Vascular disease

Vascular disease is a form of cardiovascular disease primarily affecting the blood vessels.

Some conditions, such as myocardial ischemia, can be considered both vascular diseases and heart diseases.

Cigarette smoking is the major risk factor.

Background
Vascular disease is a pathological state of large and medium sized muscular arteries and is triggered by endothelial cell dysfunction. Because of factors like pathogens, oxidized LDL particles and other inflammatory stimuli endothelial cells become activated. This leads to change in their characteristics: endothelial cells start to excrete cytokines and chemokines and express adhesion molecules on their surface. This in turn results in recruitment of white blood cells (monocytes and lymphocytes), which can infiltrate the blood vessel wall. Stimulation of smooth muscle cell layer with cytokines produced by endothelial cells and recruited white blood cells causes smooth muscle cells to proliferate and migrate towards the blood vessel lumen. The process causes thickening of the vessel wall, forming a plaque consisting of proliferating smooth muscle cells, macrophages and various types of lymphocytes. This plaque result in obstructed blood flow leading to diminished amounts of oxygen and nutrients, that reach the target organ. In the final stages, the plaque may also rupture causing the formation of clots, and as a result strokes.

Diagnosis
It can be very difficult to make a vascular disease diagnosis as there are a wide variety of symptoms that a person can carry. Vascular diagnosis is primarily made upon the symptoms, family history and after a physical examination performed by a specialist.

The physical exam may be slightly different depending on the type of vascular disease that is suspected. In the case of a peripheral vascular disease the physical exam consists in checking the blood flow in the legs or flow or the blood pressure. During the physical examination of a cerebrovascular disease the doctor listens with the help of a stethoscope to detect abnormal sounds of blood flow (called bruit) on the neck.

Tests and exams
In order to confirm a cerebrovascular disease, few additional tests may be required whenever there are doubts in what the diagnosis concerns. These may include tests such as the cerebral angiography (carotid angiogram). This test is made by inserting a catheter into the patient's artery in the leg with the help of a needle through the vessels in the abdomen and chest, until it reaches the arteries of the neck. The coronary angiogram is basically the same procedure which is however utilized for detecting cardiovascular conditions.

The carotid duplex (carotid ultrasound) is another type of noninvasive test which uses ultrasound waves in order to detect plaque, blood clots or any other type of blood flow abnormalities in the carotid arteries. The specialists may detect hemorrhagic strokes with the help of a X-ray computed tomography. They are easily visualized due to the differences in density between the blood, bone and brain tissue. The CT scans are also useful in finding out abnormalities in the heart and in diagnosing cardiovascular conditions.

The Doppler ultrasound is a test used to diagnose both cerebrovascular disease and peripheral vascular disease. It utilizes high frequency sound waves that are being directed to the vein or artery which presents abnormalities and are then detected on the Doppler.

Electroencephalography may be required in order to detect electrical impulses in the brain by placing small metal discs called electrodes on the scalp of the patient.

The magnetic resonance imaging technique is able to obtain 3D images of the body structure. The images are very clear and they are produced by using magnetic fields and recent computer technology. Due to the clarity of the pictures, the MRI can detect any signs of prior strokes. The MRI may also be performed on the heart if a cardiovascular disease is suspected. A lumbar puncture may also be performed but this is an invasive test which consists in taking a sample of cerebrospinal fluid from the space surrounding the spinal cord. The purpose of this test is finding traces of blood which may be due to cerebral hemorrhage.

Upon suspicion of peripheral vascular disease, the first-line study is the ankle brachial pressure index (ABPI/ABI) which is a measure of the fall in blood pressure in the arteries supplying the legs. A ABPI value that exceeds 0.9 is the confirmation that a peripheral vascular disease is not present. If the value of the ABPI is lower than 0.8, the peripheral vascular disease exists but it is normally a mild case. On the other hand, a value below 0.5 is the proof of a serious vascular condition.