Vascular Disease Diagnosis and Treatment

Peripheral Artery Disease

Similar to coronary arteries, which supply the heart, peripheral arteries (blood vessels located outside the heart) can also develop atherosclerosis. This condition involves the accumulation of fat and cholesterol deposits, referred to as plaque, on the inner walls of the arteries. Over time, this build-up narrows the arteries, leading to reduced blood flow. When the blood supply to tissues becomes insufficient, a condition known as "ischaemia" arises.

A blockage in the coronary arteries may result in chest pain (angina) or a heart attack. A blockage in the carotid arteries, which supply blood to the brain, can lead to a transient ischaemic attack (TIA) or a stroke. A blockage in the leg arteries may cause claudication (pain or cramps during activity), skin discolouration, sores or ulcers, fatigue in the legs, or, in severe cases, gangrene and limb loss.

A blockage in the renal arteries (supplying the kidneys) can result in renal artery stenosis. Symptoms include uncontrolled high blood pressure, heart failure, and impaired kidney function.

Aneurysm

An aneurysm is an abnormal bulge in the wall of a blood vessel. While aneurysms can develop in any blood vessel, they are most frequently found in the aorta, the body's main artery. Aortic aneurysms are classified into two types:

• Thoracic aortic aneurysm: This occurs in the portion of the aorta located in the chest.
• Abdominal aortic aneurysm: Develops in the segment of the aorta in the abdomen.

Small aneurysms are usually harmless; however, they pose risks such as:

• Formation of atherosclerotic plaque at the site.
• Development and dislodgement of a clot (thrombus).
• Enlargement of the aneurysm, which may exert pressure on surrounding organs and cause pain.
• Rupture of the aneurysm due to thinning of the artery wall, potentially resulting in life-threatening bleeding.

Renal (Kidney) Artery Disease

Renal artery disease is primarily caused by atherosclerosis, which affects the renal arteries. It is commonly seen in individuals with generalised vascular disease. In rarer cases, it may result from congenital abnormalities in the structure of the renal arteries, typically affecting younger individuals.

Raynaud's Phenomenon

Also referred to as Raynaud's disease or Raynaud's syndrome, this condition involves spasms in the small arteries of the fingers and, occasionally, the toes. These spasms are triggered by cold exposure or emotional stress. Occupational exposure can also provoke episodes.

Symptoms include a temporary reduction in blood supply, leading to the affected areas becoming pale or bluish, cold, and numb. In some cases, Raynaud's may be linked to underlying conditions such as lupus, rheumatoid arthritis, or scleroderma.

Buerger's Disease

This condition predominantly affects the small- and medium-sized arteries, veins, and nerves, often in the arms and legs. While its exact cause is unknown, it has a strong correlation with tobacco use or exposure.

Symptoms include:

• Reduced blood supply (ischaemia) to the fingers, hands, toes, and feet.
• Persistent pain in the affected limbs, even at rest.
• Severe blockages leading to tissue death (gangrene), which may necessitate amputation.

Superficial vein inflammation and Raynaud-like symptoms are frequently observed in individuals with Buerger's disease.

Peripheral Venous Disease

Veins are hollow, flexible tubes equipped with valves that prevent blood from flowing backwards. When muscles contract, the valves open, allowing blood to flow. When muscles relax, the valves close, maintaining unidirectional blood movement.

If these valves are damaged, blood may flow in both directions, causing pooling and swelling in the veins. This leads to visible bulging veins beneath the skin and a slower blood flow, increasing the risk of clot formation.

Varicose Veins

Varicose veins are swollen, twisted veins that appear under the skin due to damaged valves. They are more common in women and tend to run in families. Contributing factors include pregnancy, excessive weight, and prolonged standing.

Symptoms:

• Bulging, swollen, purple veins.
• Spider veins—small, reddish or purplish bursts on the knees, thighs, or calves caused by swollen capillaries.
• Leg discomfort, such as swelling, aching, and stinging, or particularly in the evening or at bedtime.

Blood Clots in Veins

Blood clots in veins often result from:

• Extended periods of immobility or bed rest.
• Vein damage from injuries or infections.
• Valve damage leading to blood pooling.
• Pregnancy or hormonal factors, including contraceptive use.
• Genetic conditions.
• Slow or thickened blood flow caused by conditions like heart failure or tumours.

Types of clots:

• Deep vein thrombosis (DVT): A clot in a deep vein.
• Pulmonary embolism: A clot that travels to the lungs.
• Chronic venous insufficiency: A condition where damaged valves or a DVT cause long-term pooling, resulting in swelling, fluid leakage, and potential skin ulcers.

Blood Clotting Disorders

Blood clotting disorders increase the likelihood of clot formation in arteries or veins. They may be congenital or acquired. Causes include:

• Elevated levels of clotting factors.
• Deficiency in natural anticoagulants like antithrombin, protein C, or protein S.
• High blood cell counts.
• Impaired fibrin breakdown.
• Abnormal vessel lining changes.

Lymphedema

The lymphatic system, a crucial part of the circulatory and immune systems, includes lymph vessels and nodes. Lymphedema is characterised by abnormal fluid accumulation, leading to swelling, typically in the arms or legs.

• Primary lymphedema: A rare condition caused by congenital absence or abnormalities in lymph vessels.
• Secondary lymphedema: Results from blockages or interruptions in the lymphatic system due to infections, malignancies, trauma, surgery, deep vein thrombosis, or cancer treatments.

Takeaway

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