Are you having problems with your blood vessels? Let's talk about Vascular Disease!

Have you ever thought about how important this vascular system is throughout our body? It is like roads, these blood vessels carry blood to all parts of our body. So if there is any problem in this vascular system, that is, in the roads through which blood flows, then we simply call it "Vascular Disease" . This is not a single disease, but many different types of diseases belong to this.

What is the Circulatory System? Let's understand it simply!

Imagine, inside our body there is a system that is like a big network of roads. This is what we call the circulatory system . The main components of this are the blood vessels. There are three types of these blood vessels:

1. Arteries: These are the large veins that carry clean, oxygenated blood from the heart to all other organs and tissues. Just like the large pipes that carry water from the water tank to the houses.

2. Veins: These are the veins that carry used, oxygen-poor blood back to the heart from all over the body. They are like pipes that collect used water.

3. Capillaries: These are the smallest blood vessels in our body, the size of a hair . These tiny veins carry oxygen and nutrients from the arteries to the cells of our body, and collect waste products from the cells and deliver them to the veins. They are like tiny byways connecting large roads to small houses.

So, if there is a problem with any of these three organs - arteries, veins, and capillaries - or with the blood itself, which affects blood circulation, it could be a disease of the blood vessel system, that is, a ``vascular disease''.

What are the types of vascular diseases?

This term `(Vascular Disease)` can come in many forms. Some affect only the arteries, some only the veins. Sometimes these diseases can occur only in specific areas of the body. Let's look at a few of the main types.

1. Peripheral Artery Disease (PAD)

What happens in this is that, like the coronary arteries, other arteries outside the heart (especially the arteries that carry blood to the legs) become clogged with fat and cholesterol (this is called ``Atherosclerosis``). Over time, this blockage increases and blood flow decreases. Then, because the blood does not flow properly, tissue damage can occur ``Ischemia``.

There are several types of ``Peripheral Artery Disease``:

• Peripheral Artery Disease of the Legs: This is when the blood flow to the legs is reduced. Sometimes, if the blood flow is completely stopped, the tissue in that area can die (Gangrene) and the leg may even have to be amputated. Think of it like the trees dying when the garden water pipe gets clogged with dirt and the water stops flowing.
• Intestinal Ischemic Syndrome: A condition caused by blockage of the blood vessels supplying the intestines.
• Renal Artery Disease: Blockage of the arteries that carry blood to the kidneys. This can lead to high blood pressure and kidney failure.
• Popliteal Entrapment Syndrome: This is a rare condition, especially in young athletes, where the popliteal artery, located behind the knee, can become compressed by the muscles and tendons in that area, causing a blockage in blood flow.
• Raynaud's Phenomenon: When exposed to cold or under stress, the small arteries in the fingers and toes suddenly constrict. The fingers may turn pale, blue, and then red.
• Buerger's Disease: This mostly affects the small and medium-sized arteries, veins, and nerves in the hands and feet. The exact cause is unknown, but it has been linked to tobacco use (smoking, chewing tobacco) . There are cases where the blood supply to the hands and feet is reduced, causing ``Ischemia``, tissue death in the fingers and toes, and ``Gangrene`

2. Carotid Artery Issues

There are two main arteries on either side of our neck that carry blood to the brain. These are called ``Carotid Arteries''. If there are problems with these, it can be very dangerous.

• Carotid Artery Disease: This is a blockage or narrowing of the artery that supplies blood to the brain. This can cause a transient ischemic attack (TIA) or stroke .
• Carotid Artery Dissection: A tear in the artery wall, causing blood to leak through.
• Carotid Body Tumors: Tumors that form in the nerve tissue surrounding the carotid artery.
• Carotid Artery Aneurysm: A weakening of the artery wall that bulges like a balloon. This can also burst.

3. Venous Disease

Veins are flexible blood vessels that have valves inside that allow blood to flow in only one direction. When we contract our muscles, these valves open and blood flows upward. When we relax our muscles, the valves close and blood stops flowing back down.

But if these valves are damaged, they don't close properly . Then blood starts flowing in both directions. When the muscles relax, the valves in the damaged veins can't hold the blood. This causes the veins to fill with blood, swell, and look like they're knotted. Symptoms like heaviness in the legs, pain, swelling, tingling, and itching can occur. Blood clots can also form.

• Varicose Veins: Swollen, purple, twisted veins that appear under the skin. This is caused by damage to the valves in the veins. You may have seen this problem in many people.
• Spider Veins: Small red or purple streaks that appear on the knees, ankles, and thighs. These are caused by swollen capillaries.
• Klippel-Trenaunay syndrome (KTS): This is a rare congenital blood vessel disorder.
• May-Thurner syndrome (MTS): The right iliac artery compresses the left iliac vein, increasing the risk of deep vein thrombosis (DVT) in the left leg.
• Thoracic Outlet Syndrome (TOS): A group of symptoms caused by compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck, armpit, and upper chest.
• Chronic Venous Insufficiency (CVI): A condition in which the walls and/or valves of the veins in the legs do not work properly, making it difficult for blood to return to the heart.

4. Blood Clots

Blood clots are when something in our blood causes our blood to become a little thick and jelly-like. If a blood clot (thrombus) forms inside a blood vessel, it can break off and travel with the blood, causing a deep vein thrombosis (DVT), pulmonary embolism (Pulmonary Embolism), heart attack, or stroke .

If blood clots form in the arteries, they increase the risk of stroke, heart attack, severe leg pain, difficulty walking, and possibly even loss of a limb.

• Hypercoagulable states / Blood Clotting Disorders: Some people's blood clots more quickly than normal. This can be genetic (inherited) or it can develop later in life. This increases the risk of blood clots in the arteries and veins. This can be caused by an excess of substances in the blood that help blood clot, such as `(Fibrinogen)`, `(Factor 8)`, `(Prothrombin)`, or a decrease in natural proteins that prevent blood clotting, such as `(Antithrombin)`, `(Protein C)`, `(Protein S)`.
• Deep Vein Thrombosis (DVT): A blood clot forms in a deep vein inside the body.
• Pulmonary Embolism: A blood clot that forms in a vein breaks loose and lodges in a vein in the lungs. This is a very dangerous condition .
• Axillo-subclavian vein thrombosis (Paget-Schroetter Syndrome): A blood vessel condition that is common in young, competitive athletes. The risk of blood clots is increased when the clavicle, first rib, or surrounding muscles compress the axilla or subclavian vein.
• Superficial Thrombophlebitis: A blood clot forms in a vein just beneath the skin and causes swelling.

5. Aortic Aneurysm

An aneurysm is a weakening of the wall of a blood vessel, causing it to bulge like a balloon. Although it can occur in any blood vessel, it is most commonly seen in the aorta, the main blood vessel leading from the heart.

• Thoracic Aortic Aneurysm: A bulge in the aorta in the chest area.
• Abdominal Aortic Aneurysm: A bulge in the aorta in the abdominal area.

Important: If an aneurysm ruptures, it can be life-threatening, so it is very important to be aware of this.

6. Fibromuscular Dysplasia (FMD)

This is also a rare condition. In this condition, cells in the walls of medium and large arteries grow abnormally. This can change the shape of the arteries, giving them a beaded appearance, and narrow the veins. This can lead to problems like aneurysms and arterial dissection.

7. Lymphedema

The lymphatic system is a network of lymph vessels and lymph nodes that help our body's immune system. This system protects our body from foreign substances. Lymphedema is when these lymph vessels or nodes are damaged, damaged, or removed, causing lymph fluid to accumulate in one place and swell.

• Primary Lymphedema: Rare. Some people are born without some lymph nodes or with abnormalities in them.
• Secondary Lymphedema: This occurs when there is a blockage or obstruction in the lymphatic system. This can be caused by things like infection, cancer, surgery, scar tissue, injury, DVT, and radiation therapy.

8. Vasculitis

This is an inflammation of the blood vessels, which means they become swollen. This can be caused by a medication, an infection, or sometimes no cause can be found. This makes it difficult for blood to flow through the blood vessels. Sometimes it can also be associated with rheumatological conditions or connective tissue diseases. Vasculitis can also cause an aneurysm.

Who is most affected by vascular disease?

Some people inherit blood vessel problems from their parents through genes. In such cases, for example, blood clotting conditions, they have to live with these problems from a young age.

However, many vascular diseases are caused by the buildup of fat and cholesterol (plaque) in the arteries over time. For example, Peripheral Artery Disease or Carotid Artery Disease. Atherosclerosis, a thickening of the artery walls, can begin in young adulthood and can cause problems in middle age or later.

How common are these diseases in Sri Lanka?

These blood vessel diseases have become very common in Sri Lanka as well. This risk has increased due to factors such as poor eating habits, the increase in diabetes mellitus, lack of exercise, and smoking . Conditions called `(Peripheral Artery Disease - PAD)` and `(Carotid Artery Disease)` are relatively common.

What are the symptoms of blood vessel disease?

This varies depending on the type of disease. Let's look at the symptoms of a few major types of diseases.

Peripheral artery disease (PAD) symptoms:

• Blocked arteries in the legs: Pain or stiffness in the legs while working or walking, which subsides after a short rest. Skin discoloration, non-healing wounds, and a feeling of tiredness in the legs.
• Intestinal ischemia: Severe abdominal pain, nausea, vomiting, diarrhea, loss of appetite, and weight loss.
• Renal artery disease: Uncontrolled high blood pressure (Hypertension), congestive heart failure, and kidney function abnormalities.
• Popliteal entrapment syndrome: numbness, tingling, loss of sensation, and discoloration in the leg and foot.
• Raynaud's phenomenon: fingers and toes turning red, blue, or white, tingling, and numbness.
• Buerger's disease: Pain in the hands, feet, and fingers even at rest. Fingers may turn blue or pale.

Symptoms of problems related to the main artery in the neck (Carotid Artery):

• Carotid artery disease: Often, symptoms do not appear until a stroke or TIA occurs . Symptoms of a stroke include: difficulty seeing or speaking, confusion, and memory problems.
• Carotid artery dissection: Headache, neck pain, eye or facial pain.
• Carotid body tumors: Rapid heartbeat, high blood pressure, sweating, headache.
• Carotid artery aneurysm: Stroke or transient ischemic attack (TIA) may occur.

Symptoms of Venous Disease:

• Varicose veins and spider veins: swelling, pain, and the appearance of blue or red veins in the legs.
• Klippel-Trenaunay syndrome (KTS): Pain or heaviness in the leg or arm.
• May-Turner syndrome (MTS): leg swelling, pain when pressed, red or discolored skin.
• Thoracic Outlet Syndrome (TOS): Pain in the neck, arm, and shoulder, numbness in the hand or fingers.
• Chronic venous insufficiency (CVI): Leg cramps, heaviness or cramps in the legs, swelling.

Symptoms of Blood Clots:

• Blood clotting conditions: `(DVT)` or `(Pulmonary Embolism` may occur.
• Deep vein thrombosis (DVT): leg pain, swelling, warmth, redness of the skin.
• Pulmonary Embolism: Coughing up blood, chest pain, difficulty breathing. This is an emergency!
• Axillo-subclavian vein thrombosis: swelling, heaviness or pain in the arm or fingers, bluish discoloration of the skin.
• Inflammation of superficial veins due to blood clots: swelling, pain, warmth, and redness of the skin around the vein.

Aortic Aneurysm Symptoms:

• Thoracic artery aneurysm: chest pain, rapid heartbeat, difficulty swallowing, neck swelling.
• Abdominal aortic aneurysm: Abdominal or back pain, dizziness, nausea and vomiting, (if the aneurysm ruptures) rapid heartbeat. This is also an emergency!

Fibromuscular dysplasia (FMD) symptoms:

Neck pain, vision changes, high blood pressure, dizziness, hearing a "ringing" sound inside the ears, or hearing the heartbeat.

Symptoms of Lymphedema:

Swelling of the hands or feet, especially.

Vasculitis symptoms:

Feeling unwell, fever, swelling.

What are the causes of vascular disease?

The exact cause of some blood vessel problems is not known, but there are some common causes:

• High Cholesterol
• High Blood Pressure
• Smoking or using tobacco products (this is the biggest enemy!)
• Diabetes (Diabetes Mellitus)
• Genes inherited from parents
• Some medications
• Injuries
• Infections
• Blood clots

How is vascular disease diagnosed?

If you have these symptoms, the first thing you should do is see a doctor . The doctor will ask you about your symptoms, whether anyone in your family has had these conditions, and will do a physical exam. It can help to have you take off your shoes and socks and show the doctor your feet.

Depending on the type of vascular disease the doctor suspects, he or she may order blood tests and special scans (imaging).

What are the diagnostic tests?

In many vascular diseases, there are clots or blockages inside the blood vessels. So, to see these exactly, ``(Imaging)`` methods are used that can look inside the blood vessels.

• Vascular Ultrasound: This uses sound waves to create images of blood vessels. It can check blood flow and determine if there are any blockages.
• Catheter Angiography: A small tube (catheter) is passed through a blood vessel, a special fluid is injected, and X-ray images are taken. This allows the inside of the blood vessel to be seen clearly.
• CT Angiography: A CT scan uses a special fluid to take three-dimensional pictures of blood vessels.
• MR Angiography: An MRI scan is used to take detailed pictures of blood vessels.

How are blood vessel diseases treated?

There is no single cure for this either. Treatment varies depending on the type of disease. Sometimes, lifestyle changes like switching to a healthy diet and exercising can provide significant relief. Some diseases require medication, while others require surgical procedures.

Let's take a brief look at the treatments for several major diseases:

Treatment for peripheral artery disease (PAD):

• Blocked arteries in the legs: diet, exercise, medication, surgery.
• Intestinal ischemia: Painkillers, clot-busting drugs, surgical removal of the clot. For chronic conditions, angioplasty, stenting, or bypass surgery may be performed.
• Renal artery disease: Low-salt, heart-healthy diet. High blood pressure medication, `(Statins)` (cholesterol-lowering medications).
• Popliteal entrapment syndrome: Surgery to release the ``Popliteal Artery''.
• Raynaud's phenomenon: Keep your hands and feet warm. Take ``(Dilated)`` medications that help keep blood vessels open.
• Buerger's disease: It is essential to completely stop using tobacco products. Keep your hands and feet warm. Take vasodilators.

Treatment for problems related to the main artery in the neck (Carotid Artery):

• Carotid artery disease: A healthy diet. Blood thinners and cholesterol-lowering medications. Carotid endarterectomy to remove plaque. Angioplasty and stenting to keep the artery open.
• Carotid artery dissection: `(Antiplatelets)` (drugs that prevent blood platelet aggregation), `(Anticoagulants)` (drugs that prevent blood clotting), `(Stenting)`.
• Carotid body tumors: Surgical removal of the tumor.
• Carotid artery aneurysm: Antihypertensives, cholesterol-lowering drugs, blood-clotting drugs. Bypass or stent-graft surgery.

Treatment for Venous Disease:

• Vein and spider veins: Removal using heat, salt water, or laser.
• Klippel-Trenaunay Syndrome (KTS): The same treatment as for venous thromboembolism.
• May-Turner Syndrome (MTS): The same treatment as `(DVT)`.
• Thoracic Outlet Syndrome (TOS): Physical Therapy, Medication.
• Chronic venous insufficiency (CVI): Frequent leg movements, wearing compression stockings. Treatment of veins with salt water, laser, or incision.

Treatment for Blood Clots:

• The treatment for blood clotting conditions: `(DVT)` and `(Pulmonary Embolism)` is the same.
• Deep vein thrombosis (DVT): Elevation of the legs. Blood thinners and painkillers.
• Pulmonary Embolism: Blood thinners and thrombolytics (blood clot dissolvers). Surgery to remove the clot.
• Axillo-subclavian vein thrombosis: `(Thrombolytics)`, blood-thinning drugs. Removal of the blood clot.
• Superficial vein thrombosis: Elevate the affected arm/leg above the heart. Apply heat. Wear support stockings. Surgical removal of the vein.

Treatment for Aortic Aneurysm:

• Thoracic Aneurysm: Surgery to insert a fabric graft or stent. This can be a major operation depending on the location and surgical technique.
• Abdominal aortic aneurysm: Surgery to insert a graft. Endovascular Repair is a less invasive procedure.

Treatment for fibromuscular dysplasia (FMD):

Blood thinners, painkillers. `(Angioplasty)`. Surgery to prevent an artery from bursting.

Treatment for Lymphedema:

Elevate the affected arm/leg above the level of your heart while lying down for about 45 minutes twice a day. Wear a compression sleeve. Use the affected arm/leg for daily activities. If your doctor recommends it, go to a specialized lymphedema clinic.

Treatment for Vasculitis:

The doctor may prescribe medications such as steroids.

What are the complications/side effects of the treatment?

Any medication can have side effects, but the benefits are usually worth taking. Most of the time, the side effects will go away within a few days. If they don't, you can talk to your doctor about switching to a different medication.

When considering a procedure or surgery, talk to your doctor about the risks and benefits. What works for your neighbor may not work for you.

What should I do to avoid vascular disease?

You can't change things like your age, family history, or genes. But you can do these things:

• Control your diabetes, high cholesterol, and high blood pressure .
• Exercise regularly. Walking for at least 30 minutes a day is also good.
• Eat healthy foods. Reduce oil, sugar, and salt. Eat more fruits, vegetables, and fiber-rich foods.
• If you have to sit or stand for hours at a time, move around a little and walk around at least once an hour .
• Maintain a healthy weight.
• Reduce stress.
• Avoid tobacco products completely. This is a must-do.

What should I expect if I have a blood vessel disease (Vasculopathy)?

Arterial disease can sometimes be a lifelong problem. Once your doctor finds out that you have fatty deposits in your arteries, he or she will tell you to make some lifestyle changes. You will need to continue to do things like exercise, avoid smoking, and make healthy food choices. You may also need to continue taking medication to reduce your risk of having a heart attack or stroke.

Outlook of this situation

In many vascular diseases, the sooner a doctor diagnoses the problem , the better the outlook. Many vascular problems become difficult to treat as they get worse. Some vascular conditions, such as `(Carotid Artery Dissection)`, `(Abdominal Aortic Aneurysm)` and `(Pulmonary Embolism)`, can be life-threatening.

How can I take care of myself?

In addition to the above, you should continue to take the medication exactly as prescribed by your doctor and go for medical checkups on scheduled dates.

When should I see a doctor?

If there is any change in your blood pressure, or if you have a problem with a medication prescribed by your doctor, see your doctor immediately.

When should I go to the Emergency Treatment Unit (ETU) ?

If you experience any of these symptoms , call 911 (1990 in Sri Lanka) immediately :

• Confusion or dizziness
• Difficulty speaking (stuttering)
• Sagging of one side of the face
• Severe chest pain
• Severe stomach pain
• Loss of vision
• Weakness in an arm or leg

What questions should I ask my doctor?

• What is the best treatment for my specific condition?
• Is there anything else I should do to take care of my blood vessel condition?
• Are there any other related medical conditions I should be aware of along with this blood vessel problem?

The best thing you can do for your blood pressure is to be vigilant . Don't skip medical checkups or medication. Since some blood pressure problems run in families, sharing your health information with your family can help them avoid and be aware of blood pressure. Since high blood pressure and cholesterol are risk factors for blood pressure, ask your family to get them checked too.

Summary (Take-Home Message)

Okay, so I hope you now have a good understanding of the vascular diseases we talked about today. Remember, these are not things to take lightly . However, if you recognize them early, treat them properly, and make lifestyle changes, you can live well with these diseases. Simple things like a healthy diet, regular exercise, and avoiding smoking can make a big difference. If you have any doubts or symptoms, don't hesitate to seek medical advice. Stay healthy!

` Vascular Disease, Arteries, Veins, Blood Clots, Stroke, Cholesterol