malformation that involves the veins. They can often extend deeper from their surface appearance, reaching underlying muscle or bone.[12] In the neck they may extend into the lining of the mouth cavity or into the salivary glands. They are the most common of the vascular malformations.[13] A severe venous malformation can involve the lymph vessels as a lymphaticovenous malformation.

Arterial disease

Lymphatic disease

Mechanism

Vascular disease is a pathological state of large and medium muscular arteries and is triggered by endothelial cell dysfunction.[21]

Because of factors like pathogens, oxidized LDL particles and other inflammatory stimuli endothelial cells become active.[22]

The process causes thickening of the vessel wall, forming a plaque that consists of proliferating smooth muscle cells, macrophages and lymphocytes.[23] [24]

The plaque results in restricted blood flow, decreasing the amount of oxygen and nutrients that reach certain organs.[25]

This plaque can also rupture, causing the formation of clots.[26]

Diagnosis

Diagnosing vascular disease can be complex due to the variety of symptoms vascular diseases can cause. Reviewing a patient's family history and conducting a physical examination are important steps in making a diagnosis. Physical exams may differ depending on the type of vascular disease suspected. For example, in the case of a peripheral vascular disease, a physical exam consists of checking blood flow in a patient's legs.[27] [28]

Treatment

Treatment varies based on the type of vascular disease being treated. In treating renal artery disease, a 2014 study indicates that balloon angioplasty can improve diastolic blood pressure and potentially reduce antihypertensive drug requirements.[29] In the case of peripheral artery disease, treatment to prevent complications is important; without treatment, sores or gangrene (tissue death) may occur.

More generally, treatments for vascular disease may include:[30]

Further reading

Notes and References

  1. Web site: Vascular Diseases: MedlinePlus . 2015-06-23 . www.nlm.nih.gov.
  2. Web site: Coronary Artery Disease . 13 February 2023 . medlineplus.gov.
  3. Hirsch . Alan T. . Haskal . Ziv J. . Hertzer . Norman R. . Bakal . Curtis W. . Creager . Mark A. . Halperin . Jonathan L. . Hiratzka . Loren F. . Murphy . William R.C. . Olin . Jeffrey W. . Puschett . Jules B. . Rosenfield . Kenneth A. . Sacks . David . Stanley . James C. . Taylor . Lloyd M. . White . Christopher J. . 29 . 2006 . ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎ Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) . Journal of the American College of Cardiology . 47 . 6 . e1–e192 . 10.1016/j.jacc.2006.02.024 . 2016-02-02 . free . White . John . White . Rodney A. . Antman . Elliott M. . Smith . Sidney C. . Adams . Cynthia D. . Anderson . Jeffrey L. . Faxon . David P. . Fuster . Valentin . Gibbons . Raymond J. . Halperin . Jonathan L. . Hiratzka . Loren F. . Hunt . Sharon A. . Jacobs . Alice K. . Nishimura . Rick . Ornato . Joseph P..
  4. Goel . RR . Hardy . SC . Brown . T . 30 September 2021 . Surgery for deep venous insufficiency. . The Cochrane Database of Systematic Reviews . 2021 . 9 . CD001097 . 10.1002/14651858.CD001097.pub4 . 8483065 . 34591328.
  5. Web site: Publishing . Licorn . 9 April 2013 . The venous valves of the lower limbs . 9 January 2023 . Servier - Phlebolymphology.
  6. Web site: 20.1 Structure and Function of Blood Vessels - Anatomy and Physiology 2e OpenStax . 25 January 2023 . openstax.org . en.
  7. Di Nisio M, Wichers IM, Middeldorp S . February 2018 . Treatment for superficial thrombophlebitis of the leg . Cochrane Database Syst Rev . 2018 . 2 . CD004982 . 10.1002/14651858.CD004982.pub6 . 6953389 . 29478266.
  8. Kahn SR . August 2006 . The post-thrombotic syndrome: progress and pitfalls . British Journal of Haematology . 134 . 4 . 357–65 . 10.1111/j.1365-2141.2006.06200.x . 16822286 . 19715556 . free.
  9. Cosmi . B. . July 2015 . Management of superficial vein thrombosis . Journal of Thrombosis and Haemostasis . 13 . 7 . 1175–1183 . 10.1111/jth.12986 . 25903684 . free.
  10. Steiner . JE . Drolet . BA . September 2017 . Classification of Vascular Anomalies: An Update. . Seminars in Interventional Radiology . 34 . 3 . 225–232 . 10.1055/s-0037-1604295 . 5615389 . 28955111.
  11. Chim . H . Drolet . B . Duffy . K . Koshima . I . Gosain . AK . August 2010 . Vascular anomalies and lymphedema. . Plastic and Reconstructive Surgery . 126 . 2 . 55e–69e . 10.1097/PRS.0b013e3181df803d . 20679788 . 30865392.
  12. Chen . RJ . Vrazas . JI . Penington . AJ . January 2021 . Surgical Management of Intramuscular Venous Malformations. . Journal of Pediatric Orthopedics . 41 . 1 . e67–e73 . 10.1097/BPO.0000000000001667 . 32815867 . 221199574.
  13. Markovic . JN . Shortell . CK . October 2021 . Venous malformations. . The Journal of Cardiovascular Surgery . 62 . 5 . 456–466 . 10.23736/S0021-9509.21.11911-1 . 34105926.
  14. Web site: Peripheral Arterial Disease: MedlinePlus . 2015-06-23 . www.nlm.nih.gov.
  15. Web site: 2017-10-18 . Erythromelalgia . 2019-01-04 . nhs.uk . en.
  16. Web site: Renal Artery Stenosis . 2015-06-23 . www.niddk.nih.gov.
  17. Web site: Thromboangiitis obliterans: MedlinePlus Medical Encyclopedia . 2015-06-23 . www.nlm.nih.gov.
  18. Web site: Raynaud's Disease: MedlinePlus . 2015-06-23 . www.nlm.nih.gov.
  19. Web site: Disseminated intravascular coagulation (DIC): MedlinePlus Medical Encyclopedia . 2015-06-25 . www.nlm.nih.gov.
  20. Web site: 2017-10-24 . Stroke . 2022-06-29 . nhs.uk . en.
  21. Rajendran . Peramaiyan . Rengarajan . Thamaraiselvan . Thangavel . Jayakumar . Nishigaki . Yutaka . Sakthisekaran . Dhanapal . Sethi . Gautam . Nishigaki . Ikuo . 2013 . The Vascular Endothelium and Human Diseases . International Journal of Biological Sciences . 9 . 10 . 1057–1069 . 10.7150/ijbs.7502 . 1449-2288 . 3831119 . 24250251.
  22. Book: Bikfalvi, Andreas . Encyclopedic Reference of Vascular Biology & Pathology . 2013-12-19 . Springer . 9783642570636 . en.
  23. Book: Rubin, Emanuel . Pathology Reviews · 1989 . Damjanov . Ivan . 2013-11-11 . Springer Science & Business Media . 9781461245025 . en.
  24. Book: Gunstone, Frank D. . The Lipid Handbook with CD-ROM, Third Edition . Harwood . John L. . Dijkstra . Albert J. . 2007-03-13 . CRC Press . 9781420009675 . en.
  25. Book: Rolfes, Sharon Rady . Understanding Normal and Clinical Nutrition . Pinna . Kathryn . Whitney . Ellie . 2011-06-20 . Cengage Learning . 978-0840068453 . en.
  26. Ząbczyk . Michał . Natorska . Joanna . Undas . Anetta . 2021-07-05 . Fibrin Clot Properties in Atherosclerotic Vascular Disease: From Pathophysiology to Clinical Outcomes . Journal of Clinical Medicine . 10 . 13 . 2999 . 10.3390/jcm10132999 . 2077-0383 . 8268932 . 34279484 . free.
  27. Web site: How Is Peripheral Arterial Disease Diagnosed? - NHLBI, NIH . 2015-06-23 . www.nhlbi.nih.gov.
  28. Andras . Alina . Ferket . Bart . 2014 . Screening for peripheral arterial disease . Cochrane Database of Systematic Reviews . en . 4 . CD010835 . 10.1002/14651858.CD010835.pub2 . 11103656 . 24711093.
  29. Jenks . Sara . Yeoh . Su Ern . Conway . Bryan R. . 2014 . Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis . The Cochrane Database of Systematic Reviews . 12 . 12 . CD002944 . 10.1002/14651858.CD002944.pub2 . 1469-493X . 7138037 . 25478936.
  30. Web site: How Is Peripheral Arterial Disease Treated? - NHLBI, NIH . 2015-06-23 . www.nhlbi.nih.gov.

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