Vascular Disease

normal medium large




     

    Understanding Vascular Disease

    The vascular system is a network of blood vessels including arteries, veins, and capillaries. Arteries carry oxygen and nutrients to the body; veins return blood from the tissues to the heart. Vascular disease refers to changes that can occur in blood vessels affecting the normal flow of blood. These disorders can be life- or limb-threatening and can run in families.

    Arteries
    vascular 
      Veins
    vascular 2 

    Lifestyle and heredity can play a strong role in whether someone will develop vascular disease. It is especially important to understand the risk factors, signs/symptoms, and warning signs associated with vascular disease, which are as follows:

    Risk Factors
    • Age (more than 60 years)
    • High blood pressure
    • Smoking
    • Obesity
    • High cholesterol
    • Diabetes mellitus
    • Family history
    • Sedentary lifestyle
    Signs/Symptoms
    • Stroke
    • Hardening of the arteries
    • Non-healing wounds
    • Aneurysms
    • Varicose or spider veins
    • Difficulty walking
    Warning Signs
    • Temporary weakness, numbness or paralysis on one side of the body
    • Temporary, sudden vision changes in one or both eyes
    • Difficulty speaking or difficulty understanding words
    • Falling for no apparent reason
    • Loss of balance
    • Abdominal, chest or back pain
    • Leg pain with walking or foot pain while at rest
    • Non-healing wounds of the feet or legs

    Diagnosing Vascular Disease

    A complete physical examination conducted by a vascular specialist can help diagnose vascular disease. Physicians at the University Vascular Center use painless, non-invasive diagnostic tools, such as a Doppler machine, which helps assess blood flow, and blood pressure cuffs.

    Other diagnostic tools include use of CAT scan, MRI, and ultrasound. In addition, Stony Brook offers diagnosis through special radiology (x-ray) procedures.

    For more information, please visit the web site of the Non-Invasive Vascular Laboratory 

    Treating Vascular Disease

    Vascular disease is treatable. Lifestyle changes, medical treatment and surgery can improve the life of those with vascular disease. Listed below are non-operative treatments, minimally invasive therapies, and surgical interventions:

    Minimally Invasive Therapies
    • Balloon angioplasty
    • Vascular stenting
    • Endoscopic vein ligation
    • Thrombolysis
    • Sclerotherapy and laser therapy
      Surgical Interventions
    • Carotid endarterectomy
    • Lower extremity bypass
    • Aneurysm repair
    • Endoscopic-assisted vein harvest
    • Varicose vein surgery
    Non-Operative Treatments
    • Blood pressure control
    • Low-fat diet
    • Strict diabetes management
    • Weight reduction
    • Exercise program
    • Smoking cessation
    • Support hose and leg elevation for varicose veins

    Vascular Glossary

    Stroke

    Hardening of the arteries — for which the medical term is atherosclerosis (or arteriosclerosis) — is a chronic, progressive disease. Plaques of fatty deposits form on the inner walls of the arteries causes a narrowing (stenosis) of an artery. In atherosclerosis, fatty deposits are progressively coating the interior lining (intima) of arteries over a period of years. As cholesterol is deposited on the lining, tiny wounds enlarge and thicken to form plaque, which narrows the vessel and obstructs the flow of blood through it. Scar tissue and calcification may also accompany the formation of fatty deposits. This makes the vessel walls less elastic and flexible, leading to an impaired blood flow and increased blood pressure. Eventually an artery may be completely blocked by thick plaques, or a blood clot (thrombus) may form at the site of a plaque and further obstruct the vessel.

    Peripheral vascular disease refers to diseases of any of the blood vessels outside of the heart and to diseases of the lymph vessels. It is often a narrowing of the blood vessels that carry blood to leg and arm muscles. There are two types of these circulation disorders:

    Functional Peripheral Vascular Disease
    These diseases are not organic in cause and do not involve defects in the structure of the blood vessels. They are short-term effects and may be reversed. An example is Raynaud's disease or phenomenon, a condition in which the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or as the result of emotional upset. This disease happens most commonly in women between the ages of 18 and 30.

    Organic Peripheral Vascular Disease
    These diseases are caused by structural changes, such inflammation and tissue damage, in the blood vessels. An example is Buerger's disease (thromboangiitis obliterans), a chronic inflammatory disease found chiefly in the peripheral arteries and veins of the extremities. This disease most commonly happens to men between the ages of 20 and 40 who smoke cigarettes. Symptoms include pain in the legs or feet, clammy and cold skin, and a diminished sense of heat and cold.

    Non-healing wounds, also called chronic wounds, are sores (ulcers) that do not show improvement in four weeks or are not healed within eight weeks. Among the causes of such wounds are diabetes, poor circulation, bad veins, and advanced age. When these wounds occur on the leg, ankle, or foot, they may progress to the point where amputation of the limb is necessary. Fortunately, limb salvage and prevention of disfigurement and disability are achievable in the vast majority of patients.

    Aneurysms are an enlargement or bulge in an artery (a blood vessel carrying blood from the heart to the body) caused by a weak artery wall. They occur most often in the aorta (major artery in the chest and abdomen), arteries that supply the brain or legs, or heart wall after a heart attack. If an abdominal aortic aneurysm is revealed in the physical or duplex exam, the next step is to identify the size and location of the aneurysm. In patients who have an abdominal aortic aneurysm over 2 inches in size and who have a low risk for surgery, an aortic replacement operation may be the best answer. When patients with a known aneurysm complain of sudden, unexplained tenderness or pain in the belly or the back, emergency testing and possibly surgery are needed.

    Aside from the size, there are other things our physicians look for as an indication that surgery is needed. If a patient presents with the "blue toe" syndrome, a sign that emboli (bits of plaque) have been sent to the foot or leg, surgical intervention is apt to be discussed.

    Dissecting aneurysm occurs when blood gets through a lengthwise tear between layers of the wall of an artery. These layers then separate and swell, making a balloon-shaped formation that causes severe pain. This condition—which can be fatal if the artery bursts—can be caused by a disease, birth defect, or injury. It is usually caused by hardening of the arteries (atherosclerosis), a common disorder that causes narrowing of arteries and reduces circulation. High blood pressure also contributes to this disease.

    Patients with thoracic dissecting aneurysms describe the pain in the chest as being of a "ripping" or "tearing" character, which is frequently mistaken for a heart attack.

    The preferred treatment for dissecting aneurysm is immediate surgery. The surgeon replaces the weakened part of the artery with a graft made of artificial material. If patients have high blood pressure, they are generally given fast-acting intravenous medication to lower it. Unless it is surgically removed, an aneurysm is a permanent condition. The outlook varies, depending on the location of the aneurysm and the individual patient's age and overall health. The less urgent the need for surgery, the better the chance for survival.

    Varicose veins are blood vessels, usually in the legs, that become permanently dilated (widened) and twisted. They may include superficial veins, deep veins and veins that connect superficial and deep veins. The signs of varicose veins are enlarged, disfiguring, snakelike, bluish veins which are visible under the skin upon standing; they appear most often in the back of the calf or on the inside of the leg from ankle to groin. Symptoms may include vague discomfort and aching in the legs, especially after standing; and fatigue. Click here to see photos of varicose veins in the leg before and after treatment.

    Spider veins — for which the medical term is telangiectasias — are tiny, superficial blood vessels which have become permanently dilated. The veins are generally blue, red, or purple in color. Although spider veins can occur on most areas of the body, common sites for the condition are the legs and face. Up to 41% of women and 15% of men in the United States have spider veins. The veins usually cause no serious problems, but some patients experience burning or pain in the affected area of the body. For many people, especially those with large areas of spider veins, the condition can be cosmetically unappealing. Click here to see photos of spider veins in the leg before and after treatment. 

     

    Stony Brook Medicine Heart Institute

    For additional information, please call (631) 444-4000.