The Medical Minute: What is vascular disease?

By Robert G. Atnip

In simplest terms, "vascular" is a word that refers to blood vessels, those little tubes called arteries and veins that carry blood throughout the body. Health professionals often describe blood vessels based on their location, such as cardiovascular (heart), cerebrovascular (brain), and peripheral vascular (all the other vessels in the body). The most common diseases of veins are varicose veins and venous thrombosis (clots), which range in severity. But when we talk of vascular disease, we are usually talking about diseases of arteries. The most common arterial disease is atherosclerosis, often called "hardening of the arteries" because of the stiffening and clogging it causes in arteries, leading to loss of circulation in the heart, brain, limbs and other organs.

What causes vascular disease?

Medical science has not found the exact cause of atherosclerosis, but has definitely identified several conditions that seem to set the stage for vascular disease to develop. These risk factors include diabetes, high blood pressure, high cholesterol, and smoking. In addition, a family history of vascular disease seems to play an important role.

Peripheral arterial disease (PAD) and aneurysm

The symptoms and signs of heart disease are well known, but many people are not as familiar with peripheral arterial disease, often called PAD. Though PAD can affect any peripheral artery, it is most likely to be found in the neck (carotid artery) and the arteries supplying blood to the lower body (aorto-iliac and femoral arteries). Carotid artery disease can lead to stroke, and lower limb PAD can deprive the legs of circulation, making it painful to walk or even leading to painful ulcers or gangrene.

In addition to clogging of the arteries and loss of circulation, PAD also includes the disease known as aneurysm, in which the blood vessel wall becomes weak and begins to bulge under pressure. An enlarging aneurysm poses a very real danger of either massive clotting or bleeding.

Do I have PAD?

If you think you have circulation problems, your doctor can detect them with a good physical exam and some simple, non-invasive diagnostic tests. The most common test for circulation in the legs can be done in a doctor's office, and involves the Doppler, a small microphone that detects blood flow. By comparing blood pressure in the legs to your normal arm blood pressure, a nurse or doctor can calculate a number called the ankle brachial index (ABI), which is a very accurate indicator of the presence of PAD. If the ABI is abnormal, more sophisticated Doppler ultrasound tests can be done to study the problem thoroughly.

Where can I be tested for PAD?

Not every doctor’s office has the equipment to do ABI testing, but beginning this month, Penn State Hershey Heart and Vascular Institute will begin offering the screening at its clinic on Nyes Road in Lower Paxton Township. At your doctor’s request, all varieties of Doppler testing, including the ABI test, are also available in Penn State Hershey Medical Center’s vascular laboratory. A satellite vascular lab is expected to open at the Nyes Road clinic in the near future.

Tell your doctor if you think you might have PAD. Testing and treatment are available through Penn State Hershey Heart and Vascular Institute. The sooner you know, the better you’ll feel.

Robert G. Atnip is professor of surgery and radiology, Penn State Hershey College of Medicine and interim director, vascular services Penn State Hershey Heart and Vascular Institute.