What Is Vascular Disease?

With every beat, your heart pumps blood through a complex network of blood vessels to supply your body with oxygen and nutrients. When any part of the vascular system is endangered, a host of problems can arise. Vessels can widen or narrow to excess, or become partially or totally blocked, causing an array of conditions, from aortic aneurysms to peripheral artery disease.

"Everyone has a friend or family member who's dealt with angina, heart attack, heart failure, or another cardiac-related event," says Michael L. Marin, MD, Professor and Chair of the Department of Surgery. "But in sheer numbers, people with peripheral vascular disease far outnumber those with cardiac disease."

Several conditions can block the normal flow of blood through the arteries and veins:

Aortic Aneurysm

The aorta is your largest artery and your body's most important blood vessel. When the aorta's walls are weakened, usually by a buildup of plaque deposits, they can bulge and swell into pockets called aortic aneurysms. If an aneurysm dissects or ruptures, blood is released outside the aorta's walls. These occurrences are often fatal.

"The major focus of most people in this field is to figure out when the risk of rupture becomes significant and to forestall that with an operation," says Randall B. Griepp, MD, Professor of Cardiothoracic Surgery, who specializes in aortic surgery.

Common risk factors for aortic aneurysm include:

  • Age
  • High blood pressure, (hypertension)
  • Smoking
  • Genetic conditions, such as Marfan syndrome
  • Narrowing of the arteries (atherosclerosis)
  • History of coronary artery disease
  • High cholesterol
  • Traumatic injury
  • Gender and race, with higher rates in men than women and for Caucasians over other races
  • Family history of aortic disease

"We have discovered one of the largest genetic populations of patients with two or more members of their family with aortic aneurysm disease," says Dr. Marin. "As we target specific DNA to understand the genetic linkages, we will be able to identify families and people at greater risk and detect their disease earlier."

Aortic Aneurysm Signs and Symptoms

Aneurysms can grow slowly and undetectably for many years.

"Occasionally, patients feel warning pain and seek medical attention; but in many cases, that's not true," Dr. Griepp explains.

In fact, patients may be at high risk for vascular disease without their doctors realizing it. Men in their 60s with a history of smoking are at highest risk, but women, who also face risk, may not be getting screened as a matter of course.

If you experience any of the following, seek medical assistance:

  • Strong pulsing around the navel, which may signal the presence of an abdominal aortic aneurysm
  • Concentrated tenderness or pain in the abdomen or back
  • Chest pain, or vague awareness that something does not feel right in the chest

Aortic Dissection

The aorta, about the diameter of a garden hose, has three-layered walls. As an aortic aneurysm grows larger and places stress on the layers, the probability increases that the bulge will tear the layers apart, allowing blood to rush in between them and create an alternate channel. This process, called dissection, has potentially disastrous effects all over the body, from embolism to stroke to heart attack.

Risk factors for aortic dissection include:

  • Uncontrolled high blood pressure
  • Narrowing of the arteries (atherosclerosis)
  • Pre-existing aorta-related conditions
  • Genetic disposition and disorders, such as Marfan syndrome

Aortic Dissection Signs and Symptoms

Symptoms of an aortic dissection are often sudden and excruciating. The sensation that accompanies the splitting of the vessel wall feels just like that, an internal tearing. The blood loss can cause symptoms that include:

  • Dizziness
  • Sweating
  • Loss of consciousness
  • Rapid pulse
  • Shortness of breath

Peripheral Artery Disease

Peripheral arteries distribute blood to the outer reaches of your body. When blockage or narrowing significantly reduces the blood and oxygen flowing to your arms or legs, the result is peripheral arterial disease (PAD).

"Peripheral arterial disease can negatively impact the patient's health, well being and lifestyle," says Peter L. Faries, MD, Chief of Vascular Surgery and Professor of Surgery. Peripheral arterial disease can cause severe pain while walking and, in extreme cases, amputation may be necessary.

Risk factors for peripheral artery disease include:

  • Narrowing of the arteries (atherosclerosis)
  • Obesity
  • Diabetes
  • High blood pressure (hypertension)
  • Aging
  • Male gender
  • Physical inactivity
  • Family history of heart disease or peripheral arterial disease

Peripheral Artery Disease Signs and Symptoms

The symptoms of peripheral arterial disease are not always noticeable, and some people may mistake milder symptoms for the result of overexertion or aging. Symptoms are more evident after walking or climbing steep hills or stairs and may include:

  • Moderate to severe pain or cramping in the arms or legs
  • Coldness or numbness in the arms, legs, fingers, or toes
  • Thinning or loss of hair on the arms and legs
  • Skin ulcers
  • Muscle spasms
  • Loss of sensation in the arms or legs
  • Erectile dysfunction

Fortunately, says Dr. Faries, "Recent advances made at Mount Sinai enable more patients to be treated. These novel techniques are performed through a small catheter, eliminating morbidity and speeding up patient recovery."

Deep-Vein Thrombosis

Public awareness of deep vein thrombosis (DVT) increased as the news media began reporting the risk of blood clots in the legs of people making long-distance car or airplane trips. Blood that pools in the veins of stationary travelers for long periods creates the ideal condition for clot formation. When the jostled clots travel and clog major arteries, the result can be a heart attack, pulmonary embolism, or stroke.

Deep vein thrombosis primarily affects the veins in your legs. Only in rare cases does it affect the arms. Clots may form due to injured valves or a pre-existing clotting disorder. Prolonged bed rest, such as after surgery or during pregnancy, may also heighten risk.

Risk factors for deep vein thrombosis include:

  • Age
  • Injury
  • Long periods of immobility
  • Clotting disorders
  • Heart Failure
  • Certain cancers
  • Smoking
  • Medications containing estrogen
  • Prior episodes or family history of thrombosis

Deep-Vein Thrombosis Signs and Symptoms

People usually don't realize they have deep vein thrombosis. Symptoms are generally vague and often blamed on leg fatigue. Affected areas might produce tender swelling along the line of the vein and may be warm to the touch. The ankle, foot, or thigh may also be swollen.

Other symptoms that may precede an embolism, which occurs when the clot breaks free, include:

  • Sudden shortness of breath
  • Chest pain that worsens with deeper breathing
  • Lightheadedness, dizziness, fainting
  • Coughing that produces blood

Vasculitis

Vasculitis is an inflammation of the blood vessels. Though the cause of any particular vasculitis may never be known, it might be triggered by a viral or bacterial infection, certain medications, toxins, cancer, or a misinformed immune system, as with autoimmune diseases. The inflammation can cause the vessels that supply the body's organs to shut down entirely.

Vasculitis Signs and Symptoms

Symptoms can vary depending upon the type of condition. Symptoms include:

  • Unusual bruising or rashes
  • Diarrhea or gastrointestinal ulcers
  • Blurred vision
  • Shortness of breath
  • High blood pressure in the kidneys
  • Confusion and headaches
  • Fever, night sweats
  • Fatigue
  • Loss of appetite, weight loss
  • Joint pain

Thromboangiitis obliterans, a type of vasculitis known as Buerger's syndrome, was first identified at Mount Sinai.

"In 1908, Mount Sinai physician Leo Buerger first described this rare condition," says Jeffrey W. Olin, DO, Professor of Cardiology and Director of Vascular Medicine and the Vascular Diagnostic Laboratory. "I see many young men and women with this form of arterial disease, which causes severe pain in the legs."

Carotid Artery Disease

Over time, cholesterol deposits called plaque can build up in the carotid arteries of the neck, causing them to become narrow or blocked. The plaque can break up in small pieces and travel to the brain, causing a stroke.

"Stroke is the third leading cause of death and the leading cause of permanent disability in the United States," says Dr. Faries. "Our treatments eliminate narrowing in the carotid arteries, which bring blood to the brain. By repairing the blockage in the carotid artery, we are able to prevent stroke."

Carotid artery disease can be treated in its early stages with medication, lifestyle changes, and regular physician visits. In some cases, severe narrowing of one or both carotid arteries is treated with a surgery involving a small neck incision called a carotid endarterectomy. For some, the most appropriate treatment may be a minimally invasive procedure called carotid stenting . Both procedures usually allow patients to be discharged the day after surgery.

Carotid Artery Disease Signs and Symptoms

While carotid artery disease itself may not have any symptoms, signs of an impending stroke include:

  • Loss of vision in one or both eyes
  • Weakness and/or numbness of the arm, leg, or face on one side of the body
  • Slurring of speech, difficulty talking or understanding what others are saying
  • Loss of coordination, dizziness or confusion

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