Overview

What are vascular diseases?

Vascular diseases (VD) are conditions that affect the vascular system, and they pose an increasing risk in the global population. The vascular system is the network of blood vessels in the body, consisting of:

• Arteries - carrying oxygen-rich blood from the heart to the entire body, including organs and tissues 
• Veins - returning oxygen-poor blood to the heart 
• Capillaries - tiny blood vessels that exchange blood, nutrients and oxygen to cells throughout the body 

VDs mostly affect blood flow, and therefore circulation throughout the body. It may do this by blocking or weakening blood vessels, or by causing damage to valves found in the veins. The blockage is most commonly caused by plaque, which is made up of fat and cholesterol resulting from lifestyle choices such as poor diet, lack of exercise, and obesity. 

Due to the lack of oxygenated blood flow, organs and other structures in the body may be damaged by vascular disease. The disease can also lead to fatal cardiovascular complications, including heart attack, blood clots, and stroke. In some severe cases, it can also result in death.

What causes vascular diseases?

The exact causes of VD depend on the type of disease and sometimes are unclear. However, many risk factors can increase your risk of developing it. 

Who is at risk for vascular diseases?

Anyone is susceptible to developing VD, although some people are more at risk than others. Risk factors include:

• High blood pressure (BP)
• High cholesterol
• Smoking
• Diabetes
• Over 60 years of age
• Being overweight or obese
• Genetics
• Blood clots
• Medications 
• High-fat diet
• Inactive lifestyle 

This article details the most common types of VD, as well as their associated symptoms and treatments. Read on to discover the different types to seek early and effective treatment, preserve your vascular well-being and prevent long-term complications.  

Types of vascular disease

Types of VD vary. Some affect the arteries, while others can occur in the veins. 

Atherosclerosis 

Atherosclerosis is the accumulation of fatty deposits, cholesterol, and calcium in the artery walls, forming a substance known as plaque. Over time, plaque can cause blockage in the arteries, resulting in inflammation. Inflammation causes the arterial walls to narrow, thus reducing blood flow to reach other organs and tissues, causing myocardial ischemia and tissue hypoxia.¹ Plaque build-up can be caused by:

• Tobacco use
• High BP
• High cholesterol
• Diabetes

Symptoms of atherosclerosis depend on where the arteries are narrow or blocked. Atherosclerosis causes abdominal aortic aneurysm (AAA), peripheral artery disease (PAD) and carotid artery disease (CAD). 

Generally, atherosclerosis treatment can involve making lifestyle modifications to control the risk factors, including:

• Eating a low-fat diet
• Cardiovascular exercise to increase blood flow in the body
• Avoiding smoking 

Additionally, the following medications may be prescribed to reduce the risk factors that cause artery blockages:^1,2,3,4

• Statins to manage high cholesterol 
• Antihypertensive medicines to control high BP
• Antiplatelet medicines to prevent the formation of blood clots

Abdominal aortic aneurysm (AAA)

AAA is the swelling in the part of the aorta that extends through to the abdomen. The aorta is the large artery carrying oxygen-rich blood from the heart to the rest of the body. Swelling causes a bulge in the aorta which expands outwards and can continue to grow over time where it is at risk of rupturing, causing internal bleeding. AAA can be due to atherosclerosis and is generally diagnosed in those where the aortic diameter has exceeded 3 cm.⁴

Symptoms may occur if the aneurysm increases and puts pressure on surrounding organs. You may have:

• Deep pain in the lower back, abdomen, leg, groin or pelvic area
• A pulsating sensation in the abdomen
• Fever or weight loss

However, if the AAA ruptures, it can cause the following symptoms and without immediate treatment, death:

• Sudden and severe pain
• Extremely low BP
• Dizziness and fainting 

Treatments specific to AAA, with the primary goal of controlling growth and preventing a rupture, include surgical intervention in severe cases if AAA has grown to a diameter of at least 5.5 cm or is causing symptoms.⁴ Procedures could involve endovascular aneurysm repair (EVAR), or AAA open repair

In the case of a ruptured aneurysm, immediate surgery will be required. 

Peripheral artery disease (PAD)

PAD is a common condition that occurs when atherosclerosis affects the arteries that carry blood to the legs and feet. 

Symptoms of PAD may not become obvious until the artery narrows by 60% or more. However, the most common symptom of PAD is claudication. Claudication is characterised by pain and cramping in the leg muscles whilst walking or exercising. The first symptom includes intermittent claudication, where pain diminishes with rest. This can progress to severe claudication and ischemic rest pain. Claudication happens as blocked arteries cause poor blood flow to the muscles.² 

Other typical symptoms of PAD include:²

• Leg sores and wounds that do not heal
• Pale discoloration on the leg or feet 
• Weak or absent pulses on the legs
• Shiny skin 

Patients with PAD are at a higher risk of heart attack, stroke, cardiovascular death, and limb amputations. 

Carotid artery disease (CAD)

CAD is characterised by atherosclerosis of the arteries that carry oxygen-rich blood from the heart to the brain, known as carotid arteries. Carotid arteries are located on either side of the neck, and blockage of these blood vessels can increase your risk of stroke, and thus permanent loss of brain function.³ 

Most people have no symptoms of CAD, with the first signs of the disease occurring in the form of a stroke or transient ischemic attack (TIA), commonly known as a mini-stroke. Symptoms of stroke and TIA may involve:

• Sudden vision changes
• Difficulty speaking
• Difficulty moving arms and legs
• Numbness
• Sudden and severe headache 
• Imbalance

Patients with severe blockages may be referred for surgical interventions, including:

• Carotid endarterectomy - Removal of plaque from carotid arteries to restore blood flow
• Stenting - Insertion of a tiny balloon to enlarge the narrowed portion of the artery, whilst fitting a stent to prevent the closing up of the artery

However, these methods can put patients at risk for a stroke or heart attack, so this must be decided with your doctor.³

Venous diseases

Veins carry oxygen-poor blood back to the heart and contain valves to keep blood flowing in one direction. Venous diseases are caused by vein damage, whereby the valves do not close completely and allow the flow of blood backwards when the muscles relax. This high-pressure results in stretching and twisting of the veins, causing swelling, poor blood flow and blood clot formation.⁵ 

Venous diseases include deep vein thrombosis (DVT), pulmonary embolism (PE), and varicose veins. 

Deep vein thrombosis (DVT)

DVT occurs due to blood clot formation in a deep vein, commonly in the legs or pelvic area. Blood clots are a semi-solid mass of platelets and fibrin that form in the blood vessels. Their primary objective is as the first point of defence if blood vessels are damaged. However, they can be dangerous as they may partially or completely block blood flow and lead to long-term problems.⁶ 

DVT can sometimes occur without symptoms. In those who do experience symptoms, they can develop slowly or suddenly:

• Swelling in one or both legs
• Pain
• Skin that is warm to the touch
• Discoloration (blue or red) of the skin
• Firmness of the veins beneath the skin

Preventing DVT usually involves exercising the lower legs, as movement stimulates circulation and prevents blood clot formation. Pain and swelling may be minimised with compression stockings. 

Pulmonary embolism (PE)

Blood clots that form in the deep veins in the legs can break free, travel through the bloodstream and get lodged in a lung artery, blocking blood flow. This is known as PE, and is a potentially deadly condition that requires immediate medical attention.  

Those with PE may experience:

• Sudden shortness of breath
• Chest pain with deep breathing
• Sudden, unexplained sense of anxiety
• Sudden collapse
• Coughing up blood
• Irregular heartbeat

DVT and PE are both treated with anticoagulant medicines, which prevent existing clots from growing and new clots forming. 

However, in some severe cases, treatment can include:⁶

• Intravenous (IV) fibrinolytic therapy to break down the clot
• Thrombolytic drugs to rapidly dissolve blood clots
• Vena cava filter which prevents clots from travelling to the lungs
• Embolectomy to remove the clot

Varicose veins

Varicose veins are enlarged, bulging and twisted superficial veins caused by incompetent valves. They are mostly found in the legs and ankles and are usually larger than 3 mm in diameter.⁷ Varicose veins are common but do not pose a serious health risk. They may be removed if they cause discomfort or for cosmetic reasons. 

Varicose veins may cause the following:

• Heavy, achy feeling 
• Itching and burning sensation
• Blue or dark purple 
• Muscle cramps in the legs
• Swelling

The first choice of treatment may include the use of compression stockings, elevating the affected area when resting and regular exercise.⁷ If pain and discomfort do not reduce, the most common treatment options include:

• Endothermal ablation - Using heat to seal the affected veins
• Sclerotherapy - Use of special foam to close the veins
• Ligation and stripping - Surgical removal of affected veins

Conclusion

VD affects the vascular system and can be caused by a build-up of plaque which blocks blood flow. Common VD affecting the arteries consist of atherosclerosis, abdominal aortic aneurysm, peripheral artery disease, and carotid artery disease. Types involving the veins include deep vein thrombosis, pulmonary embolism, and varicose veins. Steps you can take to avoid developing VD are to adopt a low-fat diet, have an active lifestyle, and cease smoking. Consider visiting a doctor if you have any symptoms of VD to receive appropriate medical care and prevent serious complications.