Robert Wood Johnson University Hospital

Medical Management, Vascular Conditions

Medical Management of Vascular Conditions

Vascular system overview

The blood vascular system, also called the circulatory system, of the body is made up of arteries, veins, and capillaries (tiny blood vessels between arteries and veins that distribute oxygen-rich blood to the body). The heart is responsible for pumping blood through this network of blood vessels throughout the body.

Illustration of the circulatory system, arterial and venous
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Another vascular system of the body is the lymph system. The lymph vessels carry lymphatic fluid (a clear, colorless fluid containing water and blood cells). The lymphatic system helps to protect and maintain the fluid environment of the body by filtering and draining lymph away from each region of the body.

Collectively, the blood and lymphatic systems are the transport systems of the body. They supply oxygen, nutrients, removal of waste products, fluid balance, as well as many other functions, to all organs and tissues of the body. Therefore, conditions that affect the vascular system may affect the organs supplied by a particular vascular network such as the coronary arteries of the heart, for example. A blockage in the coronary arteries of the heart may cause a heart attack.

What causes vascular conditions and diseases?

A vascular disease is a condition that affects the arteries and/or veins. Most often, vascular disease affects blood flow, either by blocking or weakening blood vessels, or by damaging the valves that are found in veins. Organs and other body structures may be damaged by vascular disease as a result of decreased or completely blocked blood flow.

There are many different causes of the various types of vascular conditions and diseases. However, coronary artery disease (heart attack), cerebrovascular disease (stroke), and peripheral arterial disease (loss of limb or use of limb) are some of the leading causes of illness and death in the U.S. Since there is a potential for the occurrence of heart attacks, stroke, and loss of limb(s) to be prevented or decreased, the focus of medical management of vascular conditions information will be concentrated on these conditions.

These three vascular disease conditions (heart attack, stroke, and peripheral vascular disease) can be associated with the same cause, atherosclerosis (a build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery), and are all linked to the same risk factors.

Atherosclerosis is a systemic, progressive, chronic vascular disease process that particularly affects the carotid arteries (major blood supply to the brain), coronary arteries (blood supply to the heart), and the peripheral arteries in the same manner.

Illustration of a normal and diseased artery
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It is unknown exactly how atherosclerosis begins or what causes it. Atherosclerosis may start as early as childhood. However, the disease has the potential to progress rapidly. It is generally characterized by the accumulation of fatty deposits along the innermost layer of the arteries. If the disease process progresses, plaque formation may take place. This thickening narrows the arteries and can decrease blood flow or completely block the flow of blood to organs and other body tissues and structures.

The presence of atherosclerosis in any one of these areas is a strong indicator that there is also the presence of atherosclerosis in the arteries of other parts of the body. Just as atherosclerosis in the arteries of the heart can cause a heart attack, or atherosclerosis of the arteries to the brain can cause a stroke, so can atherosclerosis of the leg arteries cause a blockage. A blockage can obstruct blood flow, and potentially result in pain in the leg(s), ulcers or wounds that do not heal, and/or the need for amputation (surgical removal) of the foot or leg.

Therefore, management of risk factors should be optimized to control the progression of vascular disease conditions caused by atherosclerosis. Studies have shown that lifestyle changes have not only stopped but also reversed the progression of atherosclerosis development.

Because vascular conditions and diseases may involve more than one of the body's systems at a time, many types of doctors treat vascular problems. Specialists in vascular medicine and/or surgery work closely with doctors in other specialties, such as internal medicine, interventional radiology, cardiology, and others to ensure comprehensive care of patients with vascular conditions.

What are the risk factors for vascular diseases?

Modifiable risk factors that are associated with all four major vascular conditions are:

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.

Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

How can risk factors be medically managed?

Medical management of vascular conditions most often includes management of modifiable risk factors, such as diabetes, hyperlipidemia, smoking, and high blood pressure. An overview of the management of these four risk factors is given below:

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