Angiology is a branch of internal medicine that deals with vascular diseases and is therefore also referred to as vascular medicine . Angiology doctors diagnose and treat vascular diseases that originate in the arteries as well as those that originate in the veins or lymphatic vessels. These include, for example, circulatory disorders due to vasoconstriction or vascular occlusion.
Typical procedures in the diagnosis of vascular diseases are angiography and Doppler/duplex sonography. Vascular diseases can be treated with medication, physically conservative or invasive methods. The insertion of a stent is now a frequently performed procedure in the Clinic for Angiology.
A stent is an implant that helps to keep blocked or narrowed blood vessels open @ peterschreiber.media /AdobeStock
In a healthy state, we do not realize that the blood flows through our dense vascular network and supplies all the organs and cells of the body. The vascular system forms the transport routes for nutrients, oxygen, hormones and much more, and at the same time removes toxic waste products from the body. However, as soon as something is wrong in the blood vessels, i.e. we suffer from vascular disease, the person affected very quickly notices signs of illness or failures.
Modern angiology, the study of vascular diseases, was only founded in the 1950s by Ratschow in Darmstadt. It is therefore the youngest sub-discipline of internal medicine. As many vascular diseases also affect other medical specialties, angiologists often work together with neurologists, cardiologists, dermatologists and lymph specialists.
Vascular diseases are roughly divided into diseases of the supplying (arterial) system and the draining (venous and lymphatic) system.
Arterial vascular diseases are mostly occlusive diseases due to advanced arteriosclerosis. Deposits on the vessel walls and inflammatory processes lead to a narrowing (stenosis) or total occlusion of important arteries. This prevents or completely interrupts the oxygen supply to the downstream organ or tissue. This undersupply or occlusion in the arterial vascular system is associated with severe pain and is always an emergency situation, as tissue is at risk of dying off.
Vascular diseases of the veins on the other hand are often varicose veins or thromboses (blood clots). They can lead to drainage obstructions, particularly in the legs, but can also trigger a heart attack, pulmonary embolism or stroke if a thrombus becomes detached.
Varicose veins are widespread and become more common with increasing age @ Elena /AdobeStock
Examples of vascular diseases that are treated at an angiology clinic are
- Intermittent claudication, also known as peripheral arterial occlusive disease (PAOD), causes pain in the legs due to reduced blood flow in the arteries of the pelvis and legs.
- Carotid artery stenosis is a narrowing of thecarotid artery.
- Circulatory disorders of the blood vessels, such as narrowing in the arteries of heart disease vessels, can cause serious illnesses such as coronary heart disease or even a heart attack.
- In varicose vein disease(varicosis), the superficial venous system is weakened, the closure valves in the veins no longer function properly, resulting in congestion of the blood in the veins with the characteristic dilation of the vessels.
- Venous thrombosis, i.e. the blockage of veins by a blood clot, can result in an open leg(leg ulcer), post-thrombotic syndrome or a pulmonary embolism if left untreated.
- In diabetic foot (diabetic foot syndrome), wounds in patients with diabetes mellitus no longer heal spontaneously due to circulatory disorders, resulting in nerve damage and ulcers; in extreme cases, amputation of the foot may be necessary.
- In the case of lymphoedema, fluids can no longer be adequately removed via the lymph vessels, resulting in fluid accumulation in the affected area of the body.
- Aneurysms are dilated blood vessels that burst and can lead to life-threatening bleeding (e.g. aortic aneurysm).
- In the case of embolisms, blood vessels are partially or completely blocked by material (blood clots, air bubbles, fat droplets).
- Vascular malformations
Peripheral arterial occlusive disease (PAD)
Vascular diseases with circulatory disorders and arterial occlusions are particularly common in the legs. These are strongly promoted by lifestyle and the associated arteriosclerosis.
This leads to slowly progressive deposits and narrowing of the vessels and finally to complete occlusion. Pain and rapid signs of fatigue in the legs can be the first indication of an impending occlusion.
An arterial occlusion then manifests itself with sudden stabbing pain. The pulse beyond the occlusion site can no longer be felt. As the section of the vessel behind the occlusion is no longer supplied with blood, the section of the leg that is not supplied with blood is at risk of dying off. If left untreated, a leg amputation may be necessary.
A peripheral arterial occlusion is therefore an acute emergency and requires immediate medical treatment.
Acute vascular occlusion of a limb artery
While peripheral occlusive disease progresses slowly, in acute occlusion the artery is blocked very suddenly, e.g. by a blood clot.
Acute vascular occlusion in the leg is always an emergency and must be treated immediately by a doctor. Irreparable damage to the muscles and tissues of the leg can occur after just 6 to 8 hours. A leg amputation would then often be the last resort for the affected person.
Aneurysms: Sack-like vascular diseases
Aneurysms are primarily bulges in the vessel wall. They can take many forms, but berry- or sac-shaped, tortuous and tendril-shaped aneurysms are common.
As the vessel wall can crack over time, similar to an over-inflated balloon, an aneurysm often threatens to burst. A vascular rupture of this kind in the area of one of the body's major arteries (e.g. the abdominal aorta) causes major blood loss, which can be life-threatening within minutes.
An operation to close the vascular damage is urgently required in such cases. Interestingly, men are affected by this vascular disease about 10 times more often than women.
Brain aneurysms
A special form of aneurysm is arterial dilatation in the area of the large cerebral arteries. Such brain aneurysms are not uncommon, but are usually only found by chance. Many sufferers live with this defect for the rest of their lives, but some people die if the aneurysm bursts as a result of shocks or an increase in pressure.
There is an increased risk of death with this vascular disease.
Vasculitis: Inflammatory vascular diseases
Rheumatic and other inflammatory vascular diseases are caused by inflammation of the blood vessels. These vascular diseases are also known as vasculitis.
A special form is giant cell arteritis, which very often affects older people. Even minor inflammatory events damage the vessel walls and lead to turbulence in the blood flow and uneven surfaces.
The turbulence ultimately leads to the formation of blood clots, while the uneven surfaces promote deposits and arteriosclerosis. Inflammatory vascular diseases are therefore always a risk factor for occlusions, embolisms and infarctions.
Thrombangiitis obliterans (TAO): Vascular disease of smokers
Thrombangiitis obliterans is an inflammatory vascular disease that leads to vascular occlusion. It is almost exclusively found in smokers.
In addition to the arteries of the legs and arms, superficial and deep-seated veins are also frequently affected. The vascular occlusions lead to further tissue damage, so that eventually toes and fingers have to be amputated. As this vascular disease is not accompanied by an inflammatory reaction, causal therapies are ineffective.
Arteriosclerosis: a widespread vascular disease
Arteriosclerosis is 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 seen in childhood. In the course of life, these deposits become thicker and then completely block the vessel.
Arteriosclerosis is a vascular disease that affects the whole body and not just individual blood vessels or organs. Arteriosclerosis always becomes critical when the blood supply to the heart, brain, arms or legs is affected.
Diabetes and the heart: vascular damage caused by sugar
Diabetes in itself is not fatal. However, an elevated blood sugar level promotes vascular disease and damages the vascular wall. The sugar causes damage to nerves and blood vessels, resulting in inflammation and poor healing of wounds.
Inflammation leads to turbulence in the bloodstream and the smallest vascular injuries. This can result in deposits and even arterial occlusion or thrombus formation.
It is therefore not uncommon for poorly controlled diabetics to die as a result of a heart attack or stroke.
Varicose veins (varices)
Deposits or inflammation in the veins disrupt the work of the venous valves, which no longer close properly. The blood backs up and swings back and forth in the veins.
In order to relieve the excess pressure in the venous system, the vessels stretch further and smaller veins in particular appear on the skin. Such curved and tortuous formations are called varicose veins.
However, varicose veins are neither caused by a spasm nor do they trigger it. Rather, their name is derived from the medieval term "crooked veins". Varicose veins continue to progress if left untreated and can contribute to serious illnesses such as embolisms.
Esophageal varices are a particularly dangerous form of varicose veins. They develop along the oesophagus when the outflow of blood via the liver is impaired. This is very often the case with alcoholics. Their liver is severely damaged and is increasingly transformed into non-functional connective tissue. The doctor calls this cirrhosis of the liver.
However, as the liver serves to "wash the blood", the blood backs up further and further in the body. Eventually, short circuits become active that lead the blood past the liver. As a result, venous plexuses remote from the liver are overstretched and sag. In this way, life-threatening oesophageal varices develop in the area of the oesophagus. If they burst, death usually occurs very quickly due to internal bleeding.
Hemorrhoids: Vascular disease of the rectum
The anus is surrounded by cavernous cushions which, among other things, guarantee a tight closure. Weak connective tissue, hard bowel movements or regular pushing cause blood to accumulate in these cavernous cushions. As a result, the venous plexuses sag and form pockets that can bulge outwards or even into the bowel. The doctor calls such varicose veins in the rectal area hemorrhoids.
Although there appears to be a hereditary predisposition, everyone can reduce their own risk of developing hemorrhoids. Exercise, a high-fiber diet and less straining during bowel movements can protect the cavernous cushions and prevent varicose veins.
Thrombophlebitis - Superficial vein inflammation
In some cases , varicose veins can also become inflamed. The superficially protruding venous plexuses are affected. The doctor calls this vascular disease thrombophlebitis.
Women are up to 4 times more likely to suffer from this vascular disease than men.
Phlebothrombosis - deep vein thrombosis
Overall, venous disorders are among the most common vascular diseases. It 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 flow of blood to the heart or even block the vein completely. These clots (thrombi) can sometimes detach easily and then travel to the heart, lungs or brain, where they block a vessel. The downstream area is no longer supplied with blood and dies.
Depending on the organ involved, this can lead to a life-threatening heart attack, stroke or the dreaded pulmonary embolism.
Phlebothrombosis is almost exclusively limited to the leg and pelvic veins and often persists there undetected for many years before secondary diseases become apparent. Due to the risk of clot detachment, it is a particularly dangerous vascular disease.
Vascular disease of chronic venous insufficiency
Various venous diseases can damage the blood vessels. As a result, they often lose the ability to return blood to the heart. If the venous valves are also affected, a chronic drainage disorder develops as a vascular disease.
This is very often the case in the legs, where oedema occurs after some time. The constantly increased venous pressure and the lack of blood flow ultimately lead to tissue damage and partial death.
Skin damage becomes visible, which can develop into an open leg. Protracted inflammation and ulcers are the result.
As with most medical fields, there are various options for treating vascular diseases in angiology:
- Drug treatment of vascular disease: In addition to the medicinal treatment of underlying diseases(increased blood pressure, increased blood lipid levels, diabetes), drugs that promote blood circulation, dilate blood vessels or inhibit blood clotting ("blood thinning") play a particularly important role in the treatment of vascular diseases.
- Conservative therapy of vascular diseases: This includes physical measures such as manual lymphatic drainage, exercise therapy and compression therapy. Compression therapy uses bandages and stockings to exert external pressure on the vessels so that lymphoedema can no longer develop or existing swelling is reduced.
- Invasive procedures for vascular diseases: If the vascular disease could not be treated conservatively or with medication, various vascular surgery procedures are available for further treatment, depending on the underlying disease. For example, vascular constrictions can be widened by balloon dilatation and kept open permanently with vascular stents. Blood clots can be aspirated. In varicose vein sclerotherapy, the dilated vessels close after a drug is injected into the veins.
The diagnosis of vascular diseases is very varied and often very time-consuming despite the latest technology.
Depending on the patient's medical history and symptoms, the doctor's physical examination initially focuses on the veins, lymph vessels and tissue perfusion as well as palpation of the pulses in the respective body regions.
Blood pressure measurements can also provide an indication of whether there is unexplained high blood pressure. The causes can be hormonal, but can also be caused by vasoconstriction and heart defects.
Close cooperation between angiologists and cardiologists as well as a number of other specialists is often essential.
It is typical for arterial occlusions that the pulse in the subsequent part of the body may be weaker or completely absent, depending on the extent of the constriction.
Typical procedures in the diagnosis of vascular diseases are angiography (X-ray of the vessels) and Doppler/duplex sonography (ultrasound of the vessels).
In angiography, the vessels are visualized using, for example, X-rays or magnetic resonance imaging(MRI) using a contrast agent. The contrast agent accumulates in the vessels, making the vessels stand out better from the surrounding tissue. Vascular constrictions or dilatations can thus be more clearly recognized.
Doppler/duplex sonography, on the other hand, is a special form of ultrasound examination that can be used to determine the flow velocity of the blood. This in turn allows conclusions to be drawn about reduced blood flow or flow obstructions. Depending on the clinic and suspected diagnosis, one or the other procedure will be used in the diagnosis of vascular diseases.
An ultrasound examination of the arteries or veins is sufficient for the diagnosis of most circulatory disorders and venous diseases. Ultrasound is particularly good at visualizing deposits and thrombi.
The reliability of the diagnosis ultimately determines the treatment chosen for the vascular disease and ultimately its success. If there are still doubts or if a patient is facing a serious operation, further imaging procedures are indicated. However, these procedures usually use radiation or radioactive contrast agents, which can be harmful to the body. Nevertheless, their resolution is much higher, so that even disorders in the capillary area of the vessels and other vascular diseases can still be detected.
Depending on the problem, the doctor chooses between X-ray examinations with contrast medium (angiography, phlebography or computer tomography) and magnetic resonance imaging ("angio-MRI"). For special angiological examinations there are also
- plethysmography,
- capillary microscopy or
- light reflection rheography are also available.
With these modern diagnostic procedures, vascular diseases of the arteries and veins, vascular occlusions in the legs, arm artery diseases, vascular diseases of the carotid arteries, thromboses and chronic venous diseases can be diagnosed beyond doubt.
It is not possible to designate a clinic as the "best clinic" or "top clinic" for angiology. However, there are doctors and clinics that specialize in the treatment of vascular diseases and have a great deal of experience. You can find these angiology experts in the Leading Medicine Guide.
Only selected highly qualified medical experts and specialists are presented in the Leading Medicine Guide. All listed doctors have a high level of specialist expertise, have excellent experience in the field of angiology and meet the strict inclusion criteria of the Leading Medicine Guide.
