Your vascular system is made up of vessels that carry your blood throughout your body. Arteries carry oxygen-rich blood away from your heart. Veins carry oxygen-poor blood back to your heart. Your blood leaves the left side of the heart and is pumped out to the rest of your body. The main artery from your heart is called the aorta. As your blood travels throughout your body, it enters smaller and smaller blood vessels, reaching every cell, dropping off nutrients and picking up waste products and carbon dioxide. Your blood then starts the trip back in your veins, entering larger and larger ones as it goes, passing through your kidneys and liver on the way to drop off waste products. The blood eventually arrives back at the right side of your heart to start the trip all over again. As we age, our arteries tend to thicken, get stiffer, and narrow. This is called arteriosclerosis. A form of arteriosclerosis is atherosclerosis, which is the build-up of plaque and cholesterol in large and medium-sized arteries. A narrowing of the arteries from the build-up of plaque can lead to coronary heart disease, and can cause a heart attack when this occurs in the blood vessels leading to the heart. The same situation in the arteries leading to the brain can cause strokes. Narrowing of the arteries in other places, such as your legs, can cause what is called Peripheral Arterial Disease, or PAD. PAD can lead to sores, pain with walking, or amputation. When the smaller arteries are affected it is called arteriolosclerosis.
Many Americans are familiar with heart disease and the consequences of blockages in the vessels carrying blood to and from the heart. Very few people realize that blockages caused by a buildup of plaque and cholesterol affect more than coronary arteries. Arteries throughout the body carry oxygen-rich blood away from the heart, so blockages can occur in all arteries with serious effects.
Abdominal Aortic Aneurysm (AAA) is an enlargement or “bulge” that develops in a weakened area within the largest artery in the abdomen. This is one of three most recognized vascular diseases. The pressure generated by each heartbeat pushes against the weakened aortic wall, causing the aneurysm to enlarge. If the AAA remains undetected, the aortic wall continues to weaken, and the aneurysm continues to grow. Eventually, the aneurysm becomes so large, and its wall so weak, that rupture occurs. When this happens there is massive internal bleeding, a situation that is usually fatal. The only way to break this cycle is to find the AAA before it ruptures.
Carotid arteries occur when the main blood vessels to the brain develop a buildup of plaque caused by atherosclerosis, or hardening of the arteries. When the buildup becomes very severe, it can cause a stroke. This is also one of three most recognized vascular diseases. A stroke occurs when part of the brain is damaged by these vascular problems; in fact, 80 percent of strokes are “ischemic strokes” where part of the circulation to the brain is cut off, usually due to blockages in the carotid arteries. The process is similar to the buildup of plaque in arteries in the heart that causes heart attacks. Strokes are the third leading cause of death in the United States according to the National Center for Health Statistics.
Peripheral arterial disease (PAD) occurs when atherosclerosis, or hardening of the arteries, causes a buildup of plaque in the blood vessels that carry oxygen and nutrients to all the tissues of the body. As these plaques worsen, they reduce essential blood flow to the limbs and can even cause complete blockages of the arteries. This is also one of three most recognized vascular diseases. Early on, PAD may only cause difficulty walking, but in its most severe forms, it can cause painful foot ulcers, infections, and even gangrene, which could require amputation. People with PAD are three times more likely to die of heart attacks or strokes than those without PAD.
Typically, patients are referred to a Vascular Medicine specialist by their primary care physician or by another specialist. Sometimes patients become acquainted with a vascular medicine specialist after an unexpected event lands them in the hospital. You might be referred to a vascular medicine specialist if you see your regular doctor for pain in your legs, and learn that you have peripheral arterial disease (PAD), for example. If you are in a high PAD risk category: are age is 65 or above, a smoker, diabetic, and/or have high blood pressure and high cholesterol, you may want to consider PAD screening test.
You are more likely to have vascular disease as you get older. Other factors that make vascular disease more likely include:
The aorta, the main vessel that carries blood from your heart to the rest of your body, is made of 3 layers. An aortic dissection is a tear that occurs between the innermost and middle layers of the aorta. Aortic dissections occur in approximately 3 per 100,000 patients per year. Both men and women are affected. Sometimes an aortic dissection is harmless. However, this is not always the case.
Arm artery disease is rare, and usually indicates other health issues. Typically, blockages in your arm arteries occur when blood clots float there from your heart or from an injured artery within your chest.
Chronic Venous Insufficiency or CVI is also called Phlebitis, Post-Thrombotic Syndrome, Venous Insufficiency, or Venous Leg Ulcer. When you have CVI, valves in your veins (usually in the leg or sometimes the arms) don’t work, causing blood to pool in your legs and putting increased pressure on the walls of the veins. This may be due to valve dysfunction (usually hereditary) or due to valve destruction after a Deep Vein Thrombosis (DVT) or blood clot. CVI may affect up to 40% of the U.S population. More common in women (especially after multiple pregnancies) and in people who are middle-aged or older. CVI is treatable and preventing complications is important.
Even with very successful treatment, recurrence is common and you may need further care.
CTD disorders affect the main proteins that are responsible for the strength and integrity of all of our organs, vessels, skin and bones. They cause weakness in the blood vessels, particularly the arteries, that can lead to vascular problems such as aneurysms, aortic dissections, and ruptures. The risk of significant vascular problems varies by each disorder, by vascular health factors (such as smoking) and your genetics. If you are diagnosed with a CTD, you may need ongoing monitoring to head off or treat any possible vascular problems.
Deep Vein Thrombosis or DVT occurs when your blood thickens in a clump that becomes solid, forming a clot. Nearly 300,000 first-time cases of DVT occur in the U.S. every year, usually in the leg. DVT requires prompt attention. If you develop a clot and a piece of it breaks off, it could travel to one of your lungs and make breathing difficult, or even cause death. DVT is most commonly treated with blood thinners. DVT can last from weeks to months.
Endoleaks occur when blood leaks back into an aneurysm sac following an Endovascular Aneurysm Repair (EVAR) procedure—one of the procedure’s most common complications.
Fibromuscular disease causes narrowing of arteries throughout your body, most frequently the arteries to the kidneys (renal arteries) and brain (carotid arteries). In rare cases, FMD can affect leg or intestinal arteries. FMD most commonly affects young women of European descent. FMD of the kidney arteries is found in 4–7% of women. FMD of the brain arteries is found in 0.3–3% of women. Though FMD is a life-long condition, it rarely causes symptoms severe enough to treat.
Giant cell arteritis encompasses two distinct disorders, both causing severe inflammation in the affected arteries. Though both disorders are rare, they can cause damage to your arteries that lasts for years and can lead to serious consequences. Giant cell arteritis is rare, but can have serious consequences. TEMPORAL ARTERITIS affects about 20 in every 100,000 women over age 50 each year. Untreated, temporal arteritis can lead to impaired vision or blindness. TAKAYASU’S ARTERITIS affects about 5 in every 1 million women each year, most frequently young Asians. Takayasu’s arteritis affects the arteries to the arms, brain and abdominal organs and, if severe, can lead to stroke.
Hyperlipidemia is an umbrella term that refers to any of several acquired or genetic disorders that result in a high level of lipids (fats, cholesterol and triglycerides) circulating in the blood. These lipids can enter the walls of arteries and increase your risk of developing atherosclerosis (hardening of the arteries), which can lead to stroke, heart attack and the need to amputate. The risk of atherosclerosis is higher if you smoke, or if you have or develop diabetes, high blood pressure and kidney failure. Hyperlipidemia is extremely common. More than 3 million people have this genetic disorder in the United States and Europe. It is extremely common for those who live in developed countries and follow a Western high-fat diet. Hyperlipidemia is usually chronic, requiring ongoing statin medication to control blood lipid levels. It is treatable and usually life-long.
Lymphedema is an accumulation of lymph fluid in the soft tissues, most frequently in the arms or legs. Lymph fluid, rich in protein, is normally filtered by the lymph nodes and is then released into the bloodstream. When the nodes are obstructed, their filtering capacity is overwhelmed and lymph fluid collects and causes swelling. Lymphedema is usually a chronic condition, but generally can be controlled. Untreated, lymphedema can lead to irreversible skin changes, frequent infections, reduced mobility of the affected limb and diminished quality of life.
Mesenteric ischemia is poor circulation in the vessels supplying blood flow to your mesenteric organs: your stomach, liver, colon and intestine. With poor circulation, blockages can form and compromise the function of these organs. Mesenteric ischemia can come on suddenly or build slowly and become an ongoing health issue. It is part of a systemic disease process known as peripheral vascular disease or Peripheral Artery Disease (PAD).
Peripheral aneurysms are a weakening in the wall of a blood vessel in your abdomen or sometimes in a leg which results in an abnormally dilated area. This dilated area is prone to:
If you have liver disease or other liver problems, you may develop portal hypertension. As cirrhosis of the liver progresses, blood is unable to flow normally through your liver, which filters toxins from the blood. Instead, the blood backs up and causes bleeding and the accumulation of fluid inside your abdomen. Portal hypertension lasts as long as your liver disease or another underlying condition exists. If you suffer from this condition then preventing complications is important. Leads to an enlarged spleen that may reduce platelets in your blood, which are responsible for clotting (stopping bleeding). If excess fluid develops in your abdomen (a condition called ascites), the fluid may become infected (spontaneous bacterial peritonitis).
A Pulmonary Embolism is a sudden blockage of a major artery in your lung. Usually due to a blood clot that develops in another part of your body, breaks off and travels in the blood stream into the lung where it blocks the pumping of your heart and prevents it from taking in oxygen. It is the third most common cardiovascular disease after heart attack and stroke. Pulmonary embolism is a medical emergency. If any of the symptoms below occur, seek immediate medical attention. Call 911 as stroke/PE may result in permanent injury or death if not addressed immediately. After the high-risk period has elapsed (roughly one week), blood clots in your lung will need months or years to completely resolve. You may develop pulmonary hypertension with life-long implications, including shortness of breath and exercise intolerance.
The renal arteries originate in your heart and are responsible for carrying blood rich in oxygen and nutrients to your kidneys. When the renal arteries become blocked, a condition called renal artery stenosis, your kidneys do not receive enough blood or oxygen. These arteries can also be affected by a number of diseases, most commonly atherosclerosis. Less common conditions that may occur in the renal arteries include: renal artery aneurysms, fibromuscular dysplasia (FMD), and vasculitis (inflammation of the arteries).
A Stroke occurs when the blood supply to a part of your brain is suddenly interrupted. ISCHEMIC STROKE, approximately 75% of all strokes, can occur when blood supply to your brain is blocked. HEMMORRHAGIC STROKE can occur when there is bleeding in your brain. TRANSIENT ISCHEMIC ATTACK (TIA) or mini-stroke is a condition similar to stroke, but the symptoms only last seconds or a few minutes and completely resolve within 24 hours. Can be a warning sign of a future stroke, and medical attention should be sought as soon as possible. A Stroke is a medical emergency and requires calling 911. If you experience any of the symptoms below, seek immediate medical attention. Stroke is the fourth most common cause of death in the United States, and the most common cause of permanent disability. Most causes of stroke are treatable with medical and surgical intervention, provided they are diagnosed early.
Thoracic Aortic Aneurysm is an expansion, or ballooning, of a section of the aorta within your chest (thorax) that slowly degenerates. The aorta, the body’s main blood vessel, starts at your heart and extends all the way to your pelvis, where it branches toward your legs. The larger the aneurysm, the higher the risk it may rupture, leading to damage of the aortic wall and bleeding that could cause death. Thoracic aortic aneurysms are rare, occurring in approximately 6-10 per every 100,000 people. About 20% of those cases are linked to family history. Your risk is higher if you have certain genetic syndromes (see “Causes” below), as you age, if you smoke and if you have high blood pressure. Surgery is offered when the risk of rupture is greater than the risk of the operation. The procedure is called open thoracic aortic aneurysm repair or TAA. Sometimes misnamed a thoracic aortic dissection, which represents a different process that causes a tear in the wall of the aorta. This can be caused by an aneurysm or can occur spontaneously and develop into an aneurysm.
Thoracic Outlet Syndrome is a group of conditions that result from compression of the nerves or blood vessels that serve your arms. Usually affects otherwise healthy, young and active people. Once treated, ideally by combining medical treatment with physical therapy, you should be able to return to an active lifestyle.
Varicose veins are large bulging veins in the legs that can cause many different types of symptoms. Varicose veins can occur in almost anyone and affect up to 35% of people in the United States. You may inherit a tendency to develop varicose veins from a parent. Women who have had multiple children, and obese persons are at a higher risk.
An artery or vein or a graft that has been used to replace an artery or vein can get infected by bacteria, viruses or fungus. The infection flows through your bloodstream, and may cause you to become very sick with fevers, chills and weight loss. The infection could occur within months of the replacement procedure or many years later. Your own arteries and veins very rarely get infected. However, a graft or stent-graft is a foreign body and is susceptible to infection; it happens in approximately 1-2 cases out of every 100. Antibiotics are used but often are not sufficient to clear the infection. In most cases, the artery, vein or graft needs to be removed. If infected grafts are not removed, many of them will slowly decay and can break open, bleed excessively and potentially cause loss of a limb, or even death. If you have a fever, chills, or notice cloudy drainage from an incision after a graft is placed, get immediate help and go immediately to the nearest emergency room. Be alert for other symptoms listed below.
The term “vascular trauma” refers to injury to a blood vessel—an artery, which carries blood to an extremity or an organ, or a vein, which returns blood to the heart. Vascular medicine specialists categorize these injuries by the type of trauma that caused them: blunt or penetrating injury.
Vasculitis refers to a group of disorders that involve inflammation of blood vessels. The inflammation is due to the immune system attacking and damaging your arteries, veins and/or capillaries. About 1–2 new cases of vasculitis per 50,000 people are found each year. Vasculitis affects men and women of all ages and races. The duration of vasculitis ranges from short-term to lifelong. Patients often have episodes or flares over a period of years.
An aneurysm is an expansion of an artery due to a weakening of the artery wall. As the artery enlarges like a balloon, the wall becomes thinner and can burst. A visceral artery aneurysm is one associated with the arteries supplying your liver, spleen, kidneys or intestines. This type of aneurysm is uncommon. Successful treatment with catheter-based or conventional (open) surgery relieves symptoms and should remedy the problem. Visceral aneurysms, like other aneurysms in the body, are not treated until they reach a certain size or cause symptoms. The size threshold varies with gender and age, but few aneurysms under 2 cm are treated.