Angiology | Specialists and Information

Vascular diseases are broadly classified into diseases of the supply (arterial) system and the drainage (venous and lymphatic) system.

Arterial vascular diseases are mostly occlusive diseases resulting from advanced atherosclerosis. Deposits on the vessel walls and inflammatory processes lead to a narrowing (stenosis) or complete blockage of an important artery. This prevents or completely interrupts the oxygen supply to the downstream organ or tissue. This insufficient supply or an occlusion in the arterial system is associated with severe pain and is always a medical emergency, as the tissue is at risk of necrosis.

Vascular diseases of the veins, on the other hand, often involve varicose veins or thrombosis (blood clot formation). They can lead to impaired blood flow, particularly in the legs, but can also trigger a heart attack, pulmonary embolism, or stroke if a thrombus breaks loose.

Varicose veins are very common and become increasingly frequent with age @ Elena /AdobeStock

Examples of vascular diseases treated at a clinic for angiology include:

• Intermittent claudication, also known as peripheral arterial disease (PAD), causes leg pain due to reduced blood flow in the arteries of the pelvis and legs.
• Carotid stenosis is a narrowing of the carotid artery (arteria carotis).
• Circulatory disorders of the blood vessels, such as narrowing of the arteries supplying the heart, can trigger serious conditions like coronary heart disease or even a heart attack.
• In varicose veins (varicosis), the superficial venous system is weakened, and the valves in the veins no longer function properly, leading to blood pooling in the veins and the characteristic dilation of the vessels.
• Venous thrombosis—the blockage of veins by a blood clot—can, if left untreated, lead to an open leg (ulcus cruris), post-thrombotic syndrome, or a pulmonary embolism.
• In diabetic foot (diabetic foot syndrome), wounds in patients with diabetes mellitus no longer heal spontaneously due to circulatory disorders; this leads to nerve damage and ulcers, and in extreme cases, amputation of the foot may be necessary.
• In lymphedema, fluids can no longer be adequately drained through the lymphatic vessels, leading to fluid accumulation in the affected area of the body.
• Aneurysms are dilations of blood vessels that can rupture, leading to life-threatening bleeding (e.g., aortic aneurysm).
• In embolisms, blood vessels are partially or completely blocked by material carried in the bloodstream (blood clots, air bubbles, fat droplets).
• Vascular Malformations

Peripheral arterial disease (PAD)

Vascular diseases involving circulatory disorders and arterial occlusions frequently occur, particularly in the legs. These conditions are strongly influenced by lifestyle and the associated atherosclerosis.

This leads to a slowly progressive buildup of deposits and narrowing of the vessels, eventually resulting in complete occlusion. Pain and rapid fatigue in the legs can be an early sign of an impending occlusion.

An arterial occlusion then manifests as sudden, stabbing pain. The pulse beyond the site of the occlusion is no longer palpable. Since the section of the vessel beyond the occlusion is no longer receiving blood flow, the affected part of the leg is at risk of necrosis. If left untreated, a leg amputation may become necessary.

Peripheral arterial occlusion is therefore a medical emergency and requires immediate medical attention.

Acute occlusion of a limb artery

While peripheral arterial disease progresses slowly, acute occlusion causes the artery to become blocked very suddenly, e.g., by a blood clot.

Acute vascular occlusion in the leg is always a medical emergency and must be treated immediately by a doctor. Irreparable damage to the muscles and tissues of the leg can occur as early as 6 to 8 hours after the onset. In such cases, a leg amputation is often the only option left for the patient.

Aneurysms: Sac-like Vascular Conditions

Aneurysms are primarily bulges in the vessel wall. They can take many forms, but berry-shaped, sac-shaped, sinuous, and vine-like aneurysms are common.

Since the vessel wall can become cracked over time, much like an overinflated balloon, an aneurysm is often at risk of rupturing. Such a vascular rupture in one of the major arteries (e.g., the abdominal aorta) causes massive blood loss, which can become life-threatening within minutes.

In such cases, surgery to repair the vascular damage is urgently needed. Interestingly, men are about 10 times more likely to be affected by this vascular condition than women.

Cerebral Aneurysms

A special type of aneurysm involves dilations of the major cerebral arteries. Such cerebral aneurysms are not uncommon, but they are usually discovered by chance. Many people live their entire lives with this condition, but some die if the aneurysm ruptures as a result of trauma or increased pressure.

This vascular disease poses an increased risk of death.

Vasculitides: Inflammatory Vascular Diseases

Rheumatic and other inflammatory vascular diseases originate from inflammation of the blood vessels. These vascular diseases are also known as vasculitides.

One specific form is giant cell arteritis, which very often affects older adults. Even minor inflammatory processes damage the vessel walls and lead to turbulence in the blood flow as well as uneven surfaces.

These turbulence patterns eventually lead to the formation of blood clots, while the uneven surfaces promote plaque buildup and atherosclerosis. Inflammatory vascular diseases are therefore always a risk factor for occlusions, embolisms, and infarcts.

Thrombangiitis obliterans (TAO): A Vascular Disease Common Among Smokers

Thrombangiitis obliterans is an inflammatory vascular disease that leads to vascular occlusion. It is known to occur almost exclusively in smokers.

In addition to the arteries in the legs and arms, superficial and deep veins are also frequently affected. Vascular occlusions lead to further tissue damage, ultimately necessitating the amputation of toes and fingers. Since this vascular disease is not accompanied by an inflammatory response, treatments aimed at addressing the underlying cause are ineffective.

Atherosclerosis: A Vascular Disease Affecting the General Population

Atherosclerosis refers to the gradual blockage of blood vessels due to lifestyle-related deposits and inflammatory reactions.

Due to a lack of exercise and an unhealthy lifestyle, the first deposits in the blood vessels can already be detected in childhood today. Over the course of a person’s life, these deposits thicken and eventually completely block the blood vessel.

Atherosclerosis is a vascular disease that affects the entire body, not just individual blood vessels or organs. Atherosclerosis becomes critical whenever the blood supply to the heart, brain, or arms and legs is compromised.

Diabetes and the Heart: Vascular Damage Caused by Sugar

Diabetes itself is not fatal. However, elevated blood sugar levels promote vascular disease and damage the vessel walls. Sugar causes damage to nerves and blood vessels, leading to inflammation and poor wound healing.

Inflammation leads to turbulence in the bloodstream and microscopic damage to blood vessels. This can result in plaque buildup, which may progress to arterial blockage or even blood clot formation.

It is not uncommon for poorly controlled diabetics to die as a result of a heart attack or stroke.

Varicose Veins

Deposits or inflammation in the veins interfere with the function of the venous valves, which can no longer close properly. Blood backs up and flows back and forth within the veins.

To relieve the excess pressure in the venous system, the vessels expand further, causing smaller veins in particular to become visible through the skin. These twisted and meandering structures are then referred to as varicose veins.

However, varicose veins are neither caused by a cramp nor do they trigger one. Rather, their name is derived from the medieval term “krumpe Adern” (crooked veins). If left untreated, varicose veins continue to progress and can contribute to serious conditions, such as embolisms.

Esophageal varices are a particularly dangerous form of varicose veins. They develop along the esophagus when blood flow through the liver is impaired. This is very common among alcoholics. Their liver is severely damaged and is increasingly being converted into non-functional connective tissue. Doctors refer to this as liver cirrhosis.

However, since the liver serves to “filter” the blood, blood continues to back up in the body. Eventually, shunts develop that bypass the liver. As a result, venous plexuses distant from the liver become overstretched and bulge out. In the area of the esophagus, this leads to life-threatening esophageal varices. If they rupture, death usually occurs very quickly due to internal bleeding.

Hemorrhoids: Vascular Disease of the Rectum

The anus is surrounded by cushions of tissue that, among other things, ensure a tight seal. Weak connective tissue, hard stools, or regular straining can cause blood to pool in these cushions. As a result, the venous plexuses bulge and form sacs that can protrude outward or into the interior of the intestine. Doctors refer to such varicose veins in the rectal area as hemorrhoids.

Although there appears to be a genetic predisposition, anyone can reduce their own risk of developing hemorrhoids. Exercise, a high-fiber diet, and avoiding excessive straining during bowel movements can protect these cushions and prevent varicose veins.

Thrombophlebitis – Superficial Vein Inflammation

In some cases, varicose veins can also become inflamed. This affects the superficial, protruding venous networks. Doctors refer to this vascular condition as thrombophlebitis.

Women are up to four times more likely than men to suffer from this vascular disease.

Phlebothrombosis – Deep Vein Thrombosis

Overall, venous disorders are among the most common vascular diseases. The condition becomes particularly dangerous when the deep veins are affected and a venous thrombosis (phlebothrombosis) develops due to inflammation, turbulence, and deposits in the vessels.

Blood clots then obstruct the return of blood to the heart or may even completely block the vein. These clots (thrombi) can sometimes break off easily and travel to the heart, lungs, or brain, where they block a blood vessel. The area downstream of the clot is no longer supplied with blood and dies.

Depending on the organ affected, this can result in a life-threatening heart attack, stroke, or the dreaded pulmonary embolism.

Phlebothrombosis is almost exclusively limited to the veins of the legs and pelvis and often goes undiagnosed there for many years before complications arise. Due to the risk of clot detachment, it is considered one of the most dangerous vascular diseases.

Vascular Disease Associated with Chronic Venous Insufficiency

A wide variety of venous disorders can damage the veins. As a result, the veins often lose their ability to return blood to the heart. If the venous valves are also affected, a chronic outflow disorder develops as a vascular disease.

This is very common in the legs, leading to the development of edema over time. The constantly elevated venous pressure and insufficient blood flow ultimately result in tissue damage and, in some cases, tissue necrosis.

Skin damage becomes visible and can progress to the point of causing an open leg. Prolonged inflammation and ulcers are the result.

As in most medical fields, there are various options in angiology for treating vascular diseases:

• Medication for vascular diseases: In addition to medication for underlying conditions (high blood pressure, high blood lipid levels, diabetes), medications that promote blood flow, dilate blood vessels, or inhibit blood clotting (“blood thinners”) play a particularly important role in the treatment of vascular diseases.
• Conservative treatment of vascular diseases: This includes physical measures such as manual lymphatic drainage, exercise therapy, and compression therapy. In compression therapy, external pressure is applied to the vessels using bandages and stockings, preventing the formation of lymphedema or reducing existing swelling.
• Invasive procedures for vascular diseases: If vascular diseases cannot be treated either conservatively or with medication, various vascular surgical procedures are available for further treatment, depending on the underlying condition. For example, narrowed blood vessels can be widened through balloon dilation and kept open permanently with stents. Blood clots can be suctioned out. In varicose vein sclerotherapy, the dilated veins close off after a medication is injected into them.

The diagnosis of vascular diseases is highly varied and, despite state-of-the-art technology, often very time-consuming.

The physical examination by a doctor initially focuses—depending on the patient’s medical history and symptoms—on the veins, lymphatic vessels, and tissue perfusion, as well as palpating the pulses in the respective body regions.

Blood pressure measurements can also provide an indication of whether unexplained high blood pressure is present. The causes of this can be hormonal, but may also be due to vascular narrowing or heart defects.

Close collaboration between angiologists and cardiologists, as well as a variety of other specialists, is often essential.

A typical sign of arterial occlusion is that the pulse in the affected body part may be weaker or completely absent, depending on the extent of the narrowing.

Typical diagnostic procedures for vascular diseases include angiography (X-ray imaging of the blood vessels) and Doppler/duplex sonography (ultrasound imaging of the blood vessels).

In angiography, the blood vessels are visualized using, for example, X-rays or magnetic resonance imaging (MRI) in conjunction with a contrast agent. The contrast agent accumulates in the blood vessels, making them stand out more clearly from the surrounding tissue. This makes it easier to identify narrowings or dilations of the blood vessels.

In contrast, Doppler/duplex sonography is a specialized form of ultrasound examination that can be used to measure blood flow velocity. This, in turn, allows for the identification of reduced blood flow or obstructions to blood flow. Depending on the clinic and the suspected diagnosis, one or the other procedure will be used in the diagnosis of vascular diseases.

For the diagnosis of most circulatory disorders and venous diseases, an ultrasound examination of the arteries or veins is sufficient. Ultrasound is particularly effective at visualizing deposits and blood clots.

Ultimately, the reliability of the diagnosis determines the chosen treatment for the vascular disease and, ultimately, its success. Where doubts remain, or if a patient is facing major surgery, additional imaging procedures are indicated. However, these procedures usually involve radiation or radioactive contrast agents, which can place a strain on the body. Nevertheless, their resolution is much higher, allowing even abnormalities in the capillary region of the vessels and other vascular diseases to be detected.

Depending on the clinical question, the physician chooses between X-ray examinations with contrast agents (angiography, phlebography, or computed tomography) and magnetic resonance imaging (“MRI angiography”). For specialized angiological examinations,

• plethysmography,
• capillary microscopy, or
• light-reflection rheography.

These modern diagnostic procedures allow for the definitive diagnosis of vascular diseases of the arteries and veins, vascular occlusions in the legs, diseases of the arm arteries, diseases of the carotid arteries, thromboses, and chronic venous diseases.

It is not possible to designate a single clinic as the “best clinic” or “top clinic” for angiology. However, there are certainly doctors and clinics that specialize in the treatment of vascular diseases and have extensive experience. You can find these angiology experts in the Leading Medicine Guide.

The Leading Medicine Guide features only select, highly qualified medical experts and specialists. All listed doctors possess a high level of professional expertise, have extensive experience in the field of angiology, and meet the Leading Medicine Guide’s strict admission criteria.