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 veins, arteries and lymph vessels of the body.

In a healthy state, we do not notice that the blood flows through our dense vascular network, supplying all the organs and cells of the body. The vascular system forms the transport routes for nutrients, oxygen, hormones and much more, and at the same time disposes of 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 mostly occlusive diseases due to advanced arteriosclerosis. Deposits on the vessel walls and inflammatory processes lead to a narrowing (stenosis) or a total occlusion of important arteries, which prevents or completely interrupts the oxygen supply to the downstream organ or tissue. This undersupply or occlusion in the arterial vascular system is associated with severe pain and is always an emergency situation, as tissue threatens to die. Heart attacks, strokes and window-diagnosis (PAD) can occur in this way.

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

Most common diseases of the veins

The venous system carries the oxygen-poor blood from the organs back to the heart. Drawing, cramping pain, itching along dilated skin veins, as well as a feeling of heat and swelling of the legs are the first alarm signs for the presence of venous disease. If there is a sudden onset of painful hardening, e.g. of a leg, an examination of the veins should be carried out immediately to rule out deep vein thrombosis.

We distinguish the superficial from the deep vein system. 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 by numerous bridging veins.

The most common diseases of the superficial veins are:

• Varicosis (varicose veins)
• 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, caused by a weakness of the walls of the deep leg veins as a result of long-standing varicose vein disease or as a result of thrombosis).

Varicose veins (varicosis) are primarily visible as thickened, tortuous skin veins on the legs. Such curved and tortuous structures are then called varicose veins. Varicose veins, however, are neither caused by a cramp nor do they trigger it. Rather, their name is derived from the medieval "krumpe (crooked) veins". The valves of the veins are no longer able to close (insufficiency) and lead to a backlog of blood, which causes the dilatation. In most cases, there is a congenital weakness of the connective tissue, but long periods of standing or sitting without movement can also promote varicosis.

Varicose veins often do not cause any symptoms at first except for a cosmetic problem. However, advanced varicose vein disease can cause non-specific, pulling or cramping pain or itching along the leg veins and a feeling of heaviness in the legs. Years of varicose veins can lead to brownish changes in the skin of the legs. These chronic skin changes can lead to skin ulceration.

Furthermore, varicose veins can promote the development of superficial phlebitis (thrombophlebitis). Varicose veins that do not cause any significant discomfort do not initially require any significant therapy. In the case of complaints and especially venous congestion with leg oedema (dimpling when pressure is applied with a finger, especially on the inner edge of the shin) and/or chronic skin changes, compression treatment with compression stockings (usually sufficient up to the knee) should be carried out.

Furthermore, direct exposure of the legs to heat, such as frequent visits to the sauna and hot baths, should be avoided. Painful or cosmetically disturbing varicose veins can be removed by classical surgical interventions (stripping), sclerosing (sclerosing) measures or so-called endovascular therapy measures (e.g. laser therapy).

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

Deep vein thrombosis is an acute blockage of a deep vein, usually in a leg, by a blood clot. It is a serious condition that can even cause a life-threatening pulmonary embolism or pulmonary infarction if venous blood clots are carried into the pulmonary circulation. Bedriddenness, general lack of exercise, smoking, contraceptives (the pill), obesity, injuries or heart failure can promote its development.

The thrombosis leads to warming, painful, prallel elastic thickening of the affected limb (usually one leg affected). If stitch-like chest pain, shortness of breath and/or palpitations occur, think of a venous blood clot being carried into the pulmonary circulation.

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

The most common causes of chronic venous insufficiency are the destruction of the venous valves due to a previous venous thrombosis or varicose veins that have gone untreated for many years. As a result, the blood can no longer be sufficiently transported back from the legs towards the heart and it becomes congested, especially in the lower legs and feet.

Chronic insufficiency of the deep veins causes a feeling of heaviness, swelling, 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 with compression therapy - by wearing compression stockings or compression bandages. In advanced cases, when ankle ulcers are present, the leg ulcer can be healed by selective surgical elimination of feeding leaky veins as well as by local wound care and ultimately by skin grafting.

Most common diseases of the arteries

Peripheral arterial occlusive disease (pAVK, shop window disease)

Arteriosclerosis is a vascular disease that affects the whole body and not just individual blood vessels or organs. Arteriosclerosis is strongly promoted by risk factors of the cardiovascular system, especially high blood pressure, diabetes, lipometabolic disorders and unhealthy lifestyle such as smoking. The result is a slowly progressing build-up and narrowing of the vessels and finally a complete blockage. Pain and rapid signs of fatigue in the legs can be a first indication of constriction or impending occlusion.

The pAVK is divided into four stages, whereby stage 2 shows the typical picture of a shop window walk (Claudicatio intermittens - frequent standing due to pain). Stage 3 is characterised by pain at rest, and stage 4 shows necrosis (cell death, death of tissue) of the affected region. The pulse beyond the site of occlusion is no longer palpable. Since the blood supply to the section of the vessel behind the occlusion is no longer sufficient, there is a risk that the unprovided section of the leg will die. In advanced cases, toe or leg amputation may become 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, and sac-shaped aneurysms are common. Since the vessel wall can become cracked over time, much like an over-inflated balloon, an aneurysm often threatens to burst. A vessel rupture in the area of one of the large body arteries (e.g. abdominal aorta) causes a great loss of blood, 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

• Medical 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 abdominal aorta
• Ankle-brachial index (ABI) and pulse wave velocity to examine the current blood flow situation of the arms and legs and estimate the individual cardiovascular risk
• Cardiovascular diagnostics with ECG, exercise ECG with bicycle (ergometry), echocardiography, 24 h ECG, 24 h blood pressure measurement
• Detailed discussion of the clinical and instrumental findings and, if necessary, further therapy recommendations.