VASCULAR DISEASES

Most common diseases of the veins | Most common diseases of the arteries | Diagnostics and therapy | PDF Vascular Diseases

Angiology is a branch of internal medicine and deals with vascular diseases and treatment options for the body's veins, arteries and lymphatic vessels.

When we are healthy, we do not notice that the blood flows through our dense vascular network and supplies all of the body's organs and cells. The blood vessel system forms the transport routes for nutrients, oxygen, hormones and much more and at the same time removes toxic waste products from the body.

Vascular diseases are roughly divided into diseases of the afferent (arterial) system and the efferent (venous and lymphatic) system. Arterial vascular diseases are usually occlusive diseases resulting from advanced arteriosclerosis. Deposits on the vessel walls and inflammatory processes lead to a narrowing (stenosis) or total closure of important arteries, which prevents or completely interrupts the oxygen supply to the downstream organ or tissue. This undersupply or blockage in the arterial vascular system is associated with severe pain and is always an emergency situation as tissue threatens to die. This can cause a heart attack, stroke and intermittent intermittent disease (PAD).

The vascular diseases of the veins, on the other hand, are often varicose vein disease or thrombosis (formation of blood clots). They can lead to drainage obstructions, especially in the legs, but can also trigger a pulmonary embolism or a stroke due to the detachment of a thrombus

Most common diseases of the veins

The venous system returns the oxygen-poor blood from the organs back to the heart. Drawing, cramp-like pain, itching along enlarged skin veins, as well as a feeling of heat and swelling of the legs are the first warning signs of the presence of venous diseases. If painful hardening occurs suddenly, for example in a leg, an examination of the veins should be carried out immediately to rule out deep vein thrombosis.

We differentiate between the superficial and deep venous systems. The superficial veins are visible under the skin as blue veins, the deep veins run embedded between the leg and arm muscles and are not visible. The superficial and deep veins are connected to each other by numerous bridging veins.

The most common diseases of the superficial veins are:

• Varicose (varicose vein formation)
• Thrombophlebitis (superficial phlebitis).

The most common diseases of the deep veins are:

• Deep vein thrombosis (blockage of the deep veins by a blood clot)
• Chronic venous insufficiency (inability of the deep veins to return blood to the heart, due to weakness in the walls of the deep leg veins as a result of long-standing varicose vein disease or as a result of thrombosis)

The Varicose veins (varicosis) are primarily visible as thickened, tortuous skin veins on the legs. Such curved and tortuous structures are called varicose veins. However, varicose veins are neither caused by a cramp nor do they cause it. Rather, its name derives from the medieval “crooked (crooked) veins.” The venous valves of the vessels are no longer able to close (insufficiency) and lead to a back-up of blood, which causes the dilation. There is usually a hereditary weakness of the connective tissue, and standing or sitting for long periods of time without moving can promote varicose veins.

The varicose veins often initially cause no symptoms apart from a cosmetic problem. However, advanced varicose vein disease can cause non-specific, pulling or cramp-like pain or itching along the leg veins as well as a feeling of heaviness in the legs. If varicose veins have been present for years, brownish skin changes on the legs can occur. These chronic skin changes can lead to the formation of skin ulcers.

Furthermore, the varicose veins can promote the development of superficial inflammation of the veins (thrombophlebitis). Varicose veins that do not cause any significant symptoms do not initially require any significant therapy. If there are complaints and in particular venous congestion with leg edema (dent formation when pressure is applied with a finger, especially the inner shin edge) and/or chronic skin changes, compression treatment with compression stockings (usually sufficient up to the knee) should be carried out.

Furthermore, direct heat effects on the legs such as frequent sauna visits and hot baths should be avoided. Painful or cosmetically disturbing varicose veins can be eliminated through classic surgical procedures (stripping), sclerotherapy measures or so-called endovascular therapy measures (e.g. laser therapy).

The Thrombophlebitis (superficial phlebitis) is primarily a harmless disease, but if left untreated it can spread deeper through the connecting veins and cause deep vein thrombosis. It is characterized by burning, painful redness and thickening of the affected subcutaneous veins. Thrombophlebitis is treated by local or systemic treatment with anti-inflammatory, analgesic medications. In order to prevent further progression of the superficial phlebitis, it may be advisable to use injections containing heparin under the skin. A compression bandage should also be applied. In advanced cases of purulent phlebitis, surgical opening of the pus with antibiotics is necessary.

The Deep vein thrombosis is an acute blockage of a deep vein usually in one leg due to a blood clot. It is a serious illness that can even cause a life-threatening pulmonary embolism or pulmonary infarction by carrying venous blood clots into the pulmonary circulation. Being confined to bed, a general lack of exercise, smoking, taking contraceptives (the pill), being overweight, injuries or heart failure can all contribute to its development.

The thrombosis leads to warming, painful, bulging thickening of the affected extremity (usually a leg affected). If you experience stabbing chest pain, shortness of breath and/or palpitations, you should think about the spread of a venous blood clot into the pulmonary circulation.

If deep vein thrombosis is present, the blood coagulation system must be checked and possible cancer as a cause of the thrombosis should be ruled out. Thrombotic diseases of the pelvic and leg veins are clarified under inpatient conditions and treated with local compression therapy and consistent medication to thin the blood, whereas thrombosis of the lower leg veins can be clarified and treated on an outpatient basis.

The most common causes of chronic venous insufficiency are destruction of the venous valves due to a previous venous thrombosis or varicose vein disease that has been untreated for many years. As a result, the blood can no longer be sufficiently transported back from the legs towards the heart and it accumulates, particularly in the lower legs and feet.

The chronic deep vein insufficiency causes a feeling of heaviness, a tendency to swell, muscle cramps, skin changes such as brownish pigmentation, and subsequently superficial or deep painful ulcers that are difficult to heal, especially on the inner ankles.

Chronic venous insufficiency is treated using compression therapy – by wearing compression stockings or compression bandages. In advanced cases, where ankle ulcers are present, the leg ulcer can be healed by selective surgical elimination of leaky supplying veins as well as local wound care and ultimately skin transplantation.

Most common diseases of the arteries

Peripheral arterial disease (PAD, intermittent claudication)

Atherosclerosis is a vascular disease that affects the entire body and not just individual blood vessels or organs. Arteriosclerosis is strongly promoted by risk factors of the cardiovascular system, particularly high blood pressure, diabetes, lipid metabolism disorders and unhealthy lifestyles such as smoking. This leads to slowly progressive deposition and narrowing of the vessels and ultimately to complete closure. Pain and rapid signs of fatigue in the legs can be the first indication of a narrowing or impending closure.

PAD is divided into four stages, with stage 2 showing the typical picture of intermittent claudication (intermittent claudication - frequent standing due to pain). Stage 3 is characterized by pain at rest, stage 4 shows necrosis (cell death, tissue death) of the affected region. The pulse beyond the occlusion site can no longer be felt. Since the section of the vessel behind the closure no longer receives sufficient blood supply, the section of the leg that is not supplied is in danger of dying. In advanced cases, a toe or leg amputation may be necessary. A peripheral arterial occlusion is therefore an acute emergency and requires immediate medical attention.

Aneurysms are primarily bulges in the vessel wall. They can take many forms; sac-shaped aneurysms are common. Since the vessel wall can crack over time, much like an overinflated balloon, an aneurysm often threatens to burst. A ruptured vessel in one of the large arteries of the body (e.g. abdominal aorta) causes large blood loss, which can be life-threatening within minutes. Surgery or endovascular treatment to remove the aneurysm is necessary in some cases. Men are about 10 times more likely to be affected by this vascular disease than women.

Our offer diagnostics and therapy of vascular diseases

• History and clinical examination of the vessels
• Ultrasound examination (FKDS) of the arteries and veins of the neck and the
• Extremities (arms and legs) and the abdominal artery (aorta)
• Ankle-brachial index (ABI) and pulse wave velocity to examine the current blood circulation situation in the arms and legs and to estimate the individual cardiovascular risk
• Cardiovascular diagnostics with ECG, exercise ECG with bicycle (ergometry), echocardiography, 24-hour ECG, 24-hour blood pressure measurement
• Detailed discussion of the clinical and instrumental findings and, if necessary, further therapy recommendations