Vascular diseases

Dr Arvind Kohli
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. Causing brain stroke or heart attack whereas Weakened blood vessels can burst, causing bleeding inside the body. Vascular disease can strike anyone, at any age, at any time. It often strikes without warning.. symptoms may not appear  until it is limb or life threatening. Vascular disease affects the entire body and includes stroke, peripheral artery disease (PAD), abdominal aortic aneurysm (AAA), carotid artery disease (CAD), arteriovenous malformation (AVM), critical limb ischemia (CLI), pulmonary embolism (blood clots), deep vein thrombosis (DVT), chronic venous insufficiency (CVI), and varicose veins.
Everyone is at risk for vascular disease. With the increase in obesity and Type II diabetes in Indian population and as the population ages, it is estimated that by 2020 vascular disease will be leading cause of mortality or morbidity in India.
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.
Common vascular problems affecting people in India are :
Buerger’s Disease
Buerger’s disease is related to smoking. The disease causes swelling of the small and medium -sized arteries (and sometimes the veins) in your feet and legs. This rare disorder which causes the peripheral vessels to tighten or constrict, is more common in men, especially smokers aged 20 to 40.
Smoking causes the blood vessels to tighten in everyone who smokes. But in people with Buerger’s disease, there is so much tightening in the vessels that a lack of oxygen to the cells (ischemia) or tissue death (necrosis) may result.
The symptoms may be different for everyone, but the condition most often causes tender, swollen areas over the vessels, followed by coldness of the feet and hands. Pain in the legs during  walking (called intermittent claudication) may happen because of an arterial blockage. The most serious cases sometimes cause the tissue to die, and amputation of the fingers and toes may be needed. People with Buerger’s disease must stop smoking completely, and circulation usually improves soon after.
Raynaud’s Phenomenon
Raynaud’s phenomenon happens more often in women. It is a circulation disorder that causes the arteries in the fingers and toes to tighten or spasm when they are exposed to cold temperatures, smoking or emotional stress.
Often, the cause of Raynaud’s phenomenon is not known. Sometimes, it is a side effect of other conditions, such as connective tissue disease, trauma, or diseases of the glands or central nervous system. People with the disorder may feel numbness or tingling in their fingers and toes. They may also notice that their skin turns pale or blue, followed by reddening in the affected areas. Attacks may last from a few minutes  to several hours and are usually treated with gradual warming of the fingers and toes to restore blood flow. Therapy may also include pain relievers, calcium channel blockers, quitting smoking and avoiding cold temperatures and emotional upset.
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.
What causes a venous blood clot ?
Blood clots in the veins are usually caused by slowed blood flow to the legs and feet, 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, such as on a long plane ride. This is why the condition is sometimes called “economy-class syndrome’’.
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.
Vascular Diseases are rising at an alarming speed, threatening to stunt India’s growth, productivity and its youth in the coming years due to substantial loss of potentially productive years of life. Efforts at multiple levels multi-sectoral, and multi-disciplinary coordination and action, are required for creating awareness amongst general masses for preventing vascular diseases.
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. The high-risk approach aims at identifying persons with the highest risk of diseases, those with markedly elevated risk factors and also people who have already had a vascular event. These individuals are then targeted for interventions to reduce the risk factors levels. The individual benefits are large, but since the number of such persons is proportionately small, the overall benefits to the society are limited  in terms of prevention of death or disability which itself is  very significant.
(The author is Consultant Vascular Surgeon GMC Jammu)