Better Health, Better Living

A doctor will usually base a diagnosis on your medical history and your symptoms. In some cases, a doctor may refer you to a specialist for further assessment and help in managing your condition. Doctors may also request additional tests, such as Doppler ultrasound imaging tests or angiography, when dye is injected to make the arteries visible on x-rays. Other tests may include scans of the brain (CT or MRI scans) and angiograms for a better understanding of blood flow in your limbs.

If you think you have any of the symptoms listed in this Web site, or if you feel you are at risk for vascular disease, see your physician. He or she can assess your risk and decide whether further medication, tests or referral to a specialist is necessary. In many cases early treatment can prevent symptoms from progressing further.

A stroke occurs when blood flow to the brain is interrupted by a blood clot or when a blood vessel bursts. Usually, this occurs when a blood vessel in or around the brain gets blocked or ruptures. Brain cells in the immediate area die from a lack of oxygen. The resultant symptoms are often weakness or numbness on one side of the body, trouble walking or talking, or changes in vision. An ischemic stroke occurs when a blood vessel gets plugged (about 85 percent of all strokes). A hemorrhagic stroke occurs when a blood vessel ruptures (about 15 percent of all strokes).

The narrowing or blockage of the carotid artery due to plaque build-up, or “carotid artery disease” is usually the cause. This narrowing process (“atherosclerosis”) is basically the same one that causes both coronary artery disease and peripheral arterial disease (PAD) in the legs. This slow build-up of plaque (deposits of cholesterol, calcium and other cells in the artery wall) is usually the result of high blood pressure, diabetes, tobacco use, high blood cholesterol and other modifiable risk factors. Eventually, the narrowing may become so severe that a blockage decreases blood flow to the brain, causing a stroke.

The symptoms of a TIA are identical to those of a stroke, but they typically last only a few minutes or hours. TIAs are often called “mini strokes.” However, do not ignore a TIA, because it may indicate that a more serious stroke could occur in the next few days or weeks.

Aneurysms occur most often in the aorta, the main artery of the chest and abdomen. Abdominal aortic aneurysms (AAA) are caused by progressive weakening of the aortic wall, which creates a “ballooning” of the vessel. The aneurysm will grow larger and eventually rupture if it is not diagnosed and treated. The aorta carries blood flow from the heart to all parts of the body including the vital organs, legs and feet.

Peripheral Arterial Disease (PAD) is also known as atherosclerosis, poor circulation or “hardening of the arteries.” It usually occurs in the legs. For many, the outward indications of PAD will not appear until an artery has narrowed by 60 percent or more, usually later in life. The body may adapt to the narrowed arteries by developing smaller peripheral arteries that allow blood flow around the narrowed area. When a piece of cholesterol, calcium or blood clot abruptly breaks from the lining of the artery or a narrowed artery blocks off completely, blood flow stops and the organ supplied by that artery will suffer damage.

In simplest terms, arteries pump oxygen-rich blood FROM the heart; veins return oxygen-depleted blood TO the heart.

“Deep” leg veins return blood directly to the heart and are in the center of the leg, near the bones. “Superficial” leg veins are just beneath the skin. They have less support from surrounding muscles and bones than the deep veins and may thus develop an area of weakness in the wall. When ballooning of the vein occurs, the vein becomes varicose. “Perforator” veins serve as connections between the superficial system and the deep system of leg veins.

Varicose veins – which afflict 10 percent to 20 percent of all adults but serve no useful purpose in the body – are swollen, twisted, blue veins that are close to the surface of the skin. Because valves in them are damaged, they hold more blood at higher pressure than normal. That forces fluid into the surrounding tissue, making the affected leg swell and feel heavy.

Unsightly and uncomfortable, varicose leg veins can promote swelling in the ankles and feet and itching of the skin. They may occur in almost any part of the body, but are most often seen in the back of the calf or on the inside of the leg between the groin and the ankle. Left untreated, patient symptoms are likely to worsen, with some possibly leading to venous ulceration.

Varicose veins may ache, and feet and ankles may swell towards day’s end, especially in hot weather. Varicose veins can become sore and inflamed, causing redness of the skin around them. In some cases, patients may develop venous ulcerations.

Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases such as thrombophlebitis (inflammation of a vein as a blood clot forms). Women suffer from varicose veins more than men, and the incidence increases to 50 percent of people over age 50.

”ESES” (pronounced SS) is an easy way to remember the conservative approach. It stands for “Exercise, Stockings, Elevation and Still.” Exercising, wearing compression hose, elevating and resting the legs will not make the veins go away, or necessarily prevent them from worsening because the underlying disease (venous reflux) has not been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful. If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly.