Dr Arvind Kohli
As we move ahead in this milleneum, the medical sciences has moved ahead with leaps and bounds. The current era is era of minimally invasive procedures, gone are the days when surgeons were known by the size of the incisions. Patients need quick management and outcome of their health issues, however if the therauptics have advanced four folds, we cannot compare them with the awareness about diseases, the measures a person should take to avoid diseases, particular on this day. I should say Vascular diseases. We need a lot of effort at different levels to inculcate in society about importance of Vascular Diseases, their prevention and early management so as to prevent loss of limb or loss of life.
Vascular Diseases The vascular system is the body’s network of blood vessels. It includes the arteries, veins and capillaries that carry blood to and from the heart. Problems of the vascular system are common and can be serious. Arteries can become thick and stiff, a problem called atherosclerosis. Blood clots can clog vessels and block blood flow to the heart or brain. Weakened blood vessels can burst, causing bleeding inside the body.
Risk for Vascular Disease Many people are at risk for vascular disease, depending on their health, lifestyle behaviours and family history. Tobacco use High blood pressure High cholesterol or lipids. Advancing Age. Family history of coronary or vascular diseases Diabetes Overweight and sedentary life style are most important risk factors.
Types of Vascular Disease
The diseases are classified in relations to there pathology or region.
Atherosclerosis or hardening of arteries : Plaque builds up on the lining of arteries limiting blood flow. As the blood vessel narrows it is harder for oxygen rich blood to flow.
Peripheral Arterial/ Venousl/ Disease The peripheral arteries and veins are those blood vessels that are located outside of your heart. You may hear the terms PAD or PVD to describe where arteries or veins are blocked with plaque. If the artery to the kidney is blocked, this is the renal artery disease.
Carotid Artery Disease Arteries on either side of the neck are blocked from plaque, or there may be a blood clot.
Vein Thrombus/Blood Clots : Deep vein thrombus or Blood clots can occur when there is prolonged bed rest or lack of movement, damage to veins from injury or infection or other conditions that cause slow blood flow. Deep Vein Thrombosis (DVT) is a serious condition where the clot is in a deep vein of the chest, pelvis or leg.
Aneurysm A weak part of a blood vessel wall that swells and bulges out, limiting blood flow. Enlarging size of Aneurysm is life threatening and should be treated emergently Aneurysm is more likely to occur in the aorta (heart), abdomen or kidneys.
Varicose Veins A vein will swell when valves inside the vein do not work well to regulate blood flow. Varicose veins are enlarged and can appear twisted or bulging. Spider veins are like varicose veins but smaller and closer to the surface. Varicose veins are the most common cause of the Restless leg syndrome.
Buerger’s disease most commonly seen in smokers, young males it leads to blocked arteries in the arms and legs causing low blood supply to the hands and fingers or feet and toes. And usually leads to amputations if not treated in time
Raynaud’s Disease Skin of the hands or feet may be white or bluish and feel numb or cold. Usually occurs when it is seen in young females having hypersensitivity to cold.
Lymphedema By itself it is not a vascular disease, however it leads to symptoms mimicking vascular diseases, patients present with features of swollen legs and need all pertinent investigations for its management.
Signs of Vascular Disease
In the early stages, there may not be any signs.
Over a period of time, if disease progresses without any treatment patient may have these signs of poor circulation.
Pain called claudication in the leg or feet, that happens while walking or during exercise while pain may stop at rest, some people report muscle spasms and pain in advanced vascular disease. In addition there may be weak pulse in the legs and/or feet.
Rest Pain Claudication later in its course progresses to rest pain along with cool, pale skin, or cold hands and feet.
Pregangrenous toes or fingers Sores or wounds that take a long time to heal or look dar (black) in color There may be Loss of hair on legs and feet.
Carotid artery involvement patient can feel dizzyfaint or have a headache. Patients have trouble in speaking or have attacks called TIA (transient ischemic attacks)
Diagnosis
Duplex ultrasond with doppler study is the most important investigation for assessment of vascular diseases. However, with advancement in Computer Scanning CT Angiography, has become gold standard test for investigating vascular diseases Catheter Angiography MR Angiography (MRA) and DSA digital subtraction angiography are also highly useful
Lifestyle modifications
The need for regular exercise, preferably in a supervised setting to improve claudication symptom Follow dietary and medicinal interventions to ensure control of blood cholesterol levels and in diabetic blood glucose.
Foot care- foot injuries can lead to amputation, and these can be avoided by wearing well-fitting and protective footwear.
Cessation of smoking to participate in a vigorous programme to promote smoking cessation to reduce the risk of critical limb ischemia, heart attack, stroke and death control of hypertension.To undergo monitoring of systolic and diastrolic blood pressures, control of blood sugar and importance anti platelet medications.
Strategies for Prevention
Vascular diseases are markers of risk to life and limb. The Vascular prognosis, without appropriate clinical intervention, has remained poor for decades. The costs of vascular disease to the patient in terms of quality of life, as well as potential loss of employment, can be enormous. In addition, severe disease can lead to hospitalisation surgical intervention, home health costs and requirements for long-term rehabilitation. However, a combination of vascular specialist, and patient awareness can help to reduce risks, lower medical cost, and save lives.
Early diagnosis obtained by a detailed history clinical examination and screening are of paramount importance to implement an appropriate treatment plan. All patients shoould receive the appropriate education on the risk factors and subsequent help and support for lifestyle modification. With the support of all the vascular team, we can aim to improve cardiovascular mortality and quality of life for all those people with vascular diseases.
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