Angiology

Angiology ( gr ἀγγεῖον angeion " vessel " and -logy ) is a branch of internal medicine which deals with vascular disease. It deals with the origin, epidemiology, diagnosis, conservative and interventional treatment, rehabilitation and prevention of diseases of the arteries, veins and lymphatic vessels.

The exact differentiation from other disciplines or sub-areas - is neither always possible nor desirable. However, diseases of the coronary arteries are the domain of the cardiologist; for vascular diseases that affect the central nervous system, including doctors of neurology and neurosurgery are responsible. In diseases of the venous vascular system such as varicose veins or post-thrombotic syndrome and lymphatic there is overlap with the Dermatology and Phlebology. Vascular surgery is a part of the surgery and not part of Angiology. In many angiological diseases is a close cooperation with other medical specialties.

History

Angiology was founded in Germany by Professor Max Ratschow (1904-1963), who was from 1954 until his death in 1963 clinic director in Darmstadt and there established the world's first Angiological clinic at all. Angiology is the youngest branch of internal medicine, which is also reflected in a number of only 81 pure angiologic working practices in Germany. ( National Association of Statutory Health Insurance Physicians September 2005).

Diseases

Be divided, the corresponding syndromes are disorders of the afferent or arterial component of the circulatory system, thus the arteries and arterioles and capillaries as a link to the efferent portion of the circulatory system, the veins and the lymphatic vessels (or the lymphatic system ).

Diseases of the arteries

At about 90-95 % is the cause of arterial disease atherosclerosis with formation of narrow (stenosis ) or occlusion. Because of the frequency and relevance to the sufferers are particularly worthy of mention:

  • Arterial occlusive disease ( AOD) of the pelvic and leg arteries,
  • The throats of the carotid arteries ( carotid artery ),
  • The throats of the renal arteries and the visceral arteries ( superior mesenteric artery and inferior mesenteric artery )

The arteries of the shoulder girdle and the arms are rarely affected by arteriosclerotic bottlenecks.

Except for the formation of bottlenecks can occur as a consequence of atherosclerosis by weakening of the vessel wall structure and to extend the receptacles, referred to a certain extent as an aneurysm. Of importance here because of the risk of tearing of the vessel wall ( rupture) or the deposition of clotted blood in the aneurysm and subsequent detachment ( embolism) mainly extensions of

  • Iliac arteries
  • Thoracic and abdominal aorta (aorta ) and
  • Popliteal arteries.

Compared to atherosclerosis rare causes of arterial vascular disease are:

  • Radiation effects
  • Embolism
  • Inflammatory vascular disease ( vasculitis ).

A special form of inflammatory vascular disease is the thromboangiitis obliterans, which usually turns into an atherosclerosis in the disease process and

  • Vascular injuries.

" Functional circulatory disorders " are not the result of a structural vascular damage (ie, stenosis or occlusion ) but to a faulty due to various reasons control of the vascular system. Typical diseases are:

  • Acrocyanosis,
  • The erythromelalgia and
  • Raynaud's syndrome.

Raynaud's symptoms can also occur in systemic disease in terms of Begleitvaskulitis as for example lupus erythematosus or scleroderma. Taking ergotaminhaltigen drugs that are used in some forms of migraine, especially in overdose can lead to a marked spasm of the arterial vessels, which can result in irreversible damage.

The diabetic foot syndrome is only partly the result of a disturbed blood flow. Above all, it is caused by nerve damage and damage to the foot skeleton. The time perforans denotes a special form on the sole under the toe joints.

Diseases of the veins

Frequent and are not just for individuals but also economically important venous disease:

  • The primary varicose veins (primary varicose veins ), which is inherited to about 70 %,
  • Chronic venous insufficiency in congenital weakness of the deep Leitvenensystems and
  • Venous thrombosis ( thrombosis) with the result: acquired permanent vein damage, so post-thrombotic syndrome and
  • Chronic leg ulcer venous leg.

As a result of varicose veins or even as an outward sign of another underlying disease may cause inflammation and clot formation in the superficial veins of the skin, which is called thrombophlebitis.

Diseases of the lymphatic vessels

Essentially need to distinguish between a primary and secondary lymphedema. The primary lymphedema is the result of an inherited weakness or agenesis ( atresia ) of the lymphatics and usually manifests itself in the third or fourth decade of life, while the secondary lymphedema is a result of another disease that harms the lymphatic drainage. One no longer reversible and massively pronounced lymphedema is called elephantiasis. Lymphangitis and erysipelas are relatively common inflammatory disease of the lymphatic vessels ..

Vascular malformations

As angiodysplasia is called vascular malformations of arteries, veins or lymph vessels, which may occur in enormous complexity and diversity.

Methods of investigation

The physical examination focuses, depending on the medical history and clinical picture to the inspection of veins, lymphatic vessels and tissue perfusion as well as palpation of the pulses in the affected regions.

In most of the blood flow and venous diseases allows an ultrasound of the arteries or veins, possibly including Doppler and color Doppler, already a reliable diagnosis and planning of therapy. In cases of doubt, and before planned operations a further diagnostic imaging is useful in some cases. Come Depending on the problem for x-ray examinations with contrast medium ( angiography, venography or CT scan ) and magnetic resonance imaging ( " MRI Angio " ) in question.

For specific questions angiological plethysmography, capillaroscopy and Lichtreflexionsrheografie be used.

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