Today is Vascular Day
Dr Arvind Kohli
6th August in India marks Vascular Day, a time dedicated to raising awareness about the risks, prevention, and treatment of vascular diseases. .Vascular diseases encompass a range of conditions that affect the blood vessels, including arteries, veins, and capillaries. The importance of understanding vascular diseases cannot be overstated. By recognising the risk factors, adopting preventive strategies, and seeking appropriate treatment, individuals can effectively manage these conditions and potentially prevent serious complications.
Understanding Vascular Diseases:
Problems of the vascular system are common and can be serious. These diseases can disrupt blood flow, leading to various complications. Some common vascular diseases include:
* Peripheral Artery Disease (PAD):
Characterized by narrowed or blocked arteries, primarily in the limbs, causing pain, numbness, and potential tissue damage.
* Aneurysms:
Bulges in the blood vessel walls that can rupture, leading to life-threatening hemorrhages.
Carotid artery disease (CAD) can affect the arteries going to central nervous system and can cause brain stroke
* Deep Vein Thrombosis (DVT):
Blood clots in deep veins, often in the legs, which can travel to the lungs (pulmonary embolism)which is a dreaded complication.
* Varicose Veins:
Enlarged, twisted veins, typically in the legs, that can cause discomfort and cosmetic concerns.
* Vasculitis:
Inflammation of blood vessels, potentially affecting various organs.
Risk Factors for Vascular Diseases
Several factors can increase the risk of developing vascular diseases:
* Atherosclerosis: Plaque buildup in arteries, a major contributor to PAD and other vascular diseases.
* Diabetes: High blood sugar levels can damage blood vessels, increasing the risk of PAD and other complications.
* High Blood Pressure: Strains blood vessels, contributing to atherosclerosis and other vascular issues.
* High Cholesterol: Elevated cholesterol levels can lead to plaque buildup in arteries.
* Smoking: Damages blood vessels and significantly increases the risk of vascular disease.
* Obesity and Lack of Physical Activity: Contribute to other risk factors like high blood pressure and cholesterol.
* Family History: A genetic predisposition to vascular diseases can increase an individual’s risk.
* The risk factor concept forms the scientific basis for prevention of vascular diseases. Six risk factors are modifiable and responsible for majority of the disease burden. They include smoking, hypertension, uncontrolled diabetes, hyperlipidemia, obesity and stress.
Recognizing Symptoms:
Symptoms of vascular diseases can vary depending on the specific condition and its location. Common signs include:
* Pain or cramping in the legs or arms: Especially during exercise (intermittent claudication).
* Numbness or tingling in the extremities: Indicative of reduced blood flow.
(Skin discoloration: Pale or bluish skin, particularly in the affected limb.
* Slow-healing sores or ulcers: Especially on the feet or legs.
* Swelling in the legs or feet: May indicate DVT or other venous issues.
Diagnosis: The specific tests used depend on the suspected type of vascular disease, but common methods include ankle-brachial index (ABI) testing, Doppler ultrasound, angiography (including CT and MR angiography), and sometimes exercise tests. and biochemical analysis
* Prevention :
Preventing vascular diseases is a great effort and shall bring down morbidity in a big way. Screening individuals with risk factors (such as elevated age, high blood pressure, high cholesterol, a family history, diabetes, and smoking) may be useful to identify people with undiagnosed disease who could then benefit from lifestyle changes, medications, and a variety of treatment options. Awareness about vascular disease in general population is a big step toward its prevention. The following measures are important in this behalf :
* Avoid smoking or using any tobacco products,
* Adopt healthy eating habits
* Exercise regularly, walking everyday is a big step in preventing vascular diseases,
* Control of high blood pressure,
* Prevent Hyperlipidaemia,
*Control of Diabetes,
* De stressing
* Communicate your family health history to doctor, particularly if a blood relative had poor circulation, high blood pressure, high cholesterol or cardiovascular disease
Critical limb ischemia (CLI)It is true to say “STATUS OF LEG(S) MAY DECIDE LIFE STATUS
CLI is the most severe form of PAD and is associated with a high rate of lower extremity amputations typically exceeding 15-20% of patients with CLI within 1 year of symptom presentation. These amputations are oftentimes due to insufficient wound management. More than 80% of patients with CLI who undergo major amputations will not survive more than 5 years post-amputation. Because of the health-associated risks and economic burdens accompanying amputations in patients with CLI, more effort is required to improve amputation prevention, particularly through improved access to appropriate diagnosis, revascularization of the lower extremities, and wound care.
It is crucial that physical examination, noninvasive imaging evaluations, diagnosis, and intervention are implemented earlier in the continuum of care to mitigate the risks associated with lower extremity wounds in patients with CLI.
Skillsets that may be included in the multidisciplinary care team are endovascular revascularization, surgical revascularization, wound healing therapies and foot surgeries, and medical evaluation and care.
While CLI may cause significant health complications, public knowledge is lacking with frequent underdiagnosis and undertreatment until lower limb symptoms become severe.
Venous blood clots
Large number of Indians have a blood clot in their veins (also called venous thrombus). When the clot develops in a vein deep within the leg, it is called deep vein thrombosis (DVT). The condition can be life threatening if the clot breaks loose from the vein and travels of the lungs, where it can completely block blood flow.called Pulmonary Embolism
What causes a venous blood clot ?
Blood clots in the veins are usually caused by slowed blood flow to the legs and feet(stasis), which can cause the blood to clot. Venous clots may also be caused by damage to a vein from an injury or infection. Blood flow may be slowed because of physical inactivity- being confined to a bed or having an inactive lifestyle. Some people have slowed blood flow after sitting for a long time,more than 6 to12 hours such as on a long plane ride. .Other factors that lead to slowed blood flow in the legs and feet include smoking, heart disease, diabetes, high blood pressure, and certain tumours. The use of certain hormones, particularly estrogens, and pregnancy have been shown to increase the risk for blood clots in the legs. Genetic disorders may also increase a person’s risk.
Management / Intervention
A combination of mechanical and pharmacological measures can be used to prevent DVT. Mechanical prophylaxis involves the use of graduated compression stockings (GCS), intermittent pneumatic compression (IPC) and venous foot pumps to improve blood flow in the deep veins of the leg. Common agents for pharmacological prophylaxis include Warfarin, subcutaneous unfractionated heparin (UFH) and low-molecular-weight heparins (LMWH)and NOACS DVT prevention is most effective when both methods are used simultaneously. In medical and surgical patients ambulation and exercises involving ankle dorsiflexion are encouraged to further minimize venous stasis.
Medical ManagementTreatment of DVT aims to prevent pulmonary embolism, reduce morbidity, and prevent or minimize the risk of developing post-thrombotic syndrome.The cornerstone of treatment is anticoagulationusing low-molecular-weight heparins (LMWH)and NOACS(Newer oral anticoagulants)
Newer Modalities for management DVT includes placement ofIVC filter:to prevent clots from traveling to the lungs. Catheter-directed thrombolysis:This procedure involves inserting a catheter into the vein to deliver clot-dissolving medication directly to the clot.
Pharmaco mechanical Thrombectomyis a procedure that combines mechanical clot removal with thrombolytic drugs to treat blood clots, primarily in deep vein thrombosis (DVT). It aims to clear the clot faster and with less thrombolytic medication than traditional methods, potentially reducing treatment time and complications
Vascular Diseases What more needs to be done
Over the past few decades, there has been a steep rise in patients suffering from vascular diseases, the most important risk factor being diabetes(India is diabetic capital of world)and delay in diagnosis of vascular ailments. Unlike other health issues, over 80% of our population is unaware of vascular diseases or has never heard of vascular surgery. Imparting awareness plays a significant role in changing people’s beliefs and behaviour towards knowing about vascular ailments and reporting early for its management. The role of a vascular surgeon in creating the awareness is not only to draw a few patients toward vascular surgery, but it might also help many patients save their limbs and life.Lets us all look forward in attaining good Vascular Health.
(The author is Vascular Surgeon SVMM hospital Jammu)
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