• What is Vascular Disease?
• Arterial Disease and Related Terms
• Cerebrovascular Disease
• Peripheral Arterial Disease (PAD)
• Abdominal Vascular Disorders
• Vasospastic
• Venous Disease And Related Terms
• Prevention of Vascular Disease
• Glossary

Vascular Disease is a broad term describing disorders or disease processes in the blood vessels that can impair proper circulation. It is closely related to the cardiopulmonary system (the heart and lungs) and can impair the proper function of these and other organs of the body. Among the subtypes of vascular disease are Arterial Disease and Venous Disease.

A general knowledge of the heart, lungs and circulatory system may help to enhance understanding of vascular disease and related disorders.

Transportation is the sole function of the circulatory system. Oxygen, provided by the lungs, and nutrients are delivered to the body's cells and organs via the blood supply. The heart functions as a pump that pushes the blood through the arteries, which serve as vessels for the transportation of blood away from the heart. Veins are the vessels that return blood to the heart. "Peripheral" refers to the arteries and veins supplying blood to and from the arms and legs. The arteries and veins must be open to keep the circulatory system functioning adequately.

Arterial Disease refers to blockages or disorders in the arteries, vessels that carry oxygen rich blood to various organs in the body.

A. Cerebrovascular Disease refers to blockages in the arteries that lead to the brain. Significant obstructions in any of these vessels can interrupt the blood supply to the brain and result in a stroke, or CVA (cerebrovascular accident), if sufficient collateral circulation does not develop to maintain adequate blood flow.
There are two main types of stroke related to cerebrovascular disease:

Strokes are frequently caused by atherosclerotic build up in the carotid arteries, located in the neck. The carotid artery is divided into two branches - the internal carotid artery, which supplies blood to the eye and brain, and the external carotid artery, which supplies blood to the face.
Common symptoms of stroke or advanced cerebrovascular disease may include:

• Numbness, weakness, or inability to move (paralysis) of face, arm, or leg, especially on one side of the body.
• Trouble seeing in one or both eyes (such as dimness, blurring, double vision, or loss of vision).
• Confusion, trouble speaking or understanding.
• Trouble walking, dizziness, loss of balance or coordination.
• Severe headache with no known cause.

Often a stroke is preceded by a warning signal called a Transient Ischemic Attack(TIA), or "mini stroke". A TIA is the temporary interruption of the normal blood supply to the brain. The symptoms of a TIA may last a few seconds or several hours and can include numbness or weakness, temporary loss of vision or balance and other stroke-like symptoms. Many people ignore the signs because the symptoms go away within 24 hours. It is important to recognize the warning signs and report them to your physician.

B. Peripheral Arterial Disease (PAD) refers to blockages in the peripheral arteries. If sufficient collateral circulation does not develop to maintain adequate blood flow to the extremities, a number of symptoms may result.

Symptoms of PAD include:

• Persistent coldness or numbness in the feet or hands
• Claudication - the onset of pain, cramping, or weakness in the limb (typically calf, thigh or buttock), with walking short distances or brief exercise, yet the symptoms are alleviated with rest
• Rest Pain - a severe ache in the toes, heel or forefoot relieved by 'leg dependency'
  (inducing blood flow with gravity, for example, dangling the foot over the side of the bed)
• Ulcers or sores that have difficulty healing; typically occur on the foot or ankle
• Pain, abnormal coloring or lack of pulse in portions of the extremities
• Gangrene

Risk Factors

• High Blood Pressure
• Smoking
• Diabetes
• Elevated Cholesterol levels
• Lack of exercise

Aneurysms:  An aneurysm is a dilation or enlargement of an artery segment (similar to a balloon) that poses a risk due to its potential for rupture, clotting, or dissecting. The rupture of an aneurysm in the brain can cause a stroke, while the rupture of an abdominal aortic aneurysm (AAA) may cause severe shock. A ruptured aneurysm in either location can be a life-threatening event.

C. Abdominal Vascular Disorders

Renal Artery Stenosis refers to a narrowing or blockage of the renal artery, which supplies blood to the kidneys. A significant renal artery stenosis can contribute to hypertension (high blood pressure) and may be a major factor in the development of renal failure. (Fibromuscular dysplasia (FMD) is the second most common type of renal artery stenosis). The risk factors for renal artery stenosis are the same as those for arterial disease.

Mesenteric Artery Stenosis - a narrowing or blockage of the mesenteric artery, which supplies blood to the stomach, intestine and other abdominal organs. Mesenteric artery stenosis can result in mesenteric ischemia (inadequate blood supply to organs fed by this artery) which can be potentially life threatening. Symptoms of significant mesenteric artery stenosis may include:

• Abdominal pain
• Chronic diarrhea
• Unexplained weight loss
• Fear of food (or pain associated with eating)

D. Vasospastic
Raynaud's Syndrome/Raynaud's Phenomenon describes a condition characterized by intermittent attacks of ischemia (inadequate blood supply) to the skin. A Raynaud's "attack" or episode usually occurs during exposure to cold temperatures and primarily affects the fingers and/or toes. Blood vessels near the skin surface normally become smaller (vasoconstrict) when exposed to cold temperatures in order to conserve and reduce energy/heat loss. Along the same lines, they will increase in size (vasodilate) when exposed to warm or hot temperatures. In a person with Raynaud's phenomenon, however, these blood vessels will close entirely under cold temperatures and then be slower to dilate once the temperature increases. While exposure to cold temperatures is the most common trigger to a Raynaud's episode, emotional stress or certain medications can also cause an attack. Skin discoloration occurs because an abnormal spasm of the blood vessels results in a diminished blood supply. Initially, the digit(s) involved turn white because of a diminished blood supply. The digit(s) then turn blue due to the prolonged lack of oxygen. Finally, the blood vessels reopen, causing a local "flushing" phenomenon, which turns the digit(s) red. This three-phase color sequence (white to blue to red), most often upon exposure to cold temperature, is characteristic of Raynaud's phenomenon. There are two kinds of Raynaud's phenomenon:

• Primary Raynaud's (Raynaud's Disease) has no known cause and accounts for most cases of Raynaud's. This type occurs most often in women between 15 and 35 years of age.
• Secondary Raynaud's (Raynaud's syndrome) usually involves more severe symptoms and may develop as the result of other diseases such as lupus, scleroderma, rheumatoid arthritis, and atherosclerosis. Other contributing factors that may lead to secondary Raynaud's can include taking certain medications, smoking, having frostbite, or repetitive trauma such as long term use of vibrating power tools. This type begins most often in women and men older than 35 years of age.

Venous Disease typically refers to blockages in the veins most commonly caused by blood clots. These clots may obstruct blood flow within the vein or break away from the vessel wall and travel to the lungs and heart. The latter event is called a pulmonary embolism. Veins return blood to the heart. There are two main sets of veins in the legs: deep veins and superficial veins. Deep veins lie well within the tissue and drain the blood from the muscles and deeper structures in the leg, while superficial veins are located closer to the surface of the skin.

Thrombosis is a condition in which the blood changes from a liquid to a solid state and produces a blood clot (thrombus). This may also cause a complete or partial blockage within a blood vessel.

Superficial Thrombophlebitis refers to a clot and inflammation, which has formed in a superficial vein near the surface of the skin. The condition may follow an injury or occur in a varicose vein. Superficial Thrombophlebitis is usually not of great medical concern (although it can be rather painful) and responds well to treatment. Symptoms may include localized pain, swelling and redness in the area of the superficial vein.

Deep Vein Thrombosis (DVT) refers to the development of a blood clot, which can cause partial or total blockage of blood flow in a deep vein. Pain, swelling or redness in the limb may result. Unlike 'superficial thrombophlebitis', a blood clot deep within the veins (venous thrombosis) poses a greater medical risk since there exists the possibility that it might break off and travel to the lungs and become lodged in one of the pulmonary arteries. This is called pulmonary embolism (PE). If the embolus (dislodged clot or other material) is large, it can be fatal, whereas a smaller embolism may even go unnoticed. The risk of pulmonary embolism is reduced by prompt recognition and treatment of DVT.

Symptoms of DVT may include:

• Pain, swelling or tenderness in the limb
• A bluish discoloration of the skin
• An abnormal flush or redness of the skin
• Suspected pulmonary embolus (see symptoms of pulmonary embolus)

Risk factors for DVT may include:

• Recent trauma or surgery
• Prior history of DVT
• Venous insufficiency
• Prolonged bed rest or other instances of extended inactivity, such as a long car or plane ride
• Oral contraceptives or hormone replacement therapy
• Smoking
• Family history of DVT, or blood clotting disorder
• Pregnancy
• Active cancer and some cancer treatments
• Obesity

Symptoms of a pulmonary embolism (PE) may include:

• Sudden onset of chest pain
• Unexplained shortness of breath
• Unexplained rapid heart rate
• Unexplained low-grade fever

Venous Insufficiency - when veins cannot return blood to the heart properly it is referred to as venous insufficiency. Most of the veins in the body have valves that serve to prevent backflow. For example, as the blood in your legs returns to the heart, it must work against gravity while a person is standing. When functioning properly, these valves open to allow blood to flow upward toward the heart and then close to prevent blood from moving backward, toward the feet. When valves do not close properly (valvular incompetence), blood can drain back away from the heart and increase the pressure in the vein. Varicose veins are a result of valvular incompetence in the superficial veins. Over time, and depending on which and how many valves are incompetent, the increased pressure in the veins can cause swelling in the limb and even tissue damage (darkening of the skin and/or non-healing sores called ulcers). People with significant venous insufficiency are at a higher risk for developing blood clots due to the pooling of blood in the distended veins with increased pressure.

Plaque doesn't go away. Although some interventional procedures improve blood flow in damaged arteries, prevention is the best treatment for vascular disease. Prevention is best achieved by controlling risk factors that contribute to vascular disease.

Stop Smoking - Chemicals found in tobacco can injure blood vessel walls, increase the build up of plaque and impair circulation. Smoking inhibits the ability of your lungs to provide adequate oxygen, which requires the heart to work harder.

Control Diet - A high fat diet and high blood pressure are risk factors. Typically, less than one third of your daily calories should be from fats. Eat fruit and vegetables daily. Lose excess weight. (Consult your doctor or dietician before making any serious dietary changes.)

Control High Blood Pressure - - Take medication as prescribed and visit your doctor regularly.

Exercise Daily - Exercise can help to increase the amount of oxygen in your blood and lower high blood pressure. By working your muscles and the vessels that feed them, exercise improves circulation and helps develop collateral circulation where necessary in the body (Consult your doctor to help you design an exercise program that is right for you).

Avoid Immobilization - If you are traveling or recovering from an illness requiring extensive bed rest, try to walk at least once an hour. Massage legs to increase blood flow. Drink plenty of fluids to avoid constrictive clothing.

Manage Diabetes - If your blood sugar level is high your arteries may narrow. This limits blood flow to your body including your heart

Know the warning signs for stroke

• Numbness or weakness of one side of the body involving the arm leg or face
• Temporary loss of vision in one eye
• Falling for no apparent reason
• Loss of Balance
• Blurred or double vision with a return to normal vision in a short time
• Difficulty speaking or understanding spoken or written words.
• Loss of memory for brief periods of time that cannot be recalled.

The warning signs may last a few seconds or several hours. Many people ignore the signs because they do go away usually within 24 hours. It is important to recognize the warning signs and report them to your doctor.

• Aneurysm - a balloon-like swelling or bulging in the wall of an artery.
• Angiogram - an examination of the blood vessels, which involves injection of a dye into the vessel that can be seen through X-ray.
• Angioplasty - a procedure to widen a blood vessel wherein a catheter with a balloon at its tip is threaded through the vessel to the blockage. The balloon is then expanded to compress the plaque against the artery wall and open the vessel.
• Atherectomy - a procedure to widen a blood vessel wherein an atherectomy catheter is threaded through the vessel to the blockage. A small burr at the tip of the catheter grinds the plaque into small bits, which float away in the bloodstream thereby opening the vessel.
• Arterial - pertaining to an artery, a blood vessel carrying blood away from the heart.
• Atherosclerosis - a process commonly called "hardening of the arteries" where the inner lining of the artery becomes thickened and rough by a build up of cholesterol or fatty materials called plaque.
• Bruit - an unusual noise in the carotid artery that can be heard through a stethoscope; usually caused by a flow-reducing narrowing in a blood vessel.
• Carotid - arteries on each side of the neck that lead to the head. The carotid artery is divided into two branches - the internal carotid artery, which supplies blood to the eye and brain, and the external carotid artery, which supplies blood to the face.
• Catheter - a tube inserted into a narrow opening so that fluid or instruments may be passed through.
• Cerebral - pertaining to the head or cranium
• Cerebrovascular Accident (CVA) - see "stroke"
• Cholesterol - a fatty-like material that is present in most blood vessels.
• Claudication - from the French word "to limp" - a cramping pain induced by exercise and relieved by rest; caused by an inadequate supply of blood.
• Clot (Blood Clot) - a mass that forms when blood changes from a liquid to a solid (also called a thrombus).
• Collateral Circulation - blood flowing through alternate routes to circulate around a blockage.
• Digit - finger or toe.
• Doppler - the physics principle (named after Christian Andreas Doppler) that is used to calculate the velocity of blood flow; detects changes in frequency.
• Duplex - diagnostic tool that couples ultrasound imaging and waveform analysis of blood flow.
• Embolus - material such as a blood clot, fat, air or foreign body that is carried by the blood from one point in the circulation to another (plural - emboli).
• Extremity - arm or leg.
• Gangrene - death and decay of tissue due to deficient or cessation of blood supply.
• Hepato - pertaining to the liver.
• Hypertension - high blood pressure, elevation of the arterial blood pressure above the normal range expected in a particular age group.
• Iliac - pertaining to the large vein and artery that carry blood to and from the lower limbs and pelvic region.
• Interpreter/ Interpreting Physician - a professional (generally a physician) who reviews a study or exam (after the preliminary report is written by the technologist) to ensure the quality of the exam and validate the findings.
• Invasive - related to invasion - a tool or procedure, which penetrates the body.
• Mesenteric - pertaining to the abdominal organs such as the stomach, intestine, pancreas or spleen.
• Noninvasive - non intrusive; does not penetrate the body.
• Occlusion/ Occlusive - a closing or obstruction of a hollow organ or vessel.
• Peripheral - outer lying, away from the heart or the central part of the body.
• Phlebitis - a redness or inflammation.
• Plaque - a rough build up of fatty materials.
• Pulmonary - pertaining to the lungs.
• Renal - pertaining to the kidney.
• Stenosis - a narrowing in an artery or vein.
• Stent - a small metal coil or mesh tube placed in a blood vessel to keep it open.
• Stroke - a disruption of blood circulation to the brain; also called a cerebrovascular accident (CVA).
• Superficial - shallow, near the surface.
• Technologist - a professional trained in the art and science of diagnostic medical ultrasound.
• Thoracic - pertaining to the organs or vessels in the chest region above the abdominal region.
• Thrombophlebitis - a clot and inflammation that has formed in the veins near the surface of the skin.
• Thrombosis - a condition where a thrombus (blood clot) obstructs blood flow.
• Transducer - a probe used for ultrasound scanning; sends and receives ultrasound signals.
• Transient Ischemic Attack (TIA) - stroke-like symptoms that last for less than 24 hours; also called a "mini stroke".
• Ultrasound - the use of sound waves of very high frequency (inaudible to the human ear) to examine structures inside the body non-invasively.
• Vascular - pertaining to the blood vessels.
• Venous - pertaining to the veins, vessels that carry blood to the heart.