Vascular Disease

In our ageing population, vascular disease is a common cause of disability and mortality. There are more and more people affected by vascular diseases. The good news is that the range of diagnostic tests and treatment is also increasing.

Vascular disease or disease of the blood vessels can be categorised as

• Those affecting the arteries (blood vessels carrying blood away from the heart)
• Those affecting the veins (blood vessels carrying blood to the heart)

Most of the diseases affecting the arteries are associated with atherosclerosis or thickening of the artery walls due to the deposit of fats. This may cause a blockage of the affected vessels resulting in a decreased blood supply to the organs or parts of the body that are supplied by these vessels.

Depending on which parts are affected, you may end up with:

• Intermittent claudication (where you get muscle pain on walking)
• Gangrene
• Stroke
• Kidney or other organ failure
• Aneurysm (weakening of the artery wall which can rupture and cause death)

Diseases affecting the veins - These include:

• Varicose veins - These are dilated and engorged veins in the legs, which may lead to pain and ulcers in the legs, which cannot heal.
• Deep vein thrombosis - This is another common vascular disorder where blood clots form in the veins. If the blood clots break away and move to the lung, these clots may get stuck in the lung arteries and cause pulmonary embolism which is life threatening.

A vascular surgeon uses his specialised clinical skill to assess and treat vascular diseases. He is supported by vascular physicians, vascular radiologists and vascular technologists who are skilled in the different aspects of vascular diseases.

Vascular technologists carry out non-invasive vascular tests

• Non-invasive vascular investigations are tests done to assess the blood circulation without the need for injections, harmful radiation or other unpleasant interventions.
• The technology used is sophisticated and the diagnostic accuracy is high.
• The most effective is using ultrasound, which provides images of the blood vessels (using B mode scan) or detailed information about blood flow disturbances (using Doppler scan).
• These two functions can be combined (Duplex scan) to provide a more comprehensive assessment.

Invasive vascular investigations

• The most important investigation for diagnosis of all vascular diseases is angiography.
• X-ray images of the arteries, veins and lymphatics are taken after injection of radio-opaque contrast medium into the blood vessels.
• Digital systems, which can enhance these images, have improved the accuracy and safety of this investigation.

Other imaging investigations include:

• CT (computerised tomography) scans
• Radio-isotope angiography
• MRI (magnetic resonance imaging)

Symptoms depend on where the vascular diseases occur, examples are

Abdominal

• Pain in the abdominal, back or groin area
• Sudden, excruciating pain in the lower abdomen
• Deep, aching, gnawing and/or throbbing pain that may last for hours or days

Legs

• Peripheral vascular disease
• Cramping pain in the leg muscles upon exertion which settles after a few minutes' rest
• In the early stages, pain usually occurs in the calves.
• In the later stages, there may be constant pain at rest, ulceration of the lower leg, or even gangrene in the toes and feet.

General Management

• Advice on lifestyle changes include stopping smoking and eating right
• Control of risk factors like high blood lipid levels and diabetes

Medication

• This will be considered first for circulatory disordered e.g. low dose aspirin for the treatment of intermittent claudication.

Surgery

• Can be carried out for repair of blood vessels in all parts of the body except in the heart and brain
• These can be done in either an open surgery or closed surgery (endovascular procedures).

Other forms of treatment

• Structured exercise programmes for intermittent claudication (leg pain)
• Compression bandaging for the venous insufficiency (Poor or impaired flow of blood from the legs and feet to the heart)
• Physical therapy for lymphoedema (Swelling in the arms or legs caused by a build-up of lymph fluid)