What is Vascular Disease?
Vascular disease is a term used to describe disorders of the blood vessels that can impair proper blood flow. The two main types of vascular disease include:
- Arterial Disease
- Venous Disease
Arterial disease refers to blockages in the arteries, the vessels that carry oxygen-rich blood from the heart to various parts of the body.
This can include the arteries of the arms and legs, the heart, and the arteries that supply blood to the brain and other vital organs.
What causes arterial disease?
- Atherosclerosis is the most common form of arterial disease (often times referred to as “hardening of the arteries”).
- Cholesterol and fatty substances build up in the walls of the arteries, forming a thick material known as plaque.
Eventually, the build up of plaque can result in a narrowing of the artery, which reduces or completely obstructs the flow of blood. A partial or incomplete blockage of a vessel is called a stenosis, whereas a complete blockage is called an occlusion.
Without oxygenated blood, important organs may fail to function properly.
- In the brain, this can lead to symptoms of stroke.
- In the legs, this can result in pain and cramping associated with walking. In severe cases, pain can occur even at rest!
- In the kidneys, this can result in high blood pressure.
Risk factors of arterial disease:
- High Blood Pressure
- High Cholesterol
- Lack of exercise
- A family history of vascular disease
Arterial disease is more likely to occur in people over 45 years of age. The most common types of arterial disease are:
- Cerebrovascular Disease
- Peripheral Arterial Disease (PAD)
- Abdominal Vascular Disease
Cerebrovascular Disease refers to blockages in the main arteries that lead to the brain. Severe blockages in any of these arteries can interrupt the blood supply to the brain and result in a stroke, or cerebrovascular accident (CVA).
There are two main types of stroke:
1. Ischemic Stroke – occurs when an artery supplying blood to the brain becomes blocked enough to restrict blood flow.
2. Hemorrhagic Stroke – occurs when an artery in the brain leaks or ruptures. Hemorrhagic stroke is often related to a head injury or ruptured aneurysm.
Strokes are frequently caused by atherosclerotic build-up in the carotid arteries, located in the neck. The carotid artery is divided into two branches – the internal carotid artery, which supplies blood to the eye and brain, and the external carotid artery, which supplies blood to the face.
Common symptoms of stroke may include:
- Sudden numbness or weakness of the face, are or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance
- Sudden severe headache with no known cause
*There may be no symptoms in the early stages of cerebrovascular disease, and a stroke could be the first sign of a problem. Strokes, however, are often preceded by a warning signal called a Transient Ischemic Attack (TIA), or “mini-stroke.” A TIA is temporary, and the symptoms may last a few seconds or several hours. It is important to recognize the warning signs and report them to your physician immediately!
Peripheral Arterial Disease (PAD) refers to blockages in the peripheral arteries (the arteries in the arms and legs). The most common cause of PAD is atherosclerosis where cholesterol and fatty substance build up in the walls of the arteries forming what is referred to as “plaque”. Eventually, plaque can result in loss of flexibility and narrowing of the artery, reducing or completely obstructing the flow of blood.
If left untreated, a number of symptoms may result, including:
- Persistent coldness or numbness in the feet or hands
- Pain or aching in your legs with walking
- Resting pain in your foot at night
- Ulcers or sores in your toes or feet that have difficulty healing
- Gangrene (tissue death)
Abdominal Vascular Disorders
Aneurysms are dilatations or enlargements that develop in weakened areas of arteries. An aneurysm in the aorta, the largest artery in the abdomen, is known as an abdominal aortic aneurysm (AAA). Aneurysms pose a threat due to the risk of rupturing, clotting, or dissecting (causing a flap-like tear). A ruptured AAA is a life-threatening event, and can be fatal.
Most people with AAA do not have any signs or symptoms for years, until it ruptures. Risk factors include aging, smoking, high blood pressure and family history of AAA.
Renal Artery Stenosis refers to a narrowing or blockage of the renal artery, which supplies blood to the kidneys. A significant renal artery stenosis can contribute to hypertension (high blood pressure) and can be a major factor in the development of kidney failure.
Mesenteric Artery Stenosis is a narrowing or blockage of the mesenteric artery, which supplies blood to the stomach, intestine and other abdominal organs. Mesenteric artery stenosis can result in mesenteric ischemia (lack of blood to organs fed by this artery) which can be potentially life-threatening. Symptoms of significant mesenteric artery stenosis may include:
- Abdominal pain
- Chronic diarrhea
- Unexplained weight loss
- Fear of food
- Pain associated with eating
Raynaud’s Syndrome/Raynaud’s Phenomenon describes a condition characterized by intermittent episodes of ischemia (inadequate blood supply) to the skin. A Raynaud’s “attack” or episode usually occurs during exposure to cold temperatures and primarily affects the digits (fingers and/or toes).
Blood vessels near the skin surface normally become smaller (vasoconstrict) when exposed to cold temperatures in order to reduce heat loss, and then increase in size (vasodilate) when exposed to warm or hot temperatures.
In a person with Raynaud’s phenomenon, these blood vessels close entirely when exposed to cold temperatures and are slower to dilate once the temperature increases.
A symptom that is characteristic of Raynaud’s phenomenon is a three-phase skin discoloration that goes from white to blue to red. Initially, the digits involved turn white because of the lack of blood. The digits then turn blue due to the prolonged lack of oxygen. Finally, the blood vessels reopen, causing a “flushing” which turns the digits red.
Venous disease typically refers to blockages in the veins, most commonly caused by blood clots. Veins return de-oxygenated blood from all areas of the body back to the heart.
Venous disease can occur in people of any age. Two main types of venous disease are:
- Blood clots
- Venous insufficiency
Blood Clots most commonly occur in the legs, and when located within the deeper-lying veins are referred to as Deep Vein Thrombosis or DVT.
DVT may progress to the point where it obstructs blood flow within the vein, commonly resulting in pain and swelling of the limb. Deep vein thrombosis may also break away from the vessel wall and travel to the heart & lungs. This is called a pulmonary embolism (PE) which is potentially a life threatening event.
Some common risk factors of DVT include:
- Prior history of deep vein thrombosis (DVT) or pulmonary embolus (PE)
- Valves inside the veins can become damaged resulting in dilated veins and the pooling and stagnation of blood which can lead to increased likelihood of clotting.
- Active Cancer
- Recent trauma to veins or surgery
- Prolonged bed rest or other instances of extended inactivity, such as a long car or plane ride
- Oral contraceptives or hormone replacement therapy
- Family history of DVT, or blood clotting disorder
- Active cancer and some cancer treatments
- Disorders that involve increased blood clotting
- Symptoms of DVT may include:
- Pain, swelling or tenderness in the limb
- A bluish discoloration of the skin
- An abnormal flush or redness of the skin
- Suspected pulmonary embolus (see symptoms of pulmonary embolus)
Symptoms of a pulmonary embolism (PE) may include:
- Sudden onset of chest pain
- Unexplained shortness of breath
- Unexplained rapid heart rate
- Unexplained low-grade fever
Superficial Thrombophlebitis refers to a clot and inflammation, which has formed in a superficial vein near the surface of the skin. The condition may follow an injury to a vein or the recent use of an intravenous (IV) line or catheter. It also may occur for no apparent reason for those at risk, such as individuals with varicose veins.
Superficial Thrombophlebitis is usually not of great medical concern (although it can be rather painful) and responds well to treatment. Treatment can include NSAIDs to reduce inflammation, and support stockings. Symptoms may include pain, swelling and redness in the area of the vein.
Causes and Risk Factors for Superficial Thrombophlebitis:
- Varicose Veins
- Use of birth control pills
- Sitting or staying still for a prolonged period
- Disorders that involve increased blood clotting
Venous Insufficiency or Venous Reflux Disease – When veins cannot return blood to the heart properly, it is referred to as venous insufficiency. Most of the veins in the body have valves that open to allow blood to flow upward toward the heart and then close to prevent blood from moving backward, toward the feet. When valves do not close properly, blood can drain back, away from the heart, and increase the pressure in the vein.
Over time, the increased pressure in the veins can cause swelling in the limb and even tissue-damage (darkening of the skin or non-healing sores called ulcers). People with significant venous insufficiency are at a higher risk for developing blood clots due to the pooling of blood in the veins with increased pressure.
Varicose veins are a result of venous insufficiency in the superficial veins (veins near the surface of the skin). People with varicose veins often experience fatigue and aching in their legs, and skin changes including redness, rashes and sores.
Risk factors of varicose veins/venous insufficiency:
- Family history of varicose veins
- Multiple pregnancies
- Careers that require standing for long periods
- Careers that require heavy lifting
- History of deep vein thrombosis (DVT)
Varicose veins are treatable, and many treatment options exist. Including:
- Compression stockings
- Vein ablation (closing a vein with radiofrequency or laser)
- Vein stripping (surgically removal of a vein)
- Sclerotherapy (injecting medication to close a vein)
Prevention of Vascular Disease
Plaque doesn’t go away. Although some surgical procedures can improve blood flow in damaged arteries or veins, prevention is the best treatment for vascular disease. Prevention is best achieved by controlling risk factors that contribute to vascular disease.
- Stop Smoking – Chemicals found in tobacco can injure blood vessel walls, increase the build up of plaque and impair circulation. Smoking inhibits the ability of your lungs to provide adequate oxygen, which requires the heart to work harder.
- Control Diet – A high fat diet can lead to vascular disease. Typically, less than one third of your daily calories should be from fats. Eat fruit and vegetables daily. Lose excess weight. (Consult your doctor or dietician before making any serious dietary changes.)
- Control High Blood Pressure – Take medication as prescribed and visit your doctor regularly.
- Exercise Daily – Exercise can help to increase the amount of oxygen in your blood and help lower your blood pressure. Exercise improves circulation and helps develop collateral circulation where necessary in the body (Consult your doctor to help you design an exercise program that is right for you).
- Avoid Immobilization – If you are traveling, or recovering from an illness, try to walk at least once an hour. Massage legs to increase blood flow. Drink plenty of fluids and avoid constrictive clothing.
- Manage Diabetes – If your blood sugar level is high your arteries may narrow. This limits blood flow to your body including your heart.
- Know the warning signs for stroke
- Numbness or weakness of one side of the body involving the arm leg or face
- Temporary loss of vision in one eye
- Falling for no apparent reason
- Loss of Balance
- Blurred or double vision with a return to normal vision in a short time
- Difficulty speaking or understanding spoken or written words
- Loss of memory for brief periods of time that cannot be recalled
*The warning signs may last a few seconds or several hours. Many people ignore the signs because they do go away usually within 24 hours. It is important to recognize the warning signs and report them to your doctor.