Vascular Medicine Patient Information Pages Archive
Patient Information from the pages of Vascular Medicine, the official journal of the Society for Vascular Medicine. Scroll or click to learn more about each topic.
Lipedema is a painful swollen leg condition that almost exclusively affects women. It involves both legs equally, sparing the feet. Edema, or swelling, is commonly due to fluid retention. Lipedema is different.
Substances in the blood, called phospholipids, are required for blood to clot. In some people, the body mistakenly identifies phospholipids, or proteins bound to the phospholipids, as foreign substances, and makes antibodies against them. This process can be viewed as a confusion of the immune system, called an autoimmune process. These antibodies are called antiphospholipid antibodies (APLAs; sometimes also abbreviated to ‘aPL’).
Statins, or HMG-CoA reductase inhibitors, are medications that block a step in the production of cholesterol in the liver, which results in the liver putting more receptors out on its surface to remove low-density lipoprotein cholesterol (LDL-C) or ‘bad’ cholesterol.
Heparin-induced thrombocytopenia, or HIT, occurs in some patients who have been taking the anticoagulant (blood thinner) heparin. Less commonly, drugs related to heparin called low-molecular-weight heparins (LMWHs) can cause HIT. Heparin and LMWH are used to treat clotting disorders, to prevent blood clots in certain heart conditions, and to prevent blood clots in patients who have undergone surgery or are hospitalized.
Fibromuscular dysplasia (FMD) is an uncommon vascular disease that affects the arteries of the body and is more commonly seen in women. Though FMD was first described in 1938, only in the past decade have there been major advances in the understanding of this condition. In 2017, FMD remains poorly understood by many medical professionals, and arriving at the right diagnosis can be difficult, even for patients who have symptoms of this disease.
Pregnancy, contraception and venous thromboembolism
(deep vein thrombosis and pulmonary embolism)
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Venous thromboembolism (VTE) is a term used to describe blood clots that develop in the veins, such as a deep vein thrombosis (DVT) of the deep leg veins, or a blood clot that has traveled to the lungs called a pulmonary embolism (PE).1 Pregnancy increases the chance of developing VTE by about four- to fivefold.2 The chances are even higher immediately after childbirth. In the first 6 weeks after childbirth, the chance of developing VTE is 20- to 80-fold higher than for a woman who is not pregnant and has not recently given birth.3 This tendency to form blood clots has likely evolved to protect women from hemorrhage (heavy bleeding) at the time of miscarriage or childbirth. Nonetheless, the chance that a young, healthy woman will develop VTE during pregnancy is still low: about one to two per thousand.4 For women who have had VTE in the past, however, pregnancy usually requires some form of blood-thinning medication (anticoagulant) to prevent blood clots from forming.
Patients with suspected vascular disease may undergo further evaluation of the blood vessels using one of several advanced vascular imaging techniques. Two types of imaging—computed tomography angiography (CTA) and magnetic resonance angiography (MRA)—are non-invasive tests that can provide detailed anatomical pictures of the arteries. Occasionally, some patients are asked to undergo a minimally invasive imaging test called catheter-based angiography, which directly examines the structure of the blood vessels. Depending on the clinical scenario, arterial blockages can be opened or repaired at the time of this procedure.
All three types of these vascular imaging studies help evaluate for arterial diseases such as narrowings (blockages) of the arteries due to plaque (atherosclerosis). Blockages in the leg arteries, peripheral artery disease (PAD), can lead to pain in the extremities, especially with exertion. Narrowing of the abdominal arteries, such as renal and mesenteric arteries, can occur for a variety of reasons and cause abdominal pain, high blood pressure, or kidney disease. Carotid artery plaque and narrowing can limit blood flow to the brain, causing strokes, mini-strokes, or transient blindness. Imaging studies can help evaluate for other vascular diseases, including dilatation of vessels (aneurysms), tearing of the vessels (dissection), blood clots (thrombosis), and abnormal connections between blood vessels (arteriovenous fistulas). Your doctor can help you identify which test is appropriate for evaluation of your symptoms.
Leg swelling, known as edema, is a common problem, representing more than half of new referrals to a large vascular medicine practice. Edema occurs when fluid builds up in the tissues, and it may happen suddenly or develop slowly and last for months or years. Most frequently edema is a result of harmless conditions, but occasionally it is caused by more serious underlying health problems.
When thinking about the causes of leg edema, it is helpful to divide them into causes involving both legs versus involving just one leg, as some conditions may cause swelling in one or both legs. Often, the most important clues to the cause of leg edema are in the patient’s reported history and in the physical examination, and a doctor may not need blood work or any other tests to make a diagnosis.
What does smoking have to do with vascular disease?
Smoking and vascular disease go hand in hand. Smoking is more closely associated with the risk of peripheral artery disease (PAD; or blockages in the leg arteries) than it is with heart disease.2 In fact, most people with PAD are either current or former smokers. Smokers with PAD develop leg pain with walking (‘claudication’) more quickly than non-smokers, and the leg pain takes longer to subside. Smoking is the most important risk factor linked to worsening of PAD, and amputation rates are much higher in smokers than non-smokers.3
The vascular laboratory specializes in several tests that look for diseases that may affect blood flow in the arteries – the blood vessels that take blood to the tissues, and veins – the blood vessels that bring blood back to the heart. Commonly performed procedures include the ankle–brachial index (ABI), pulse volume recordings (PVRs), and segmental blood pressure analyses. These tests use inflatable blood pressure cuffs to assess arterial blood flow in the legs and arms. Another commonly used test in the vascular laboratory is Doppler ultrasound, which evaluates blood vessels and their surrounding structures using high-frequency, inaudible sound waves. Vascular ultrasound is safe and non-invasive, and it does not require the use of radiation or intravenous contrast dye.
What is aortic dissection?
The aorta is the main blood vessel that arises from the heart and supplies blood flow to the rest of the body. The aorta is divided into sections. The ascending aorta starts at the heart and travels up the chest toward the head. Its main branches are the coronary arteries, which supply blood flow directly to the heart. The aortic arch (Figure 1A) curves over the heart and gives off branches that supply blood flow to the brain and arms. The descending aorta courses through the chest, and after passing the lungs and diaphragm becomes the abdominal aorta. Branches from the abdominal aorta provide the blood supply to the major organs (liver, kidney, stomach and intestines) as well as to the legs
What is an ulcer?
An ulcer is a breakdown in the skin that may extend to the underlying fat, muscle, or even bone. There are many causes of foot and leg ulcers. The most common are venous insufficiency (called venous ulcers), peripheral artery disease (called arterial ulcers), and nerve damage (called neurotrophic ulcers).
What exactly is lymphedema?
Lymphedema is a condition that arises when some or all of the lymphatic vascular system does not function properly. There are many causes of lymphedema, but they all involve an inability of this circulatory system to move fluid efficiently. Because lymphedema alters the appearance and function of the affected parts of the body, it can very frequently alter the person’s sense of well-being or the ability to undertake normal activities. There is no cure for lymphedema at present but, fortunately, effective treatment options are available.
What are DOACs?
The term DOAC (pronounced ‘DOH-ack’) stands for ‘Direct Oral AntiCoagulant’ and refers to a group of new anticoagulant medications. An anticoagulant is a medication that either treats or prevents blood clots, often called a ‘blood thinner’. For over 50 years, warfarin was the only anticoagulant available in pill form, but now the DOACs offer more choices for patients who need to take an anticoagulant medication. The four DOACs currently available in the United States are dabigatran, rivaroxaban, apixaban, and edoxaban (Table 1). DOACs are direct because they block a single blood clotting factor to treat or prevent blood clots. They are oral because they come in pill form and are taken by mouth.
What is thoracic outlet syndrome?
Thoracic outlet syndrome (TOS) is an uncommon condition that can happen when the nerves, artery, or vein to the arm is compressed by one or more structures that make up the thoracic outlet (Figure 1).
Typically, TOS involves the first rib and anterior scalene muscle but can also be caused by a ‘cervical rib’. A cervical rib is an extra rib that connects to the cervical spine at the base of the neck. This extra rib may fuse with the first rib, which can then cause compression, particularly on the nerves and subclavian artery. The subclavius muscle, which attaches to the front of the first rib, can also compress the subclavian vein.
What is an IVC filter?
An inferior vena cava filter, or IVC filter, is a small medical device that is used to prevent blood clots from traveling from the legs to the circulation of the lungs.
The veins are the tubes that return blood from the body tissues to the heart and lungs. A blood clot that forms in the deep veins of the legs is called deep vein thrombosis (DVT). These blood clots may break off and travel through the large vein of the abdomen called the inferior vena cava (IVC) to the heart and the circulation of the lungs. This condition, called pulmonary embolism (PE), may cause shortness of breath, chest pain, and a racing heartbeat, and if severe can lead to loss of consciousness, heart failure, and even death.
What is Raynaud’s phenomenon?
Also called Raynaud’s disease or syndrome, Raynaud’s phenomenon is a blood vessel condition in which a person’s fingers or toes change colors. Raynaud’s phenomenon is named after the French physician (Dr Maurice Raynaud) who first described this condition. In Raynaud’s phenomenon, the fingers or toes may first turn white and/or bluish, particularly in cold temperatures. With rewarming, the fingers or toes may then turn red. The condition is often referred to as ‘primary’ or ‘secondary’ Raynaud’s. With primary Raynaud’s, there is no associated cause or explanation for the condition. Secondary Raynaud’s is due to other medical problems or other causes of spasm in the blood vessels.
What is thrombophilia?
Thrombophilia is an inherited (genetic) or acquired tendency to form blood clots, commonly in the veins, and, in some cases, in the arteries. Blood clots in veins usually occur in the legs (a condition referred to as deep vein thrombosis or DVT) or the lungs (pulmonary embolism or PE). Blood clots in arteries can cause heart attacks, strokes, or blocked blood flow to an arm or leg. A variety of thrombophilias, also referred to as clotting disorders or hypercoagulable states, exist.
What are varicose veins?
Veins are the blood vessels that return blood to the heart from the body. The leg veins must overcome gravity to perform their job, and are aided by the muscles of the calf, which squeeze the veins, pushing blood toward the heart. A series of valves, or one-way flaps of tissue, prevent blood from flowing backward. In some people, stretching of the veins near the surface of the skin (superficial veins) and failure of the valves to close properly allows blood to flow in both directions. This backward flow of blood is called venous reflux. Reflux can lead to twisted, bulging veins, which are known as varicose veins, or varicosities (Figure 1). The two main superficial leg veins are the great saphenous vein, which runs from the inner ankle to the inner thigh, and the small saphenous vein, which runs along the outer ankle to the back of the calf. These veins may form varicose veins, or they may feed branch veins that form varicose veins.
What is carotid artery disease?
Carotid artery disease is narrowing of the large arteries of the neck (carotid arteries), which are the main blood vessels that supply oxygen-rich blood to the brain. The narrowing is usually caused by atherosclerotic plaque. Atherosclerosis, or hardening of the arteries, can affect arteries throughout the body. When the neck arteries are narrowed or blocked, the condition is called carotid artery disease or carotid artery stenosis.
An aneurysm is a condition that involves weakening in the walls of a blood vessel, causing it to enlarge or dilate. Aneurysms can form in any blood vessel in the body, but are most commonly seen in the main artery known as the aorta, at the level below the kidney arteries (Figure 1A). This is known as an abdominal aortic aneurysm (AAA). The greatest risk associated with an aneurysm is rupture, causing internal bleeding. This happens because the aortic wall continues to dilate and weaken against the flow of blood through the vessel. The rupture of an aneurysm is a life-threatening situation with a high chance of death
What is the post-thrombotic syndrome?
The post-thrombotic syndrome is a condition that sometimes occurs after deep vein thrombosis (DVT) of the leg, or, less commonly, of the arm. Veins are the blood vessels that return blood from the arms, legs, and organs to the heart. In DVT, blood clots form in the veins, often leading to pain, swelling, and redness of the affected limb. These symptoms usually subside, but some patients may go on to develop chronic pain, swelling, and skin changes in the affected leg; this is known as the post-thrombotic syndrome, or PTS. In PTS, symptoms may come and go, and in some patients symptoms may be made worse by prolonged sitting, standing, and sometimes by walking.
What is peripheral artery disease?
Peripheral artery disease (PAD) is narrowing of the arteries, which are the blood vessels that carry oxygen-rich blood away from the heart to the body. The narrowing is usually caused by atherosclerotic plaque. Atherosclerosis, or hardening of the arteries, affects arteries throughout the body. The symptoms depend on which part of the body is involved. When the leg arteries are blocked, the condition is called PAD.
Venous Thromboembolism (deep vein thrombosis and pulmonary embolism) (Full text)
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What is venous thromboembolism?
There are three types of blood vessels: arteries, veins, and lymphatics. Veins are the blood vessels that return blood from the arms, legs, and organs to the heart. Deep vein thrombosis (often called ‘DVT’) and pulmonary embolism (often called ‘PE’) are the most common types of venous thromboembolism. A thrombus is a blood clot and an embolism is a clot that has traveled through the bloodstream and has become stuck in another blood vessel. DVT occurs when blood clots form in the veins. Blood may form clots when blood flow is sluggish, when the walls of the veins are injured or damaged, or when the blood itself is more prone to clot due to inherited or other factors (known as ‘hypercoagulable states’).