Vessels and vascular diseases – briefly explained

The blood flows through our body in a few large and an infinite number of small arteries and veins – a total of six litres of blood are constantly being moved by the heart. However, cardiovascular diseases are the most common cause of death in Germany – because hardening of the arteries and high blood pressure affect the vessels.

Blood vessels: structure and function

The heart pumps the oxygen-enriched blood with powerful pressure to the furthest parts of the body. The blood flows through the aorta into other large arteries, which divide into smaller and smallest arteries. These smallest arteries finally end in the organs, where the blood components fulfil their task: supplying the cells with oxygen and nutrients or defending against pathogens.

Blood is transported back towards the heart in other vessels, the veins. While arteries have a relatively thick, elastic wall because of the high blood pressure, veins are only surrounded by a thin wall and have door-like valves. The blood is pushed towards the heart in the veins by the movement of nearby muscles – the valves prevent the backflow. In people who move little, the blood only flows slowly back from the legs to the heart – this is how varicose veins quickly develop.

 

lymphatics and lymphatic fluid

Blood is the essential bodily fluid, but lymph fluid flows through the tissue in the finest lymph channels and transports metabolic waste products and defence cells. The importance of this less well-known fluid transport is usually only noticed in the case of illness – as in the case of lymphedema or elephantiasis.

Discomfort in the vessels

The arteries can become narrowed or completely blocked, or they can bleed. Narrowed vessels mean circulatory disorders (ischemia) with less oxygen and nutrients for the organs – pain, paleness and weakness are the consequences. This is how CHD develops in the heart, a stroke in the brain and arterial occlusive disease in the legs.

Typical vein problems are thick legs after standing for a long time or spider and varicose veins. Clots can form when the blood flow becomes too slow – this is how thrombosis occurs. Thromboses are also venous diseases that rarely occur in a calcified and narrowed artery.

In addition, deviations in blood pressure from the standard range lead to complaints:

• Low blood pressure can cause dizziness or circulatory collapse.
• High blood pressure can cause palpitations, sweating or even nosebleeds – and in the long term, it is a breeding ground for strokes, heart failure and kidney failure.

 

Diagnostics: what does the doctor do if there are vascular problems?

In the case of vascular problems, the doctor has various examination methods available to make the diagnosis:

• anamnesis
• inspection and auscultation
• blood pressure measurement
• Blood and urine tests
• Imaging procedures

Anamnesis: Inquiring about the medical history

All complaints can be narrowed down further by asking specific questions. Leg pain can occur after a short distance or only after a long walk. The onset and localization of the pain (whether in the lower leg or thigh) indicate the level at which the arteries are blocked. Therefore, every medical examination begins with an anamnesis.

Inspection and auscultation: viewing and listening

The visible sign of ischemia in the legs is pallor. Narrowed arteries in the neck sometimes make a whirring noise – and a bulge (aneurysm) in the abdominal aorta can be carefully felt.

 

blood pressure measurement

Measuring blood pressure is part of the standard of every examination. However, more than one measurement, for example, is required to diagnose high blood pressure. For some people, for example, the presence of a doctor is enough to raise blood pressure. One then speaks of “white coat high blood pressure”.

blood and urine tests

During these examinations, risk factors such as high blood sugar, high blood lipids or cholesterol levels are determined and checked after taking the medication. Protein in the urine indicates how badly the high blood pressure has damaged the kidneys.

Imaging procedures

Various imaging methods are available here:

• X-ray: Vessels can be seen well in the X-ray image if filled with a contrast medium. This examination is available for arteries (angiography) and veins (phlebography).
• Ultrasound: Modern ultrasound devices can precisely show blood flow in the vessels and deposits on the vessel walls, such as calcium or blood clots.
• Computed tomography and magnetic resonance imaging: These methods are used in the event of a stroke or an arterial bulge, for example, to determine the spread.

 

consequences of narrowing of the arteries

High blood pressure or an unhealthy change in the blood components with too much blood sugar, high blood fats and cholesterol or too little homocysteine ​​leads to hardening of the arteries in the long term – this is usually the reason for artery narrowing. But a blood clot can also block the bloodstream. Narrowed arteries lead to insufficient oxygen supply (ischemia) and, in the worst case, to the death (infarction) of organs. This is how ischemia of the legs shows up in claudication and ischemia of the heart (CHD) in an attack of angina pectoris.

A particular problem is stroke, which is caused by ischemia in the brain. Arterial occlusion is usually responsible for this, more rarely, a cerebral haemorrhage. A stroke can be announced by tingling or numbness in the arms or legs, followed by paralysis speech and vision difficulties.

Blood pressure that is too low is annoying – but over the long term, too high blood pressure leads to massive impairment of the vessels and has serious consequences such as heart failure, hypertonic retinopathy or chronic kidney failure. Diabetes mellitus is a significant risk factor for high blood pressure and arteriosclerosis. The high blood sugar already damages the vessels during the preliminary stages of insulin resistance.

In addition, the risk factor of obesity – when the fat is dangerously distributed – also plays a vital role in vascular damage. An aortic aneurysm usually occurs when the wall of the aorta is so damaged by calcification that it can bulge out.

diseases of the veins

Venous diseases range from cosmetically unsightly spider veins to leg ulcers – depending on how badly the veins and vein valves are damaged. If the drainage of the lymphatic system is disturbed – as a result of injury, radiation (e.g. as part of cancer treatment) or pressure on the lymphatic system (e.g. due to tight clothing or a tumour) – swelling of the affected part of the body occurs, known as lymphoedema.

Since vascular diseases often occur together with the “deadly quartet”, reducing obesity, drug treatment of a lipid metabolism disorder with a statin, and treatment of high blood pressure, diabetes, or insulin resistance are the first therapeutic measures.

treatment of vascular diseases

Common drugs include beta-blockers to normalize blood pressure and acetylsalicylic acid to reduce heart attack risk and “thin” the blood. When taking the tablet, the right time must be observed. Otherwise, the drug will need to be more effective.

Nowadays, clogged arteries in the neck, arms, and legs can often be dilated with a minimally invasive catheter – similar to what is usual in the heart with a cardiac catheter, and heart operations are now also minimally invasive. If blood flow cannot be restored, the body part dies – it must be amputated. This often causes phantom pains in the legs and arms.

After a stroke, optimal care in a stroke unit is critical to keep brain damage to a minimum. Ultrasound is a promising new treatment method. Venous diseases are treated with various types of surgery – sclerotherapy, laser therapy, and radio waves are just a few of many. Of course, there is a particular procedure for medication or surgery for every disease.

 

preventive measures

To prevent arteriosclerosis and high blood pressure, a healthy diet, a conscious approach to cholesterol, lots of exercise and stress reduction should be a matter of course from a young age. Mediterranean food with olive oil, onions, garlic, and red wine (correctly dosed) is recommended.

Lifestyle is vital when it comes to high blood pressure: stopping smoking and being sensitive to salt and foods such as liquorice should be a matter of course. It is also essential to have regular health checks and to see a doctor if you suspect heart disease.

Cardiovascular patients should take special care of themselves in the summer – and did you know that the flu vaccination lowers the risk of a heart attack? If you fly, consider the risk of thrombosis and help your body with exercise and plenty of fluids. Tired or diseased veins can be counteracted with fitness-compression stockings, and horse chestnut or vine leaf extracts can help.