Dr Arvind Kohli
6th August is observed as National Vascular day and this year the resounding theme of the day is” Walk a mile Live with a smile”we must analyze measures to counter massive increase in number of vascular ailments in our country and minimize the morbidity and mortality related to these diseases by prevention ,timely detection and management This can be achieved by bringing to attention the importance of vascular health.
Vascular System The vascular system refers to the system of blood vessels that transport blood throughout the body. Vascular diseases are diseases that affect the vascular system. They can interfere with blood flow to or from the body’s organs.Arteries are the blood vessels that carry blood to the rest of the body, while veins return the blood to the heart. Vascular diseases can lead to serious cardiovascular complications, such as blood clots, heart attack, and stroke. . Atherosclerosis and allied causes like arteriopathies lead to involvement of aorta and arteries resulting in aneurysmal or occlusive diseases with potential risk to limb, organ and or life. Advanced age, smoking habit, consumption of alcohol, over eating, obesity, physical inactivity coupled with diabetes and hypertension are found to enhance the disease process. Varicose veins and deep vein thrombosis with serious potential complications involving veins are also on the rise. Accidents with injury involving major vessel are rapidly increasing with socioeconomic changes in the community.
Spectrum of Vascular Ailments
Deep vein thrombosis
is a blood clot within a deep vein, usually within the leg. Blood clots can occur elsewhere in the body, but the legs are the most common location.
Risk factors . some people may be more vulnerable due to genetic or medical conditions. However, certain factors greatly increase the risk of blood clots and DVTs, including:sitting for long periods, such as on a long car ride or international flight using hormonal birth control pills, especially if a person has other risk factors excess weight on the legs from being overweight or pregnant recent injury or surgery to the leg and smoking.
Patient presents with: throbbing or cramping pain, typically in one leg swelling, warmth, and redness in the affected leg swollen veins that feel hard or sore to the touch.
If a fragment of the blood clot breaks loose, it can travel to another part of the body. A blood clot that travels to the lungs is called a pulmonary embolism.
Treatment options for DVT include: anticoagulant medications to help stop the existing clot from growing and prevent new clots from forming clot-busting medications to help dissolve the blood clot and surgical procedures to help dissolve, break up, or physically remove the blood clot.
Life threatening conditions like Pulmonary Embolism have shown tremendous rise in prevalence and its aetiology and management should be understood in details to tackle this Pulmonary embolism affects around 2,5 lac people in the India every year.
Pulmonary embolism is a blockage in the pulmonary artery, which supplies the blood to the lungs. The blockage, usually a blood clot, arising from peripheral vessels and migrating to lungs prevents oxygen from reaching the tissues of the lungs. This is life-threatening and can cause sudden death.
Treatment Immediate medical treatment for a PE focuses on ensuring a person can breathe, then dissolving the clot that caused the embolism. Treatment options include:clot-busting medications anticoagulant medications a vena cava filter, which is a filter that sits inside the vena cava vein to help prevent blood clots from traveling to the lungs pulmonary embolectomy, a surgery to help remove a PE pulmonary thrombectomy, a procedure that uses a catheter to deliver medications at the site of the PE to help break up, dissolve, or remove the clot
Peripheral vascular disease (PVD) refers to diseases of the blood vessels outside the heart and brain.In PVD, a fatty deposit called plaque accumulates on the inner walls of blood vessels, causing the vessels to narrow. This narrowing impairs blood flow through the vessels. People with PVD may experience the following symptoms in areas where blood vessels have narrowed: pain on walking called claudication, rest pain skin discoloration.skin ulcers and gangrene Limb-threatening ischemia (LTI) is an advanced stage of PAD that involves a decrease in blood flow to the limbs.putting the viability of the limb at risk.
Treatment Lifestyle changes such as quitting smoking and getting more exercise can help prevent PVD or PAD from worsening. medications, such as: statins to help reduce levels of LDL or “bad” cholesterol antihypertensives to help treat high blood pressure blood-thinning medications to help reduce the risk of blood clots Rheology regulator drugs like cilostozole and pentoxyfylline to help alleviate exercise-induced leg pain Surgery and endovascular procedures are required with aim to widen narrowed blood vessels or bypass blocked arteries and prevent Amputations or limb loss.
Carotid artery disease occurs due to accumulation of plaque in the carotid arteries, which are large arteries on either side of the neck. The carotid arteries deliver blood to the brain and head.
Symptoms
In many cases, people will be unaware that they have carotid artery disease until they experience a stroke or mini-stroke. This can happen when the carotid arteries become so blocked that either part of this blockage breaks loose and travels to the brain or, less commonly, when they completely cut off blood flow.
The symptoms of a mini-stroke or transient ischemic attack are similar to those of a stroke but do not last as long.
Treatment Lifestyle changes such as quitting smoking and eating a healthier diet may help manage carotid artery disease and prevent the condition from worsening.
Medications to: prevent blood clots from forming lower blood cholesterol levels control high blood pressure prevent or reduce inflammation procedures to widen or unblock the carotid arteries ., maintaining strict control of diabetes is also helpful in managing carotid artery disease.
Abdominal aortic aneurysm (AAA) is a bulge in the abdominal aorta The aorta is the main artery that carries blood away from the heart to other parts of the body.
An AAA usually happens when the walls of the aorta weaken with age. The aneurysm itself is not harmful and may not cause symptoms. However, if the aneurysm ruptures, it can cause severe internal bleeding that is almost always fatal.
Symptoms intense stomach pain nausea back pain weakness passing out and acute emergency of rupture of aneurysm leading to shock and if not managed in time risk of life also.
Treatment AAA is diagnosed with abdominal ultrasound and CT angio scans. Surgical treatment is necessary to correct the aneurysm before it ruptures.Recent availability of Endovascular Aneursm Repair)EVAR) has revolutionized the management of AAA
If the aneurysm ruptures, a person will require blood transfusions and emergency surgery to attempt to handle this catastrophy
Varicose veins are swollen and enlarged veins. They are most common in the legs but can also affect other areas of the body. Varicose veins are a potential complication of CVI. They develop when valves inside the veins weaken, causing blood to pool and expand inside the veins Patient presents with restless legs heaviness limb edema and even ulcerations at ankles
Treatment options are surgery and recently emerged lasers or RFA ablations of varicosities Now even glue closure of leaking valves in superficial veins have emerged with good results.
Take home Message
Vascular diseases are diseases that affect the blood vessels and impair blood flow. They can increase the risk of cardiovascular complications, such as Pulmonary embolism limb gangrene and stroke.
Some general risk factors for vascular disease include smoking, being overweight or obese, and living a sedentary lifestyle. People can reduce their risk of vascular disease by avoiding or quitting smoking, engaging in regular physical activity, and eating a nourishing diet low in trans fats and saturated fats.
There are many types of vascular disease, and each has its own associated symptoms and treatment options. In most cases, early intervention helps reduce the risk of serious and potentially life threatening complications.
(The author is Vascular Surgeon GMC Jammu)
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