Vascular Disease

 

Vascular Disease (Vasculopathy)

Vascular disease (vasculopathy) affects the blood vessels that carry oxygen and nutrients throughout your body and remove waste from your tissues. Common vascular problems happen because plaque (made of fat and cholesterol) slows down or blocks blood flow inside your arteries or veins. Lifestyle changes often help, but some people need medication or surgery.

ContentsOverviewSymptoms and CausesDiagnosis and TestsManagement and TreatmentPreventionOutlook / PrognosisLiving With

ContentsOverviewSymptoms and CausesDiagnosis and TestsManagement and TreatmentPreventionOutlook / PrognosisLiving With

Overview

Vascular disease harms your blood vessels

What is vascular disease?

Vascular disease includes any condition that affects your circulatory system, or system of blood vessels. This ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation.

Blood vessels are elastic-like tubes that carry blood to every part of your body. Blood vessels include:

• Arteries that carry blood away from your heart.
• Veins that return blood back to your heart.
• Capillaries, your tiniest blood vessels, which link your small veins and arteries, deliver oxygen and nutrients to your tissues and take away their waste.

Types of Vascular Disease

Some vascular diseases affect your arteries, while others occur in your veins. They can also happen only in specific parts of your body.

Peripheral artery disease

Like the blood vessels of your heart (coronary arteries), your peripheral arteries (blood vessels outside your heart) also may develop atherosclerosis, the buildup of plaque (fat and cholesterol deposits), inside them. Over time, the buildup narrows the artery. Eventually, the narrowed artery causes less blood to flow, which may lead to ischemia, or inadequate blood flow to your body's tissue. Types of peripheral arterial disease include:

• Peripheral artery disease: A blockage in your legs. Total loss of circulation can lead to gangrene and loss of a limb.
• Intestinal ischemic syndrome: A blockage in the blood vessels leading to your gastrointestinal system.
• Renal artery disease: A blockage in your renal arteries can cause renal artery disease and kidney failure.
• Popliteal Entrapment Syndrome: A rare vascular disease that affects the legs of some young athletes. The muscle and tendons near the knee compress the popliteal artery, restricting blood flow to the lower leg and possibly damaging the artery.
• Raynaud's Phenomenon: Consists of spasms of the small arteries of your fingers, and sometimes toes, from exposure to cold or stress.
• Buerger's Disease: Most commonly affects the small and medium-sized arteries, veins and nerves. Although the cause is unknown, there is a strong association with tobacco use or exposure. The arteries of your arms and legs become narrowed or blocked, causing lack of blood supply (ischemia) to your fingers, hands, toes and feet. With severe blockages, the tissue may die (gangrene), making it necessary to amputate affected fingers and toes. Superficial vein inflammation and symptoms of Raynaud's can occur as well.

Carotid artery issues

These happen in the two main carotid arteries in your neck.

• Carotid artery disease: A blockage or narrowing in the arteries supplying your brain. This can lead to a transient ischemic attack (TIA) or stroke.
• Carotid artery dissection: Begins as a tear in one layer of your artery wall. Blood leaks through this tear and spreads between the wall layers.
• Carotid body tumors: Growths within the nervous tissue around your carotid artery.
• Carotid artery aneurysm: A bulge in your artery wall that weakens the wall and may cause a rupture.

Venous disease

Veins are flexible, hollow tubes with flaps inside, called valves. When your muscles contract, these one-way valves open, and blood moves through your veins. When your muscles relax, the valves close, keeping blood flowing in one direction through your veins.

If the valves inside your veins become damaged, the valves may not close completely. This allows blood to flow in both directions. When your muscles relax, the valves inside the damaged vein(s) will not be able to hold the blood. This can cause pooling of blood or swelling in your veins. The veins bulge and look like ropes under the skin. The blood begins to move more slowly through your veins and may stick to the sides of your vessel walls. Symptoms include heaviness, aching, swelling, throbbing or itching. Blood clots can form.

• Varicose veins: Bulging, swollen, purple, ropy veins, seen just under your skin. Damaged valves within the veins cause this.
• Spider veins: Small red or purple bursts on your knees, calves, or thighs. Swollen capillaries (small blood vessels) cause this.
• Klippel-Trenaunay syndrome (KTS): A rare congenital (present at birth) vascular disorder.
• May-Thurner syndrome (MTS): Your right iliac artery compresses your left iliac vein, which increases the risk of deep vein thrombosis (DVT) in your left extremity.
• Thoracic outlet syndrome (TOS): A group of disorders that happen with compression, injury or irritation of the nerves and/or blood vessels (arteries and veins) in your lower neck, armpit and upper chest area.
• Chronic venous insufficiency (CVI): A condition that happens when the venous wall and/or valves in your leg veins are not working effectively, making it difficult for blood to return to your heart from your legs.

Blood clots

A clot forms when clotting factors in your blood make it coagulate or become a solid, jelly-like mass. When a blood clot forms inside a blood vessel (a thrombus), it can come loose and travel through your bloodstream, causing a deep vein thrombosis, pulmonary embolism, heart attack or stroke.

Blood clots in your arteries can increase the risk for stroke, heart attack, severe leg pain, difficulty walking or even the loss of a limb.

• Hypercoagulable states or blood clotting disorders: Conditions that put people at increased risk for developing blood clots because they make blood more likely to form blood clots (hypercoagulable) in the arteries and veins. You can inherit these conditions (congenital, occurring at birth) or acquire them. These disorders include high levels of factors in your blood that cause blood to clot (fibrinogen, factor 8, prothrombin) or not enough natural anticoagulant (blood-thinning) proteins (antithrombin, protein C, protein S). The most aggressive disorders include circulating antiphospholipid antibodies, which can cause clots in both arteries and veins.
• Deep vein thrombosis (DVT): A blood clot occurring in a deep vein.
• Pulmonary embolism: A blood clot that breaks loose from a vein and travels to your lungs.
• Axillo-subclavian vein thrombosis, also called Paget-Schroetter Syndrome: Most common vascular condition to affect young, competitive athletes. The condition develops when your collarbone (clavicle), first rib or the surrounding muscle compresses a vein in your armpit (axilla) or in front of your shoulder (the subclavian vein). This increases your risk of blood clots.
• Superficial thrombophlebitis: A blood clot in a vein just under your skin.

Aortic aneurysm

An aneurysm is an abnormal bulge in a blood vessel wall. Aneurysms can form in any blood vessel, but they occur most commonly in the aorta (aortic aneurysm) which is the main blood vessel leaving the heart:

• Thoracic aortic aneurysm.
• Abdominal aortic aneurysm.

Fibromuscular dysplasia (FMD)

Fibromuscular dysplasia (FMD): A rare medical condition in which people have abnormal cellular growth in the walls of their medium and large arteries. This can cause the arteries with abnormal growth to look beaded and become narrow. This can cause issues with the arteries, including aneurysms and dissection.

Lymphedema

The lymphatic system includes an extensive network of lymph vessels and lymph nodes that helps coordinate your immune system's function to protect your body from foreign substances. Lymphedema, an abnormal buildup of fluid, develops when lymph vessels or lymph nodes are missing, impaired, damaged or removed.

• Primary lymphedema (rare): Some people are born without certain lymph vessels or have abnormalities in them.
• Secondary lymphedema: Happens as a result of a blockage or interruption that alters the lymphatic system. Causes of this include: infection, malignancy, surgery, scar tissue formation, trauma, deep vein thrombosis (DVT), radiation or other cancer treatment.

Vasculitis

Your blood vessels can get inflamed because of a medicine, an infection or an unknown cause. This can make it hard for blood to travel through your blood vessels. This is sometimes associated with rheumatological conditions or connective tissue disease. Vasculitis can also cause an aneurysm.

Who does vasculopathy affect?

Some people are born with vascular diseases they inherit from their parents. In these cases, such as blood clotting disorders, they start dealing with this issue at a younger age. However, many vascular diseases develop over time because of an accumulation of plaque (fat and cholesterol) in the arteries, such as peripheral artery disease or carotid artery disease. Atherosclerosis, the hardening of the arteries, can start when you’re a teen and cause problems in middle age or later.

How common is vascular disease?

Vascular diseases are very common in America, partly because so many people weigh too much and have diabetes. The most common vascular diseases include peripheral artery disease (PAD) and carotid artery disease.

Symptoms and Causes

What are the vascular disease symptoms?

Symptoms vary depending on the type of vascular disease.

Peripheral artery disease symptoms

• Peripheral artery disease: Leg pain or cramps with activity but improve with rest; changes in skin color; sores or ulcers and tired legs.
• Intestinal ischemic (or mesenteric ischemia) syndrome: Severe stomach pain, nausea, throwing up, diarrhea, food fear and weight loss.
• Renal artery disease: Uncontrolled hypertension (high blood pressure), congestive heart failure and abnormal kidney function.
• Popliteal entrapment syndrome: Leg and foot cramps, numbness, tingling, discoloration.
• Raynaud’s phenomenon: Fingers and toes that look red, blue or white, throbbing, tingling, redness.
• Buerger’s disease: Pain in your arms, hands, legs and feet, even at rest. Blue or pale fingers or toes.

Symptoms of carotid artery issues

• Carotid artery disease: Usually no symptoms until having a stroke or transient ischemic attack (TIA or mini-stroke). Symptoms of these include trouble with vision or speech, confusion and difficulty with memory.
• Carotid artery dissection: Headache, neck pain and eye or facial pain.
• Carotid body tumors: Palpitations, high blood pressure, sweating and headaches.
• Carotid artery aneurysm: Stroke or transient ischemic attack (TIA or mini-stroke).

Venous disease symptoms

• Varicose veins and spider veins: Swelling, pain, blue or red veins visible on legs.
• Klippel-Trenaunay syndrome (KTS): Pain or heaviness in your leg or arm.
• May-Thurner syndrome (MTS): Swelling, tenderness, pain in your leg, red or discolored skin.
• Thoracic outlet syndrome (TOS): Neck, arm and shoulder pain, tingling and numbness in your arm or hand.
• Chronic venous insufficiency (CVI): Leg cramps, heavy or achy legs, swelling or pain in your legs.

Blood clots

• Blood clotting disorders: Deep vein thrombosis, pulmonary embolism.
• Deep vein thrombosis (DVT): Pain, swelling, warmth in your leg, red skin.
• Pulmonary embolism: Coughing up blood, chest pain, shortness of breath.
• Axillo-subclavian vein thrombosis: Swelling, heaviness or pain in your arm or hand, skin that looks blue.
• Superficial thrombophlebitis: Inflammation, pain, warmth around your vein, red skin.

Aortic aneurysm symptoms

• Thoracic aortic aneurysm: Chest pain, fast heart rate, trouble swallowing, swollen neck.
• Abdominal aortic aneurysm: Abdominal or back pain, dizziness, nausea and throwing up, fast heart rate (if the aneurysm ruptures).

Fibromuscular Dysplasia (FMD) symptoms

Fibromuscular dysplasia (FMD): Neck pain, vision changes, high blood pressure, dizziness, hearing a “whooshing sensation” or hearing your heartbeat in your ears.

Lymphedema symptoms

Swelling, most often in your arms or legs.

Vasculitis symptoms

Not feeling well, fever, swelling.

What causes vascular disease?

For some vascular problems, the cause isn’t known. Vascular disease causes include:

• High cholesterol.
• High blood pressure.
• Smoking or using tobacco products.
• Diabetes.
• Genes you get from your parents.
• Medicines.
• Injury.
• Infection.
• Blood clots.

Diagnosis and Tests

How is vascular disease diagnosed?

Your healthcare provider will want to do a physical exam and get your medical history, as well as a history of which diseases are in your family. It helps your healthcare provider look for vascular disease when you take your shoes and socks off before they examine you.

Depending on the type of vascular disease your provider suspects, they may do blood tests and imaging.

What tests will be done to diagnose vasculopathy?

Many vascular diseases involve clots or blockages in blood vessels. To diagnose these, your healthcare provider needs to be able to see inside your blood vessels using imaging methods that include:

• Vascular ultrasound.
• Catheter angiography.
• CT angiography.
• MR angiography.

Management and Treatment

How is vascular disease treated?

Eating healthier and exercising more can help with many vascular diseases. For others, you may need to take medicine or have a surgical procedure. Vascular disease treatments vary depending on the condition.

Peripheral artery disease treatment

• Peripheral artery disease: Diet, exercise, medicine, surgery.
• Intestinal ischemic syndrome: Pain medicine, clot-busting drugs, surgical removal of blood clot. Angioplasty, stenting or bypass surgery for chronic cases.
• Renal artery disease: Low-salt, heart-healthy diet. High blood pressure medicine, statins.
• Popliteal entrapment syndrome: Surgery to release the popliteal artery.
• Raynaud’s phenomenon: Keep hands and feet warm. Take medicine that helps blood vessels stay open (dilated).
• Buerger’s disease: Quit tobacco products. Warm up fingers and toes. Take medicine (vasodilators) to open blood vessels.

Treatment of carotid artery issues

• Carotid artery disease: Healthier diet. Blood thinners and cholesterol-lowering medicine. Plaque removal (carotid endarterectomy). Angioplasty and stenting to keep the artery open.
• Carotid artery dissection: Antiplatelets, anticoagulants, stenting.
• Carotid body tumors: Surgical removal of the tumor.
• Carotid artery aneurysm: Antihypertensives, cholesterol-lowering medicine, clot-busting medicine. Bypass or stent-graft surgery.

Venous disease treatment

• Varicose veins and spider veins: Removal using heat, saltwater or laser therapy.
• Klippel-Trenaunay syndrome (KTS): Same treatment as varicose veins.
• May-Thurner syndrome (MTS): Same as for deep vein thrombosis.
• Thoracic outlet syndrome (TOS): Physical therapy, medicine.
• Chronic venous insufficiency (CVI): Move legs frequently and wear compression stockings. Vein treatment with saltwater, laser or removal through an incision.

Blood clot treatment

• Blood clotting disorders: Same as for deep vein thrombosis and pulmonary embolism.
• Deep vein thrombosis (DVT): Elevate your legs. Take blood thinners and medicines for pain.
• Pulmonary embolism: Blood thinners and thrombolytics. Procedure to remove the clot.
• Axillo-subclavian vein thrombosis: Thrombolytics, blood thinners. Removal of the clot.
• Superficial thrombophlebitis: Raise your affected limb above your heart. Use a warm compress. Put on support stockings. Have the vein surgically removed.

Aortic aneurysm treatment

• Thoracic aortic aneurysm: Surgery to put in a fabric graft or a stent. This can be a major surgery depending on the location and surgical method.
• Abdominal aortic aneurysm: Surgery to put in a graft. An endovascular repair is less invasive.

Fibromuscular Dysplasia (FMD)

• Blood thinners, medicine for pain.
• Angioplasty. Surgery to prevent an artery rupture.

Lymphedema

• Let your arm rest above your heart level while you lie down for 45 minutes twice daily.
• Wear a compression sleeve.
• Use your affected limb for daily tasks.
• Visit a specialized lymphedema clinic if your healthcare provider recommends it.

Vasculitis

• Your provider may prescribe medications like steroids.

Complications/side effects of the treatment

Any medicine can have side effects, but the benefits of medicines usually make them worth taking. Side effects often go away. If they don’t, you can ask your healthcare provider to switch you to a different drug.

When considering a procedure or surgery, talk to your provider about the risks and benefits. What’s right for your neighbor may not be the right treatment for you.

Prevention

How can I reduce my risk of vascular disease?

You can’t do anything about your age, family history or genetics, but you can:

• Manage your diabetes, high cholesterol and high blood pressure.
• Exercise regularly.
• Eat healthier foods.
• Move around once an hour if you have to sit or stand for hours.
• Stay at a healthy weight.
• Reduce your stress level.
• Avoid tobacco products.

Outlook / Prognosis

What can I expect if I have vasculopathy?

Vascular disease can be a lifelong problem. Once your healthcare provider knows you have plaque accumulations in your blood vessels, they’ll want you to make some changes to how you live. These changes, such as exercising, not using tobacco products and choosing healthier foods, are things you’ll need to keep doing for years to come. You may also need to take medicines to decrease your risk of a heart attack or stroke.

Outlook for this condition

The outlook for many vascular conditions is good if your healthcare provider catches the problem early. Many vascular issues get harder to treat as they get worse. Some vascular conditions, such as carotid artery dissection, abdominal aortic aneurysm and pulmonary embolism, can be life-threatening.

Living With

How do I take care of myself?

In addition to the things mentioned above, you’ll also want to keep taking medicines your healthcare provider prescribes and keep going to your regular checkups.

When should I see my healthcare provider?

Contact your provider if anything changes with your vascular issue or if you have a problem with the medication they prescribed.

When should I go to the ER?

Call 911 if you have:

• Confusion or dizziness.
• Slurred speech.
• A droop on one side of your face.
• Severe chest pain.
• Severe abdominal pain.
• Loss of vision.
• Weakness in an arm or leg.

What questions should I ask my doctor?

• What’s the best treatment for my specific situation?
• Is there anything else I should be doing to take care of my vascular condition?
• Are there related conditions I should watch for with this vascular issue?

A note from Cleveland Clinic

With vascular disease, the best thing you can do is stay vigilant. Don’t skip any medical checkups or medicine doses. Because some vascular issues run in families, sharing health information with your family can help them prevent and be on the lookout for vascular disease. Encourage your family to get their blood pressure and cholesterol checked since high levels put them at risk for vascular diseases.