Vascular Disease

Blood vessels are a network of channels that carry blood to and from every part of the body. Arteries carry oxygen-rich blood from the heart, starting with the aorta, the main artery leaving the heart. Veins carry blood back to the heart, helped by small valves that stop blood from flowing backward. Blood vessel disease, or vascular disease, is a general term for disorders of these channels. This page gives an overview, while each type is covered in more detail on its own page.

Disorders of the Arteries

A common cause is atherosclerosis, the buildup of plaque made of fat, cholesterol, and calcium in the artery walls, which is covered on the Atherosclerosis page. Plaque makes the arteries narrow and stiff. In the legs, this narrowing causes calf pain when walking, which is covered on the Peripheral Artery Disease page. In the neck, plaque in the carotid arteries can trigger a stroke. Arteries can also be suddenly blocked by a clot carried in the bloodstream, which is covered on the Arterial Embolism page, or become inflamed because of an immune disorder, which is covered on the Systemic Vasculitis page.

Disorders of the Aorta

A weakened wall of the aorta or another artery can slowly bulge like a balloon. This widening is called an aneurysm, which is covered on the Aneurysm page. The inner layer of the aortic wall can also tear suddenly, so blood flows between the layers of the wall. This emergency is called aortic dissection, which is covered on the Aortic Dissection page and listed as a type of disease on this page.

Disorders of the Veins

Leaky valves in the leg veins let blood pool, so the veins widen into varicose veins and the legs feel heavy or swollen. A blood clot in a deep vein of the leg can break loose and block a lung artery. These vein disorders are covered on the Venous Disease page.

One System, One Assessment

Arteries throughout the body share the same risk factors: smoking, high blood pressure, high cholesterol, and diabetes. For this reason, people with narrowed leg arteries often also have plaque in the arteries of the heart and brain. The 2024 ESC guidelines recommend assessing vascular disease as a whole, not only in the part that causes symptoms. Many vascular disorders cause no symptoms at first, so needle-free tests such as vascular ultrasound and measuring blood pressure at the ankles help find them earlier.

The examination begins with questions about your symptoms, smoking habits, and your history of blood pressure, cholesterol, diabetes, and vascular disease in your family. The doctor measures blood pressure in both arms, feels the pulses in the neck, abdomen, groin, and feet, and examines the skin, veins, and any sores on the legs.

The next step depends on the suspected area. The Ankle-Brachial Index (ABI) compares blood pressure at the ankle and arm to look for narrowing of the leg arteries. Radiation-free vascular ultrasound assesses narrowing of the neck and leg arteries, widening of the abdominal aorta, leaky vein valves, and clots in the deep veins. CT angiography or MR angiography maps the blood vessels in more detail, especially before a procedure or when an aortic problem is suspected. Blood tests assess cholesterol, blood sugar, and kidney function to plan prevention.

Make an appointment with a doctor if you have leg symptoms that do not go away, or if you have several risk factors and want your blood vessels checked. If you have sudden, very severe chest or back pain, a leg that suddenly turns cold and pale, sudden shortness of breath, or signs of stroke, call an ambulance (119) right away or go to the nearest emergency room.

• Leg pain when walking that eases with rest
• Swollen or heavy legs, or veins that look bulging
• A sore on the foot that does not improve within two weeks
• Skin on the feet that changes color or feels cold
• Test results showing a widened aorta or narrowing of a neck artery
• You smoke, have diabetes or hypertension, and are over 50