Peripheral (puh-RIH-fer-ul) vascular diseases include diseases or inflammation of the arteries or veins outside of the heart. Diseases that affect the arteries include peripheral artery disease, aneurysms, and Raynaud's disease. Diseases that affect veins include varicose veins, deep vein thrombosis, and chronic venous insufficiency.
There are two types of peripheral vascular disease:
Peripheral artery disease develops when the arteries outside the heart are narrowed by atherosclerosis * and hardened by arteriosclerosis * . Like coronary artery disease, this condition develops because plaque (fatty deposit) obstructs blood flow. Peripheral artery disease has many of the same risk factors as coronary artery disease, including aging, family history, smoking, diabetes * , high blood pressure, high cholesterol * , and obesity, as well as high blood levels of a particular amino acid (homocysteine). Blockage in the carotid arteries, which carry blood through the neck to the brain, can lead to a transient ischemic attack * , or stroke * . Blockage in the arteries that carry blood to the legs can result in poor blood circulation in the legs, leading to leg pain and cramps with activity (called intermittent claudication), delayed healing, open ulcers, and even gangrene * . Initially, pain only occurs with activity, but over time it may also occur at rest. Blockage in the renal (kidney) arteries can result in high blood pressure, congestive heart failure * , and, over time, kidney failure.
Peripheral artery disease is diagnosed by using a stethoscope to listen for abnormal sounds over the carotid arteries, comparing the blood pressure in the patient's arms and legs (called the ankle-brachial index), testing for high blood cholesterol and homocysteine, and demonstrating poor blood flow through the arteries of concern via ultrasound tests, magnetic resonance imaging (MRI) or computed tomography (CT) scans, or angiography (during which dye is injected into the blood vessels to highlight areas of obstruction).
While peripheral artery disease is a common problem of aging and often runs in families, an individual's risk can be lowered by adhering to basic preventive measures, including maintaining a healthy weight, eating a low-fat/low-cholesterol diet, never smoking or quitting smoking if already smoking, drinking only moderate quantities of alcohol, exercising regularly, learning and practicing stress reduction, and following directions for taking all prescriptions to maintain normal blood cholesterol and blood pressure and treat diabetes.
Aneurysms are abnormal bulges in the wall of an artery. Any artery can develop an aneurysm, although aneurysms are simultaneously most common and most dangerous when they occur within the largest artery of the body, the aorta (called an abdominal aortic aneurysm or thoracic aortic aneurysm, depending on its specific location), and when they occur within arteries of the brain (called intracerebral aneurysms). An aneurysm may be present at birth (congenital) or may occur over time.
Some of the same factors that cause atherosclerosis and arteriosclerosis—and are responsible for coronary artery disease and peripheral artery disease—can also increase an individual's risk for developing an aneurysm. Risk factors for aneurysm include being a male over age 60, having a family history of aneurysm, high blood pressure, smoking, high cholesterol, and excess alcohol intake. Additionally, aneurysms may occur in conjunction with a number of other medical conditions, such as Kawasaki syndrome * , Marfan syndrome * , presence of an abnormal bicuspid aortic valve, giant cell arteritis, polycystic kidney disease, systemic lupus erythematosus * , and Ehler-Danlos syndrome * .
Initially, an aneurysm does not usually cause symptoms, but it will continue to expand over time very gradually. Clots may form over the area of an aneurysm, risking obstruction of the blood vessel. The clot may also break off the site, travel through the blood circulation, and obstruct a vessel at a distance, causing death or disability. Alternatively, the aneurysm may eventually reach a size at which it presses on other structures, organs, or nerves in the vicinity, causing pain or disability. Most dangerous, as an aneurysm grows, the adjacent area of artery wall becomes thinner and more fragile. Eventually, the aneurysm may rupture (burst) and cause life-threatening hemorrhage (uncontrolled or abnormal bleeding).
Rupture of an aneurysm is a serious emergency. Symptoms of a ruptured aneurysm depend on its location. Rupture of an abdominal aortic aneurysm leads to severe abdominal and back pain, low blood pressure, dizziness, lightheadedness, and ultimately unconsciousness. Rupture of a brain aneurysm leads to stroke symptoms, such as severe headache, confusion, facial drooping, visual problems, problems speaking or understanding speech, difficulty walking, and weakness or paralysis of the muscles on one side of the body. An aneurysm may be suspected when a physician discovers a pulsing abdominal mass during a physical examination, but aneurysms are often discovered incidentally during tests for other conditions. Tests to confirm the presence of an aneurysm include ultrasound, computed tomography (CT) scan, and angiography.
Smaller aneurysms can be monitored over time, without specific treatment. Some aneurysms can be repaired and reinforced by permanently placing a graft made of artificial material into the area of artery where the aneurysm is located. A large aneurysm may call for surgery to remove the aneurysm and replace that area with a graft. A ruptured aneurysm requires immediate, emergency surgery. An individual's risk for aneurysm can be lowered by adhering to basic preventive measures, including maintaining a healthy weight, eating a low-fat/low-cholesterol diet, never smoking, drinking only moderate quantities of alcohol, exercising regularly, learning and practicing stress reduction, and following all directions for taking prescription medications to maintain normal blood cholesterol and blood pressure.
Raynaud's (RAY-noes) disease is an abnormality of the small arteries, called arterioles, that bring blood to the fingers and toes. In this disease, certain factors (exposure to cold temperatures or stressful and emotional situations) cause these arteries to spasm, preventing normal blood flow. About 75 percent of all Raynaud's sufferers are women between the ages of 15 and 40.
Risk factors for Raynaud's disease include repetitive stress injuries; exposure to nicotine, caffeine, and certain chemicals; certain medicines (including chemotherapy * agents, drugs used to treat migraine headache or high blood pressure, nonprescription cold and allergy medicines, and oral contraceptives); previous injury due to frostbite or other extreme cold exposure or hypothermia; and other diseases such as rheumatoid arthritis, Sjδgren's syndrome, Buerger's disease, scleroderma, systemic lupus erythematosus, dermatomyositis, polymyositis, and atherosclerotic disease.
Symptoms of Raynaud's disease occur when the small arteries spasm, preventing blood and oxygen from reaching the tissues. The skin turns white or blue, very cold, numb, tingly, and painful. In severe cases, Raynaud's disease can result in poorly healing ulcers * and even gangrene and tissue death. Bouts may occur several times daily and may last between 15 minutes and several hours.
Raynaud's disease is treated by encouraging sensible lifestyle changes, such as avoidance of cold temperatures and use of gloves and mittens when cold temperatures cannot be avoided. Factors that the person knows will bring on an attack, such as medications, chemicals, activities, or stress, should be avoided. A variety of medications may be used to improve dilatation (opening or dilating) of blood vessels. Aspirin and heparin may be used to prevent blood clotting. Very severe cases may require surgery to cut the nerve responsible for the spasms in small arteries or to perform a bypass to replace the length of malfunctioning blood vessel with a graft.
Varicose veins are enlarged, twisted veins. Milder cases are often a cosmetic annoyance; more severe cases can cause pain and disability. Varicose veins happen when there is increased back pressure on the veins that are attempting to carry blood to the heart (for example, during pregnancy). Veins become less elastic, more stretched, and unable to prevent the backflow of blood, due to weakening of the valves within the veins that normally keep blood flowing toward the heart. When blood accumulates within the veins, the veins stretch even more, become more enlarged, and begin to take on a gnarled, twisted appearance. Because the blood within the veins has already delivered oxygen to the tissues, it is bluer in color, which causes the varicose veins to appear very blue and more obvious under the skin.
About 15 percent of all men and 25 percent of all women in the United States have varicose veins. The tendency seems to run in families and increases as one grows older. Predisposing conditions include pregnancy, obesity, history of long periods of standing, and use of oral contraceptives or estrogen replacement therapy. Symptoms of varicose veins include their characteristic appearance of thick, winding or tortuous, blue cords visible beneath the skin. Other symptoms may include a heavy aching in the legs; itchiness in the area around visible veins; poorly healing sores; and the emergence of ulcers in the skin around the ankles.
Deep vein thrombosis (DVT) is a blood clot that occurs in a vein deep within the body, usually in the thigh or lower leg. It may cause pain and swelling or it may cause no symptoms at all. DVT may be the result of certain diseases, either inherited or acquired later in life that affect how the blood clots. For example, 4 percent of people with DVT are found to have Antithrombin III deficiency. This inherited disorder is marked by a lack of the protein that controls clotting and leads to an increased tendency to form blood clots. Other risk factors for deep vein thrombosis include being immobile for a long time, such as after surgery or in a nursing home bed; sitting still for a long time, such as in airplane travel; damage to the veins from injury or infection; being obese; smoking; being on hormone replacement therapy; and pregnancy. DVT is a serious condition because of the risk that the blood clot will break free, travel to the lungs, and block blood flow. In order to diagnose deep vein thrombosis, a doctor performs a physical examination to check for tenderness or skin discoloration, and may order imaging tests such as ultrasound and CT scans, as well as blood tests. Treatment for DVT includes anticoagulants (sometimes called blood thinners) to prevent the clot from getting bigger and to prevent any other clots from forming. If the DVT is large and serious, clot busting drugs, known as thrombolytics, may be used to break up the clot. This procedure is done in a hospital setting. Compression stockings may be recommended to reduce the possibility of clots in the future.
Chronic venous insufficiency is a condition that occurs when damaged valves or an untreated DVT causes swelling and blood pooling in the legs. This can cause fluid to leak into the tissues of the ankles and feet and, if untreated, lead to skin breakdowns and ulcers. The condition tends to get worse over time, but it can be managed with lifestyle changes and treatment when necessary.
Lifestyle changes include wearing compression stockings, avoiding sitting or standing for long stretches of time, exercising regularly, and losing weight. Antibiotics may be prescribed to treat any open sores or ulcers. As with varicose veins, sclerotherapy and catheter-assisted procedures may be needed for the damaged vein. Sometimes, if the condition is severe, surgery to bypass the damaged vein may be performed. In this procedure, the surgeon takes a piece of healthy blood vessel from another part of the body and uses it to reroute blood flow around the affected vein.
Vasculitis is inflammation of the blood vessels. Vasculitis may also be called angiitis (an-jee-EYE-tis) or arteritis. There are many types of vasculitis, but they generally differ in who is affected and the organs involved. Vasculitis is a type of autoimmune disease in which the immune system mistakenly attacks the blood vessels. The cause of vasculitis is unclear. It may be associated with a preexisting infection, a coexisting autoimmune disorder such as rheumatoid arthritis or systemic lupus erythematosus, or a blood cancer such as leukemia or lymphoma. People at risk for developing vasculitis include those who have certain autoimmune disorders, and those who have certain medical conditions such as chronic hepatitis B or C infection. People who smoke are also at increased risk for developing vasculitis.
Treatment for vasculitis depends on the type of vasculitis, which organs are affected, and the severity of the condition. Usually vasculitis is treated by medication—either prescription or over the counter. Over-the-counter medications are recommended for management of pain associated with mild vasculitis, and include acetaminophen, aspirin, ibuprofen, and naproxen. The most common prescription medications used in the treatment of vasculitis are corticosteroids and cytotoxic drugs. Corticosteroids reduce inflammation in the blood vessels, and cytotoxic medications kill the cells that are causing the inflammation. Other treatments are dependent on the type of vasculitis. People with vasculitis may be managed by physician specialists depending on the type of vasculitis. If a person develops an aneurysm because of damage to the blood vessel, surgery may be required to remove the aneurysm and repair the vessel.
Buerger's disease, also called thromboangiitis obliterans (throm-bo-an-jee-EYE-tis ob-LIT-er-ans), is a form of vasculitis that occurs when small- and medium-sized arteries and veins develop severe inflammation. Although this rare condition is not due to the presence of atherosclerotic plaque, it can result in similar problems, because the inflamed arteries and veins become narrowed and significantly decrease blood flow. Organs and tissues are deprived of oxygen and nutrients. Blood clots may form within the inflamed blood vessels, resulting in further obstruction. Arms and legs are most frequently affected. Buerger's disease usually begins between 20 and 40 years of age and is more common in men, smokers, and people who are of Asian or Eastern European descent.
Symptoms of Buerger's disease include pain with activity and at rest, decreased sensation in the affected limb, poor healing, and open ulcers and sores. Over time, gangrene may develop, with the necessity of amputation (surgical removal of a body part). There is no one test that can definitively diagnose Buerger's disease. Blood tests and an echocardiogram * may be done in order to rule out other disease. Angiography involves taking x-rays, CT scans, or MRI scans, after the injection of dye into blood vessels. This test allows any obstructions to be visualized.
The first step of treatment in Buerger's disease is smoking cessation. Very severe cases may require surgery to cut the nerve responsible for the spasm or to perform a bypass to replace the length of malfunctioning blood vessel with a graft. If gangrene develops, amputation may be necessary and life saving. Although imperfect, avoiding smoking is the only potential form of prevention.
The risk of developing peripheral vascular disease can be reduced by:
See also Aneurysm • Arteriosclerosis/Atherosclerosis • Autoimmune Disorders: Overview • Diabetes • Hypertension • Kawasaki Disease • Marfan Syndrome • Phlebitis and Venous Thrombosis • Raynaud's Disease • Varicose Veins • Vascular Diseases: Overview
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* atherosclerosis (A-ther-o-skler-O-siss) is a chronic condition associated with aging where the arterial wall loses elasticity, thickens, calcifies, and becomes more rigid, causing increased resistance to blood flow through the vessel.
* arteriosclerosis (ar-TEER-eeo-skler-O-siss) is a condition in which arteries of the body become narrowed and hardened from the buildup of calcium, cholesterol, and other substances, causing decreased blood flow through these vessels.
* cholesterol (ko-LES-ter-ol) is a fatlike substance found in the blood and body tissues.
* diabetes (dye-uh-BEE-teez) is a condition in which the body's pancreas does not produce enough insulin or the body cannot use the insulin it makes effectively, resulting in increased levels of sugar in the blood.
* stroke is a brain-damaging event usually caused by interference with blood flow to the brain.
* transient ischemic attack (TRANS-ee-ent iss-KEE-mik), or TIA, is an event similar to a stroke but goes away within a short period of time; it is sometimes called a mini-stroke.
* gangrene (GANG-green) is the decay or death of living tissue caused by a lack of oxygen supply to the tissue and/or bacterial infection of the tissue.
* congestive heart failure (kon-JES-tiv), or heart failure, is a condition in which a damaged or overworked heart cannot pump enough blood to meet the oxygen and nutrient needs of the body.
* Kawasaki syndrome is a condition that causes inflammation of the walls of some blood vessels in the body.
* Marfan syndrome is an inherited disorder primarily affecting connective tissue but it may also affect the cardiovascular system.
* systemic lupus erythematosus (SLE) (sis-TE-mik LOO-pus er-i-them-a-TO-sus) is an autoimmune disorder in which the immune system mistakenly attacks normal tissues. It may attack the vascular system.
* Ehler-Danlos syndrome (AY-ler DAN-lahs) is an inherited syndrome that affects the connective tissue of the skin, joints, and blood vessels.
* chemotherapy (KEE-mo-THER-a-pee) is the treatment of cancer with powerful drugs that kill cancer cells.
* ulcers are open sores on the skin or the lining of a hollow body organ, such as the stomach or intestine. They may or may not be painful.
* echocardiogram (eh-ko-KARdee-uh-gram) is a diagnostic test that uses sound waves to produce images of the heart's chambers and valves and blood flow through the heart.