Angiology

The angiology (from the Greek ἀγγεῖον, 'vessel' and -λογία, 'study) is the medical specialty that is responsible for the study of vessels of the circulatory system (veins and arteries) and the lymphatic system; including the anatomy of blood vessels (such as arteries, veins, capillaries) and lymphatics, as well as their diseases.

In Spain, the medical-surgical specialty in Angiology and Vascular Surgery is recognized, which deals with the diagnosis and treatment of diseases of the blood vessels (arteries and veins), excluding the heart and veins. intracranial arteries.

Scope

Arterial diseases include the aorta (aneurysms/dissection) and the arteries that supply the legs, hands, kidneys, brain, and intestines. It also covers arterial thrombosis and embolism; vasculitis; and vasospastic disorders. Naturally, it deals with the prevention of cardiovascular diseases such as myocardial infarction and stroke. Venous diseases include venous thrombosis, chronic venous insufficiency, and varicose veins. Lymphatic diseases include primary and secondary forms of lymphedema. It also involves modifying risk factors for vascular disease such as high cholesterol, high blood pressure.

Cardiovascular risk factors such as high blood pressure, high cholesterol and others fall within the specialty of vascular medicine.

Disease patterns

The corresponding clinical pictures are divided into diseases of the irrigating or arterial part of the circulatory system, that is, the arteries and arterioles, as well as the capillaries as a link with the draining part of the circulatory system, the veins and the lymphatic vessels (or the lymphatic system).

Arterial diseases

About 90-95% of arterial diseases are caused by arteriosclerosis with the formation of narrowings (stenosis) or occlusions. Due to its frequency and relevance for those affected, it is especially worth mentioning:

• arterial occlusive disease of pelvic arteries and legs
• constriction of carotid artery (Arteria carotis communis)
• The narrowing of the renal artery and the internal arteries (higher mesenteric artery and lower mesenteric artery).

The arteries of the shoulder girdle and arms are rarely affected by atherosclerotic narrowings.

In addition to the formation of narrowings, arteriosclerosis can also cause dilation of the vessels due to the weakening of the structures of the vascular wall, which is called an aneurysm when it reaches a certain degree. Due to the danger of tearing the vascular wall (rupture) or of depositing clotted blood in the aneurysm and subsequent detachment (embolism), the most important are the dilations of the

• Ilious arteries
• chest and abdominal arteries (aorta)
• arteria poplítea

Compared to arteriosclerosis, rare causes of arterial vascular disease are:

• radiation sequelae
• embolia
• inflammatory vascular diseases (vasculitis)

A special form of inflammatory vascular disease is thromboangiitis obliterans, which usually develops into arteriosclerosis in the course of the disease, and

• Vascular injuries.

The "functional circulatory disorders" They are not the consequence of structural vascular lesions (i.e., stenosis or occlusion), but rather the result of defective control of the vascular system for various reasons. Typical clinical pictures are:

• acrocytosis
• eritromelalgia
• Raynaud syndrome

Raynaud's symptoms can also appear in systemic diseases in the sense of concomitant vasculitis, such as lupus erythematosus or scleroderma. The use of drugs containing ergotamine, which are used for some forms of migraine, can cause pronounced spasm of arterial vessels, especially in case of overdose, which can lead to irreversible damage.

Diabetic foot syndrome is only partly the result of impaired blood circulation. It is mainly caused by nerve injuries and damage to the skeleton of the foot. Mal perforans refers to a special shape on the sole of the foot under the metatarsophalangeal joints.

Vein diseases

Common venous diseases that are significant not only to the individual but also to the national economy are:

• Primary variations (varicosis), which are inherited by approximately 70%.
• Chronic venous insufficiency due to congenital weakness of the deep venous system.
• Venous thrombosis (trombosis) with the result of:
  • venous damage acquired permanently, i.e. postrombotic syndrome.
  • chronic ulcer of the lower leg ulcus cruris.

As a consequence of varicose veins or also as an external sign of another underlying disease, inflammation and clot formation can occur in the superficial veins of the skin, which is called thrombophlebitis.

Diseases of the lymphatic vessels

Basically, we must distinguish between primary and secondary lymphedema. Primary lymphedema is the result of an inherited weakness or non-formation (atresia) of the lymphatic channels and usually manifests in the third or fourth decade of life, while secondary lymphedema is the result of another disease that also damages the lymphatic drainage. Lymphedema that is no longer reversible and is massive is called elephantiasis. Lymphangitis and erysipelas are relatively common inflammatory diseases of the lymphatic vessels.

Vascular malformations

Angiodysplasias are vascular malformations of arteries, veins or lymphatic vessels that can occur in enormous complexity and variety.

Type of exams

The physical examination per se focuses on the history and clinical picture in the inspection of veins, lymphatic vessels and tissue perfusion and palpation of pulses in the affected regions.

For most circulatory disorders and venous diseases, an ultrasound examination of the arteries or veins, possibly including Doppler and color Doppler, already allows reliable diagnosis and planning of therapy. In cases of doubt and before planned operations, further diagnostic imaging is sometimes helpful. Depending on the needs, X-ray examinations with contrast media (angiography, venography or computed tomography) and magnetic resonance tomography ("angio MRT") can be used.

Plethysmography, capillary microscopy, and light reflection rheography are used for special angiologic questions.