Blood vessel diseases and disorders

Diseases and disorders of the blood vessels can affect the blood flow to various locations throughout the body. The following sections describe common blood vessel diseases and disorders.

Atherosclerosis-related diseases and disorders

Atherosclerosis is a condition in which plaque (atheroma) builds up and narrows the arteries. The plaque can prevent the arteries from properly constricting and dilating. At times, small cracks in the vessel wall can occur, causing a thrombus to form over the atheroma, partially or completely occluding the vessel. If a section of the thrombus breaks away and travels through the bloodstream, this is an embolus.

The cause of atherosclerosis is unknown. Studies have shown that it can develop in childhood and worsens with age. Risk factors for atherosclerosis include smoking, an unhealthy diet, lack of physical activity, high blood pressure, unhealthy cholesterol levels, and uncontrolled diabetes mellitus. The signs and symptoms depend on which arteries are affected by the plaque. In many cases, no symptoms are felt until the artery is severely narrowed or blocked. Several diseases can result from plaque buildup.

Diagnostic procedures include blood tests to check the cholesterol, glucose, and protein levels. Additional tests include an ECG, echocardiography, chest x-ray, computed tomography (CT) scan, angiography, and a stress test. The goals of treatment are to lower the risk of blood clot formation, prevent diseases, and widen the affected arteries. Heart-healthy lifestyle changes will be encouraged. This involves exercise, a healthy diet, building stress-coping and management skills, maintaining a healthy weight, and smoking cessation. Medications that lower cholesterol levels may be used. Percutaneous coronary intervention, coronary artery bypass graft (CABG) surgery, or a carotid endarterectomy may also be performed.

Deep vein thrombosis

Deep vein thrombosis (DVT) occurs when a thrombus forms in a vein deep in the body, usually in the legs, and differs from thrombophlebitis, which typically involves a superficial vein rather than a deep one. DVTs can occur at any age, but they most commonly occur in people over the age of 60. An embolus can occur from a DVT, which can lead to life-threatening conditions, including a pulmonary embolism (PE), cerebrovascular accident (stroke), or myocardial infarction (heart attack).

Watch out: A thrombus is a clot that stays in place and blocks the vessel where it formed, while an embolus is a piece that breaks free and travels through the bloodstream. A DVT that embolizes to the lungs causes the pulmonary embolism (PE) mentioned above - the reason a DVT is treated as a medical emergency.

Blood clots form due to three mechanisms known as Virchow’s triad: damage to the vein’s inner lining and valves (from surgery, injuries, inflammation, or an immune response), slowed blood flow, and blood that clots too easily, such as from increased viscosity, estrogen, birth control pills, or inherited conditions. Here are some other risk factors for DVTs:

• A family history of blood clots
• Medical conditions: Pregnancy or up to 6 months after delivery, pelvis and leg fractures, bed rest, polycythemia, surgery, an indwelling catheter in a blood vessel, lupus, and cancer
• Certain medications (e.g., estrogen, birth control pills), smoking, and obesity

Signs and symptoms of a DVT include leg pain, swelling, warmth, and redness.

The provider will do a history and physical examination. An ultrasound may be ordered as well as blood tests (e.g., D-dimer blood test, antithrombin levels, and CBC). Treatment includes anticoagulant medications, compression stockings, and possibly surgery to remove the clot.

Varicose veins

Varicose veins are swollen, twisted veins seen under the skin, usually in the legs or rectum (hemorrhoids). This is a common disorder.

The cause is the one-way valves in the veins, which keep blood flowing toward the heart. If the valves become weakened or damaged, the blood backs up or pools, leading to swollen or varicose veins. Risk factors include a family history of varicose veins, prolonged standing, heavy lifting, multiple pregnancies, and advancing age. Signs and symptoms include dark purple or blue twisty veins, swelling, and feelings of heaviness, fullness, aching, pain, fatigue, or cramping.

The provider will examine the legs and feet (or other areas involved) during the physical exam. An ultrasound may be ordered to check the functioning of the vein valves. Treatment includes wearing compression stockings, exercising, losing weight, avoiding standing for long periods of time, and elevating the legs. There are many other treatments for varicose veins:

• Sclerotherapy: Involves an injection of a substance that closes the vein, and within a few weeks, the varicose vein should fade.
• Foam sclerotherapy: Used for large veins and involves injecting a foam substance in the vein to close it.
• Laser surgery: Involves using a laser to close off small veins.
• High ligation and vein stripping: Involves tying off the vein and removing it through small incisions.

Additional blood vessel diseases and disorders

The following list provides a brief description of some additional blood vessel diseases and disorders:

• Aneurysm: A bulging of the arterial wall that can burst, causing bleeding and possible death of the blood vessel wall. Most commonly seen aneurysms occur in the aorta (aortic aneurysm). A brain aneurysm that ruptures causes a stroke.
• Esophageal varices: Enlarged veins in the esophagus that can rupture. Found in people with cirrhosis of the liver.
• Raynaud disease: A rare blood vessel disorder that affects the toes and fingers. With cold temperatures or stress, the small arteries supplying the fingers and toes spasm (vasospasm), cutting off blood flow. This causes a classic triphasic color change: the affected areas turn white, then blue, then red as blood flow returns.