Vascular disease

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Vascular disease is a class of diseases of the blood vessels – the arteries and veins of the circulatory system of the body. It is a subgroup of cardiovascular disease. Disorders in this vast network of blood vessels, can cause a range of health problems which can be severe or prove fatal.^[1]

There are several types of vascular disease, (which is a subgroup of cardiovascular disease) among them are:^[2]

• Peripheral artery disease – happens when atheromatous plaques build up in the arteries that supply blood to the arms and legs, plaque causes the arteries to narrow or become blocked.^[3]
• Renal artery stenosis – is the narrowing of renal arteries that carry blood to the kidneys from the aorta.^[4]
• Buerger’s disease – is due to small blood vessels that inflame and swell, vessels then narrow or are blocked by blood clots.^[5]
• Raynaud’s disease – a rare disorder of constriction of the peripheral blood vessels, in the fingers and toes when the person is cold.^[6]
• Disseminated intravascular coagulation – a widespread activation of clotting in the smaller blood vessels.^[7]
• Cerebrovascular disease–a group of vascular diseases that affect brain function.

Vascular disease is a pathological state of large and medium muscular arteries and is triggered by endothelial cell dysfunction. ^[8]Because of factors like pathogens, oxidized LDL particles and other inflammatory stimuli endothelial cells become active. ^[9]The process causes thickening of the vessel wall, forming a plaque that consists of proliferating smooth muscle cells, macrophages and lymphocytes.^{[10] [11]}The plaque results in a restricted blood flow which will decrease the amount of oxygen and nutrients that reach certain organs,^[12] the plaque might rupture causing the formation of clots.

It can be difficult to make a Vascular disease diagnosis since there are a variety of symptoms that a person can have, also family history and a physical examination are important. The physical exam may be different depending on the type of vascular disease. In the case of a peripheral vascular disease the physical exam consists in checking the blood flow in the legs.^[13][14]

Treatment varies with the each type of Vascular disease, in the case of Renal artery disease information from a meta-analysis indicated that balloon angioplasty results in improvement of diastolic blood pressure and a reduction in antihypertensive drug requirements.^[15] In the case of Peripheral artery disease preventing complications is important, without treatment sores or gangrene (tissue death) may occur. Among the treatments are: ^[16]

• Quit smoking
• Lower cholesterol
• Lower blood pressure
• Lower blood glucose
• Physical activity