Vascular disease

Veins and arteries
Types| Peripheral artery disease,[1] Renal artery stenosis[2]
Diagnostic method| Venography, Ultrasound[3]
Treatment| Quit smoking, Lower cholesterol[4]

Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood and lymph vessels can cause a range of health problems that can sometimes become severe, and fatal.[3] Coronary heart disease for example, is the leading cause of death for men and women in the United States.[5]

## Contents

* 1 Types
* 1.1 Venous disease
* 1.1.1 Phlebitis
* 1.1.2 Venous insufficiency
* 1.1.3 Venous thrombosis
* 1.1.4 Portal hypertension
* 1.1.5 Vascular anomalies
* 1.2 Arterial disease
* 1.3 Lymphatic disease
* 2 Mechanism
* 3 Diagnosis
* 4 Treatment
* 5 References
* 6 Further reading
* 7 External links

## Types

There are several types of vascular disease, including venous diseases, and arterial diseases, and signs and symptoms vary depending on the disease. Those of the arterial system are associated with blood supply to tissues and its obstruction due to blockages or narrowing. In the venous system disorders are often caused by a slow return of blood due to insufficient valves, or to a blood clot.[6]

### Venous disease

Most disorders of the veins involve obstruction such as a thrombus or insufficiency of the valves, or both of these.[7][8][9] Other conditions may be due to inflammation.

#### Phlebitis

Phlebitis is the inflammation of a vein. It is usually accompanied by a blood clot when it is known as thrombophlebitis. When the affected vein is a superficial vein in the leg, it is known as superficial thrombophlebitis, and unlike deep vein thrombosis there is little risk of the clot breaking off as an embolus.[10]

#### Venous insufficiency

Venous insufficiency is the most common disorder of the venous system, and is usually manifested as either spider veins or varicose veins. Several treatments are available including endovenous thermal ablation (using radiofrequency or laser energy), vein stripping, ambulatory phlebectomy, foam sclerotherapy, laser, or compression.[citation needed]

Postphlebitic syndrome is venous insufficiency that develops following deep vein thrombosis.[11]

#### Venous thrombosis

Venous thrombosis is the formation of a thrombus (blood clot) in a vein. This most commonly affects a deep vein known as deep vein thrombosis (DVT). DVT usually occurs in the veins of the legs, although it can also occur in the veins of the arms. Immobility, active cancer, obesity, traumatic damage and congenital disorders that make clots more likely are all risk factors for deep vein thrombosis. It can cause the affected limb to swell, and cause pain and an overlying skin rash. In the worst case, a deep vein thrombosis can extend, or a part of a clot can break off as an embolus and lodge in a pulmonary artery in the lungs, known as a pulmonary embolism.The decision to treat deep vein thrombosis depends on its size, a person's symptoms, and their risk factors. It generally involves anticoagulation to prevents clots or to reduce the size of the clot. Intermittent pneumatic compression is a method used to improve venous circulation in cases of edema or in those at risk from a deep vein thrombosis.[citation needed]

A clot can also form in a superficial vein (superficial venous thrombosis) which is normally not clinically significant, but the thrombus can migrate into the deep venous system where it can also give rise to a pulmonary embolism.[12]

#### Portal hypertension

The portal vein also known as the hepatic portal vein carries blood drained from most of the gastrointestinal tract to the liver. Portal hypertension is mainly caused by cirrhosis of the liver. Other causes can include an obstructing clot in a hepatic vein (Budd Chiari syndrome) or compression from tumors or tuberculosis lesions. When the pressure increases in the portal vein, a collateral circulation develops, causing visible veins such as esophageal varices.[citation needed]

#### Vascular anomalies

A vascular anomaly can be either a vascular tumor or a birthmark, or a vascular malformation. [13] In a tumor such as infantile hemangioma the mass is soft, and easily compressed, and their coloring is due to the dilated anomalous involved veins.[14] They are most commonly found in the head and neck. Venous malformations are the type of vascular malformation that involves the veins. They can often extend deeper from their surface appearance, reaching underlying muscle or bone.[15] In the neck they may extend into the lining of the mouth cavity or into the salivary glands.[14] They are the most common of the vascular malformations.[16] A severe venous malformation can involve the lymph vessels as a lymphaticovenous malformation.[14]

### Arterial disease

350px|thumb

* Coronary artery disease – the most common of the cardiovascular diseases, types include angina, and myocardial infarction[citation needed]
* Carotid artery stenosis – any narrowing of the carotid arteries[citation needed]
* Peripheral artery disease – occurs when atheromatous plaques build up in the arteries that supply blood to the arms and legs, causing the arteries to narrow or become blocked.[1]
* Erythromelalgia \- a rare peripheral vascular disease with symptoms that include burning pain, increased temperature, erythema and swelling that generally affect the hands and feet.[17]
* Renal artery stenosis \- the narrowing of renal arteries that carry blood to the kidneys from the aorta.[2]
* Buerger's disease – inflammation and swelling in small blood vessels, causing the vessels to narrow or become blocked by blood clots.[18]
* Raynaud syndrome – a peripheral vascular disorder that causes constriction of the peripheral blood vessels in the fingers and toes when a person is cold or experiencing stress.[19]
* Disseminated intravascular coagulation – a widespread activation of clotting in the smaller blood vessels.[20]
* Cerebrovascular disease – a group of vascular diseases that affect brain function, most commonly a stroke.[21]
* Vasculitis \- inflammation of blood vessels, either arteries or veins[citation needed]

### Lymphatic disease

* Lymphangitis[citation needed]

## Mechanism

Endothelium lines the inner wall of the vessel

Vascular disease is a pathological state of large and medium muscular arteries and is triggered by endothelial cell dysfunction.[22]

Because of factors like pathogens, oxidized LDL particles and other inflammatory stimuli endothelial cells become active.[23]

The process causes thickening of the vessel wall, forming a plaque that consists of proliferating smooth muscle cells, macrophages and lymphocytes.[24][25]

The plaque results in restricted blood flow, decreasing the amount of oxygen and nutrients that reach certain organs.[26]

This plaque can also rupture, causing the formation of clots.[27]

## Diagnosis

Diagnosing vascular disease can be complex due to the variety of symptoms vascular diseases can cause. Reviewing a patient's family history and conducting a physical examination are important steps in making a diagnosis. Physical exams may differ depending on the type of vascular disease suspected. For example, in the case of a peripheral vascular disease, a physical exam consists of checking blood flow in a patient's legs.[28][29]

## Treatment

Peripheral vascular disease-ulcer

Treatment varies based on the type of vascular disease being treated. In treating renal artery disease, a 2014 study indicates that balloon angioplasty can improve diastolic blood pressure and potentially reduce antihypertensive drug requirements.[30] In the case of peripheral artery disease, treatment to prevent complications is important; without treatment, sores or gangrene (tissue death) may occur.[citation needed]

More generally, treatments for vascular disease may include:[4]

* Lowering cholesterol levels
* Lowering blood pressure
* Lowering blood glucose
* Changes in diet
* Increasing physical activity (as recommended by a healthcare provider)
* Weight loss
* Quitting smoking
* Stress reduction

## References

1. ↑ 1.0 1.1 "Peripheral Arterial Disease: MedlinePlus". https://medlineplus.gov/peripheralarterialdisease.html.
2. ↑ 2.0 2.1 "Renal Artery Stenosis". http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/renal-artery-stenosis-ras/Pages/facts.aspx.
3. ↑ 3.0 3.1 "Vascular Diseases: MedlinePlus". https://medlineplus.gov/vasculardiseases.html.
4. ↑ 4.0 4.1 "How Is Peripheral Arterial Disease Treated? - NHLBI, NIH". https://www.nhlbi.nih.gov/health/peripheral-artery-disease/treatment.
5. ↑ "Coronary Artery Disease". https://medlineplus.gov/coronaryarterydisease.html.
6. ↑ Hirsch, Alan T.; Haskal, Ziv J.; Hertzer, Norman R.; Bakal, Curtis W.; Creager, Mark A.; Halperin, Jonathan L.; Hiratzka, Loren F.; Murphy, William R.C. et al. (2006). "ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎ Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease)". Journal of the American College of Cardiology 47 (6): e1–e192. doi:10.1016/j.jacc.2006.02.024. http://content.onlinejacc.org/article.aspx?articleid=1137388. Retrieved 2016-02-02.
7. ↑ Goel, RR; Hardy, SC; Brown, T (30 September 2021). "Surgery for deep venous insufficiency.". The Cochrane Database of Systematic Reviews 2021 (9). doi:10.1002/14651858.CD001097.pub4. PMID 34591328.
8. ↑ Publishing, Licorn (9 April 2013). "The venous valves of the lower limbs". https://www.phlebolymphology.org/the-venous-valves-of-the-lower-limbs/.
9. ↑ "20.1 Structure and Function of Blood Vessels - Anatomy and Physiology 2e | OpenStax" (in en). 20 April 2022. https://openstax.org/books/anatomy-and-physiology-2e/pages/20-1-structure-and-function-of-blood-vessels.
10. ↑ "Treatment for superficial thrombophlebitis of the leg". Cochrane Database Syst Rev 2018 (2). February 2018. doi:10.1002/14651858.CD004982.pub6. PMID 29478266.
11. ↑ Kahn SR (August 2006). "The post-thrombotic syndrome: progress and pitfalls". British Journal of Haematology 134 (4): 357–65. doi:10.1111/j.1365-2141.2006.06200.x. PMID 16822286.
12. ↑ Cosmi, B. (July 2015). "Management of superficial vein thrombosis". Journal of Thrombosis and Haemostasis 13 (7): 1175–1183. doi:10.1111/jth.12986. PMID 25903684.
13. ↑ Steiner, JE; Drolet, BA (September 2017). "Classification of Vascular Anomalies: An Update.". Seminars in Interventional Radiology 34 (3): 225–232. doi:10.1055/s-0037-1604295. PMID 28955111.
14. ↑ 14.0 14.1 14.2 Chim, H; Drolet, B; Duffy, K; Koshima, I; Gosain, AK (August 2010). "Vascular anomalies and lymphedema.". Plastic and Reconstructive Surgery 126 (2): 55e–69e. doi:10.1097/PRS.0b013e3181df803d. PMID 20679788.
15. ↑ Chen, RJ; Vrazas, JI; Penington, AJ (January 2021). "Surgical Management of Intramuscular Venous Malformations.". Journal of Pediatric Orthopedics 41 (1): e67–e73. doi:10.1097/BPO.0000000000001667. PMID 32815867.
16. ↑ Markovic, JN; Shortell, CK (October 2021). "Venous malformations.". The Journal of Cardiovascular Surgery 62 (5): 456–466. doi:10.23736/S0021-9509.21.11911-1. PMID 34105926.
17. ↑ "Erythromelalgia" (in en). 2017-10-18. https://www.nhs.uk/conditions/erythromelalgia/.
18. ↑ "Thromboangiitis obliterans: MedlinePlus Medical Encyclopedia". https://medlineplus.gov/ency/article/000172.htm.
19. ↑ "Raynaud's Disease: MedlinePlus". https://medlineplus.gov/raynaudsdisease.html.
20. ↑ "Disseminated intravascular coagulation (DIC): MedlinePlus Medical Encyclopedia". https://medlineplus.gov/ency/article/000573.htm.
21. ↑ "Stroke" (in en). 2017-10-24. https://www.nhs.uk/conditions/stroke/.
22. ↑ Rajendran, Peramaiyan; Rengarajan, Thamaraiselvan; Thangavel, Jayakumar; Nishigaki, Yutaka; Sakthisekaran, Dhanapal; Sethi, Gautam; Nishigaki, Ikuo (2013). "The Vascular Endothelium and Human Diseases". International Journal of Biological Sciences 9 (10): 1057–1069. doi:10.7150/ijbs.7502. ISSN 1449-2288. PMID 24250251.
23. ↑ Bikfalvi, Andreas (2013-12-19) (in en). Encyclopedic Reference of Vascular Biology & Pathology. Springer. ISBN 978-3-642-57063-6. https://books.google.com/books?id=Hd_rCAAAQBAJ&q=ldl%20activates%20endothelial%20cells&pg=PA31.
24. ↑ Rubin, Emanuel; Damjanov, Ivan (2013-11-11) (in en). Pathology Reviews · 1989. Springer Science & Business Media. ISBN 978-1-4612-4502-5. https://books.google.com/books?id=0jb2BwAAQBAJ&q=plaque%20consists%20of%20proliferating%20smooth%20muscle%20cells%2C%20macrophages%20and%20lymphocytes.&pg=PA172.
25. ↑ Gunstone, Frank D.; Harwood, John L.; Dijkstra, Albert J. (2007-03-13) (in en). The Lipid Handbook with CD-ROM, Third Edition. CRC Press. ISBN 978-1-4200-0967-5. https://books.google.com/books?id=INZa6WmqDA8C&q=plaque%20consists%20of%20proliferating%20smooth%20muscle%20cells%2C%20macrophages%20and%20lymphocytes.&pg=PA711.
26. ↑ Rolfes, Sharon Rady; Pinna, Kathryn; Whitney, Ellie (2011-06-20) (in en). Understanding Normal and Clinical Nutrition. Cengage Learning. ISBN 978-0-8400-6845-3. https://books.google.com/books?id=c27B9Y83r8cC&q=plaque%20results%20in%20obstructed%20blood%20flow&pg=PA812.
27. ↑ Ząbczyk, Michał; Natorska, Joanna; Undas, Anetta (2021-07-05). "Fibrin Clot Properties in Atherosclerotic Vascular Disease: From Pathophysiology to Clinical Outcomes". Journal of Clinical Medicine 10 (13): 2999. doi:10.3390/jcm10132999. ISSN 2077-0383. PMID 34279484.
28. ↑ "How Is Peripheral Arterial Disease Diagnosed? - NHLBI, NIH". https://www.nhlbi.nih.gov/health/peripheral-artery-disease/diagnosis.
29. ↑ Andras, Alina; Ferket, Bart (2014). "Screening for peripheral arterial disease" (in en). Cochrane Database of Systematic Reviews (4). doi:10.1002/14651858.CD010835.pub2. PMID 24711093.
30. ↑ Jenks, Sara; Yeoh, Su Ern; Conway, Bryan R. (2014). "Balloon angioplasty, with and without stenting, versus medical therapy for hypertensive patients with renal artery stenosis". The Cochrane Database of Systematic Reviews 2014 (12). doi:10.1002/14651858.CD002944.pub2. ISSN 1469-493X. PMID 25478936.

## Further reading

* "The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials". http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=12012023329.

## External links

Classification|

* ICD-10: G45-G46, I60-I95
* ICD-9-CM: 325, 430-459
* MeSH: D014652

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| Wikimedia Commons has media related to Vascular disease.

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| Scholia has a topic profile for Vascular disease.

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* v
* t
* e

Cardiovascular disease (vessels) (I70–I99, 440–456)

Arteries, arterioles
and capillaries|

| Inflammation|

* Arteritis
* Aortitis
* Buerger's disease

|

Peripheral artery disease|

| Arteriosclerosis|

* Atherosclerosis
* Foam cell
* Fatty streak
* Atheroma
* Intermittent claudication
* Critical limb ischemia

* Monckeberg's arteriosclerosis
* Arteriolosclerosis
* Hyaline
* Hyperplastic
* Cholesterol
* LDL
* Oxycholesterol
* Trans fat

|

Stenosis|

* Carotid artery stenosis
* Renal artery stenosis

Other|

* Aortoiliac occlusive disease
* Degos disease
* Erythromelalgia
* Fibromuscular dysplasia
* Raynaud's phenomenon

Aneurysm / dissection /
pseudoaneurysm|

* torso: Aortic aneurysm
* Abdominal aortic aneurysm
* Thoracic aortic aneurysm
* Aneurysm of sinus of Valsalva
* Aortic dissection
* Aortic rupture
* Coronary artery aneurysm
* head / neck
* Intracranial aneurysm
* Intracranial berry aneurysm
* Carotid artery dissection
* Vertebral artery dissection
* Familial aortic dissection

Vascular malformation|

* Arteriovenous fistula
* Arteriovenous malformation
* Telangiectasia
* Hereditary hemorrhagic telangiectasia

Vascular nevus|

* Cherry hemangioma
* Halo nevus
* Spider angioma

Veins|

| Inflammation|

* Phlebitis

|

Venous thrombosis /
Thrombophlebitis|

* primarily lower limb
* Deep vein thrombosis
* abdomen
* Hepatic veno-occlusive disease
* Budd–Chiari syndrome
* May–Thurner syndrome
* Portal vein thrombosis
* Renal vein thrombosis
* upper limb / torso
* Mondor's disease
* Paget–Schroetter disease
* head
* Cerebral venous sinus thrombosis
* Post-thrombotic syndrome

Varicose veins|

* Gastric varices
* Portacaval anastomosis
* Caput medusae
* Esophageal varices
* Hemorrhoid
* Varicocele

Other|

* Chronic venous insufficiency
* Chronic cerebrospinal venous insufficiency
* Superior vena cava syndrome
* Inferior vena cava syndrome
* Venous ulcer

Arteries or veins|

* Angiopathy
* Macroangiopathy
* Microangiopathy
* Embolism
* Pulmonary embolism
* Cholesterol embolism
* Paradoxical embolism
* Thrombosis
* Vasculitis

Blood pressure|

| Hypertension|

* Hypertensive heart disease
* Hypertensive emergency
* Hypertensive nephropathy
* Essential hypertension
* Secondary hypertension
* Renovascular hypertension
* Benign hypertension
* Pulmonary hypertension
* Systolic hypertension
* White coat hypertension

|

Hypotension|

* Orthostatic hypotension

* v
* t
* e

Symptoms and signs relating to the cardiovascular system (R00–R03, 785)

Chest pain|

* Referred pain
* Angina
* Aerophagia

Auscultation|

* Heart sounds
* Split S2
* S3
* S4
* Gallop rhythm
* Heart murmur
* Systolic
* Diastolic
* Continuous
* Pericardial friction rub
* Heart click
* Bruit
* carotid

Pulse|

* Tachycardia
* Bradycardia
* Pulsus tardus et parvus
* Pulsus paradoxus
* doubled
* Pulsus bisferiens
* Dicrotic pulse
* Pulsus bigeminus
* Pulsus alternans
* Pulse deficit

Vascular disease|

* Gangrene

Other|

* Palpitations
* Apex beat
* Cœur en sabot
* Jugular venous pressure
* Cannon A waves
* Hyperaemia

Shock|

* Cardiogenic
* Obstructive
* Hypovolemic
* Distributive
* Septic
* Neurogenic
* Refractory vasodilatory shock

* v
* t
* e

Medicine

Specialties
and
subspecialties|

Surgery

* Cardiac surgery
* Cardiothoracic surgery
* Colorectal surgery
* Eye surgery
* General surgery
* Neurosurgery
* Oral and maxillofacial surgery
* [[[Medicine:Orthopedic surgery|Orthopedic surgery]]
* Hand surgery
* Otolaryngology
* ENT
* Pediatric surgery
* Plastic surgery
* Reproductive surgery
* Surgical oncology
* Thoracic surgery
* Transplant surgery
* Trauma surgery
* Urology
* Andrology
* Vascular surgery

Internal medicine

* Allergy / Immunology
* Angiology
* Cardiology
* Endocrinology
* Gastroenterology
* Hepatology
* Geriatrics
* Hematology
* Hospital medicine|
* Infectious disease
* Nephrology
* Oncology
* Pulmonology
* Rheumatology

Obstetrics and gynaecology

* Gynaecology
* Gynecologic oncology
* Maternal–fetal medicine
* Obstetrics
* Reproductive endocrinology and infertility
* Urogynecology

Diagnostic

* Radiology
* Interventional radiology
* Nuclear medicine
* Pathology
* Anatomical
* Clinical pathology
* Clinical chemistry
* Clinical immunology
* Cytopathology
* Medical microbiology
* Transfusion medicine

Other specialties

* Addiction medicine
* Adolescent medicine
* Anesthesiology
* Dermatology
* Disaster medicine
* Diving medicine
* Emergency medicine
* Mass gathering medicine
* Family medicine
* General practice
* Hospital medicine
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* Psychiatry
* Addiction psychiatry
* Radiation oncology
* Reproductive medicine
* Sexual medicine
* Sleep medicine
* Sports medicine
* Transplantation medicine
* Tropical medicine
* Travel medicine
* Venereology

Medical education|

* Medical school
* Bachelor of Medicine, Bachelor of Surgery
* Bachelor of Medical Sciences
* Master of Medicine
* Master of Surgery
* Doctor of Medicine
* Doctor of Osteopathic Medicine
* MD–PhD

Related topics|

* Alternative medicine
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* Molecular oncology
* Nanomedicine
* Personalized medicine
* Public health
* Traditional medicine
* Veterinary medicine
* Physician
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* History of medicine

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