Vascular Diseases: Overview

Vascular diseases include a group of conditions that affect blood vessels. These conditions are common, affecting about 20 million to 30 million Americans yearly. The odds of developing a vascular disease increase as a person ages, and some of these conditions can strike with little or no warning.

What Are Vascular Diseases?

The vascular system is made up of the arteries, veins, and capillaries that carry the body's blood supply to and from the heart. Many conditions can negatively affect this system, such as clotting of the blood or stiffening of the arteries. Vascular diseases pose a serious health risk and in some cases can be fatal.

The following are some of the more common vascular diseases, along with the underlying causes, symptoms, diagnostic requirements, and treatments for each.

Heart disease and stroke

Heart disease (at times referred to as coronary artery disease) occurs when the arteries that supply blood to the heart muscle narrow and harden. This condition is due to a process called atherosclerosis (athuh-ro-skluh-RO-suhs), in which cholesterol * combines with other substances to form plaque that attaches in patches to arterial walls. As these patches expand in size, they may block blood flow to the heart muscle. Over time, this blockage can become complete enough to deprive the heart muscle of oxygen, damaging or destroying that area of heart muscle. Sometimes a blood clot * forms on top of the plaque, which can result in complete blockage of blood flow, leading to heart attack. Other times, the blood clot may break away from the plaque, travel through the bloodstream, and cause a blockage in another location. If the blood clot stays within the circulation of the heart, a heart attack occurs. If the blood clot travels to the brain, a stroke * may occur.

Coronary artery disease is more common in people who have high concentrations of cholesterol in their blood, high blood pressure, diabetes * , or a family history of coronary artery disease; or who are smokers, obese (extremely overweight), or sedentary. Symptoms of coronary artery disease include bouts of angina (chest pain), frank heart attack (pain in the jaw, neck, or back; chest pain; dizziness/faintness; pain in the arms or shoulders; shortness of breath), or signs of stroke (sudden weakness or numbness in limbs or face; sudden confusion, difficulty speaking, or understanding others; sudden visual problems in one or both eyes; and sudden problems walking or maintaining balance).

Heart disease is diagnosed by examining the results of a number of tests, including:

Treating coronary artery disease is determined by the severity of the disease. In people who have milder disease, lifestyle changes (e.g., weight loss, smoking cessation, increased exercise, learning to deal with stress, and eating a healthier diet) may be sufficient. In more complicated cases, blood cholesterol and high blood pressure may need to be lowered with medications. Other medications may also be used, including blood thinners (anticoagulants), beta-blockers, calcium channel blockers, and nitroglycerin (to treat chest pain from angina).

When blockages are more severe, one of two surgical operations may be required. Angioplasty involves slipping a small balloon into an obstructed artery and inflating the balloon to widen the narrowed artery, a procedure that may be combined with stent placement, in which an artificial tube is permanently positioned inside the artery to keep it open. Coronary artery bypass grafting involves open-heart surgery. The obstructed sections of the coronary arteries are removed and replaced with grafts * made from arteries or veins that are harvested (taken) from elsewhere in the body, often from a leg.

Peripheral artery disease

Peripheral artery disease is a common consequence of aging and develops when the arteries outside the heart narrow and harden. Like coronary artery disease, this condition develops because plaque 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, MRI or CT scans, or angiography (during which dye is injected into the blood vessels to highlight areas of obstruction).

Treatment of peripheral artery disease can include the same types of lifestyle changes used to treat coronary artery disease (weight loss, smoking cessation, increased exercise, learning to deal with stress, and eating a healthier diet). Medications may be used to lower high cholesterol and high blood pressure; to avoid blood clots with blood thinners (anticoagulants), aspirin, or clopidogrel; and to improve the ability to walk distances pain-free with cilostazol. More severe arterial obstructions may require surgery. As with coronary arteries, both angioplasty and bypass grafting can be used to treat peripheral artery disease. Additionally, the carotid arteries may require endarterectomy (en-dar-tuh-REK-tuh-mee), a surgical procedure that cleans out the plaque within the carotid arteries and places a permanent artificial tube or stent inside the artery to keep it open.

Aneurysms * (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 the atherosclerosis 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 disease * , Marfan syndrome * , presence of an abnormal bicuspid aortic valve, giant cell arteritis, polycystic kidney disease, lupus * (systemic lupus erythematosus), and Ehlers-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 of 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 * .

Rupture of an aneurysm is a serious emergency. Symptoms of a ruptured aneurysm depend on its location. Rupture of an 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, 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. Aneurysms are often discovered incidentally during tests for other conditions. Tests to confirm the presence of an aneurysm include ultrasound, 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 it and replace that area with a graft. A ruptured aneurysm requires immediate emergency surgery.

Raynaud's disease

Risk factors for Raynaud's disease include repetitive stress injuries; exposure to certain chemicals, nicotine, caffeine, certain medicines (including chemotherapy * agents, drugs used to treat migraine headache or high blood pressure, nonprescription cold and allergy medicines, oral contraceptives); previous injury due to frostbite or other extreme cold exposure/hypothermia); and other diseases such as rheumatoid arthritis * , Sjδgren's syndrome * , Buerger's disease, scleroderma * , lupus (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 becomes 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 often provisionally diagnosed based on the very characteristic symptoms that are reported. Testing can be done to confirm the condition, including a cold simulation test that uses temperature sensors affixed to the fingers to measure the response to cold exposure. Nailfold capillaroscopy (cap-uh-luh-RAS-kuh-PEE) involves placing a drop of oil on the skin at the base of fingernail and then examining the area with a microscope, which may reveal the presence of abnormal blood vessels. A variety of blood tests may be done to evaluate for the presence of one of the conditions that are strongly associated with Raynaud's disease.

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. Known precipitants (factors that bring on attacks), such as medications, chemicals, activities, or stress, should be avoided. A variety of medications may be used to improve dilatation * 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.

Buerger's disease

Symptoms of Buerger's disease include pain both 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 definitely diagnose Buerger's disease. Blood tests and an echocardiogram may be done in order to rule out other disease.

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.

Varicose veins

Varicose veins are enlarged, twisted veins. Milder cases are simply a cosmetic annoyance, whereas more severe cases can cause pain and disability. Varicose veins develop 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 extended, 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 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 with increasing age. 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, 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.

Diagnosis is usually straightforward because varicose veins are so visible. An ultrasound test of the affected veins may be performed to evaluate whether the valves are working, how hampered the blood flow is, and whether any blood clots are forming within the veins. Treatment usually begins with basic steps, such as maintaining a normal weight, exercising, avoiding tight clothing, avoiding prolonged sitting (with legs dangling) or standing, and keeping feet and legs elevated when possible. For more severe and symptomatic varicose veins, a number of procedures are available:

Clotting disorders

Clotting disorders include both conditions that prevent normal blood clotting and those that promote abnormal blood clotting.

BLEEDING DISORDERS

Bleeding disorders are diseases that interfere with the blood's ability to form a clot. Twenty different clotting factors are involved in the ability of the blood to clot normally. Absence or deficiency in any of these factors can result in a tendency to bleed. Types of bleeding disorders include von Willebrand disease and various forms of hereditary hemophilia (HE-mo-FEEL-ee-uh) (such as hemophilia A, also called classic hemophilia or factor VIII deficiency), hemophilia B (also called Christmas disease or factor IX deficiency), and hemophilia C (also called factor XI deficiency). People with bleeding disorders are at risk of severe bleeding and hemorrhage from seemingly minor cuts or trauma. Severe hemophiliacs can begin to bleed spontaneously, resulting in unexpected gushing nosebleeds, severe bruising, bleeding into the joints, or bleeding from the gastrointestinal or urinary tract.

Hemophilia is an inherited disorder that often affects many members of a family. Some types of hemophilia only affect males; other types can strike either males or females. Hemophilia is often suspected due to a family history of the disorder, although some mild cases are only diagnosed after an injury or surgical procedure results in excess bleeding. Blood tests may reveal a lack of specific clotting factors associated with hemophilia or decreased levels of the specific protein (von Willebrand factor) deficient in von Willebrand disease. Treatment of hemophilia may require infusions of fresh frozen plasma (fluid part of blood) or specific clotting factors to help stop or prevent bleeding.

HYPERCOAGULATION DISORDERS

Hypercoagulation (excessive clotting) may be hereditary (as in protein S deficiency) or acquired. People at risk of developing thromboses include women who are using oral contraceptives or estrogen replacement therapy, or who are pregnant; smokers; cancer patients; people who have recently had surgery or suffered trauma; patients who are hospitalized or debilitated patients; and individuals who are obese and/or sedentary. Diagnosis of hypercoagulation disorders usually involves demonstrating the presence of a DVT via ultrasound, CT, MRI, or venography (vih-NAH-gruh-fee) in which dye is injected into the vein and images are taken that can reveal the presence of a blood clot). Blood tests may reveal an elevation of a substance called D dimmer. Treatment of hypercoagulation requires anticoagulation via blood thinner medications such as heparin and warfarin.

Lymphedema

Lymphedema (limf-eh-DEE-mah) occurs when there is an obstruction in the lymphatic system * , reducing the normal flow of lymph (clear fluid that contains white blood cells) through the lymph vessels. As lymph fluid backs up, the vessels become leaky, allowing the fluid to seep out into the surrounding tissues and causing swelling in the affected arm, leg, or other part of the body.

Lymphedema can occur due to congenital (present at birth) malformation of the lymph vessels, as it does in a number of diseases, including Milroy disease (congenital lymphedema), Meige disease (lymphedema praecox), and lymphedema tarda (late-onset lymphedema). Lymphedema can also occur in these situations:

The diagnosis may be quite obvious, depending on the individual's history, but further visualization of the area may be obtained through ultrasound, MRI, CT scans, or lymphoscintigraphy (LIMF-oh-sin-tigraf-EE), during which radioactive dye is injected into the lymph vessels. Subsequent imaging of the dye flow can reveal the location of a lymphatic obstruction.

Can Vascular Diseases Be Prevented?

Vascular disease can be caused by hereditary factors and run in a person's family. However, the risk of many types of vascular diseases, such as heart disease, aneurysm, and peripheral artery disease, 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. Persons with diabetes should be certain to control their blood sugar levels.

Getting regular physical examinations from a doctor is advised, especially for those considered to be at a higher risk for developing a vascular condition.

See also Anemia, Bleeding, and Clotting • Aneurysm • Heart Disease: Overview • Kawasaki Disease • Lymphedema • Peripheral Vascular Disease • Raynaud's Disease • Stroke • Varicose Veins

Resources

Books and Articles

Grotta, James C., et al. Stroke: Pathophysiology, Diagnosis, and Management. 6th ed. Atlanta: Elsevier, 2015.

Jacobs, Anne Burleigh. Highs, Lows, and Plateaus: A Path to Recovery from Stroke. Bloomington, IN: AuthorHouse, 2014.

Mann, Douglas L., et al., eds. Braunwald's Heart Disease. 10th ed. Philadelphia: Saunders, 2014.

Masley, Steven. The 30-Day Heart Tune-Up: A Breakthrough Medical Plan to Prevent and Reverse Heart Disease. New York: Center Street, 2014.

Websites

Centers for Disease Control and Prevention. “About Heart Disease.” http://www.cdc.gov/heartdisease/about.htm (accessed April 14, 2016).

MedlinePlus. “Aneurysm.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/001122.htm (accessed April 14, 2016).

MedlinePlus. “Stroke.” U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/stroke.html (accessed April 14, 2016).

National Heart, Lung, and Blood Institute. “Heart and Vascular Diseases.” https://www.nhlbi.nih.gov/health/resources/heart (accessed April 14, 2016).

World Health Organization. “Cardiovascular Diseases.” http://www.who.int/cardiovascular_diseases (accessed April 14, 2016).

Organizations

American Heart Association. 7272 Greenville Ave., Dallas, TX 752314596. Toll-free: 800-242-8721. Website: http://www.heart.org (accessed April 14, 2016).

National Heart, Lung, and Blood Institute. PO Box 30105, Bethesda, MD 20824-0105. Telephone: 301-592-8573. Website: https://www.nhlbi.nih.gov (accessed April 14, 2016).

National Hemophilia Foundation. 7 Penn Plaza, Suite 1204, New York, NY 10001. Telephone: 212-328-3700. Website: https://www.hemophilia.org (accessed April 14, 2016).

National Stroke Association. 9707 E. Easter Ln., Suite B, Centennial, CO 80112. Toll-free: 800-787-6537. Website: http://www.stroke.org (accessed April 14, 2016).

Vascular Cures. 555 Price Ave., Suite 180, Redwood City, CA 94063. Telephone: 650-368-6022. Website: http://vascularcures.org (accessed June 29, 2016).

* cholesterol (ko-LES-ter-ol) is a fatlike substance found in the blood and body tissues.

* blood clot is a thickening of the blood into a jelly-like substance that helps stop bleeding. Clotting of the blood within a blood vessel can lead to blockage of blood flow.

* stroke is a brain-damaging event usually caused by interference with blood flow to the brain.

* 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.

* CT scans, or computed tomography (toe-MAH-gruh-fee), use computers to view structures inside the body. Formerly called computerized axial tomography (CAT).

* MRI, which is short for magnetic resonance imaging, produces computerized images of internal body tissues based on the magnetic properties of atoms within the body.

* ultrasound, also called a sonogram, is a diagnostic test in which sound waves passing through the body create images on a computer screen.

* 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.

* grafts are tissue or organ transplants.

* 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.

* aorta (ay-OR-ta) is the major large artery that carries blood from the heart to the rest of the body.

* aortic aneurysm (ay-OR-tik ANyoo-rizm) is a weak spot in the aorta, the body's largest blood vessel. The weak spot can rupture or break, causing massive internal bleeding.

* Kawasaki disease is an inflammatory illness in children that involves the body's blood vessels. The disease is characterized by high fever, swollen glands, and a rash, and it may lead to complications affecting the heart.

* Marfan syndrome involves the body's connective tissue and is characterized by abnormalities in the skeleton, heart, and eyes. It is caused by an abnormal gene that usually is inherited. People with Marfan syndrome are generally taller than average, have little body fat, and have long, thin fingers.

* lupus (LOO-pus), or systemic lupus erythematosus, is a chronic, or long-lasting, disease that causes inflammation of connective tissue, the material that holds together the various structures of the body.

* Ehlers-Danlos syndrome is a group of disorders that affect the connective tissues that support the skin, bones, blood vessels, and many other organs and tissues. Defects in connective tissues cause the signs and symptoms of Ehlers-Danlos syndrome, which vary from mildly loose joints to life-threatening complications.

* hemorrhage (HEH-muh-rij) is uncontrolled or abnormal bleeding.

* chemotherapy (KEE-mo-THER-uhpee) is the treatment of cancer with powerful drugs that kill cancer cells.

* rheumatoid arthritis (ROO-mahtoyd ar-THRY-tis) is a chronic disease characterized by painful swelling, stiffness, and deformity of the joints.

* Sjögren's syndrome is an autoimmune disorder that affects the glands in the body that make moisture, particularly in the mouth, throat, nose, eyes, and skin.

* scleroderma is a slowly progressive disease characterized by deposits of fibrous connective tissue in the skin and often the internal organs.

* 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.

* dilatation (DIH-luh-tay-SHUN) is the act of dilating or opening a blood vessel.

* lymphatic system (lim-FAH-tik) is a system that contains lymph nodes and a network of channels that carry fluid and cells of the immune system through the body.

* mastectomy (mas-TEK-tuh-mee) is the surgical removal of the breast.

* tumor (TOO-mor) is an abnormal growth of body tissue that has no known cause or physiologic purpose. A tumor may or may not be cancerous.

  This information is not a tool for self-diagnosis or a substitute for professional care.