The medical specialty of angiology is dedicated to diseases of the blood and lymph vessels. Circulatory disorders are a particular focus.
What is angiology?
Angiologists are most often confronted with the consequences of arteriosclerosis in daily practice. Deposits in blood vessels lead to narrowed areas in this common disease. Angiology is the medical specialty that deals with diseases of the blood and lymph vessels. Phlebology includes only the veins and arteries and excludes the lymphatic vessels as a field of expertise. According to the official classification, angiology is subordinate to internal medicine as a sub-specialty. This “medicine of the vessels” deals with the diagnosis, therapy and prophylaxis of arterial, venous and lymphatic malformations, acquired chronic syndromes as well as acute diseases. Some overlaps occur with other sub-specialties of medicine. For example, the angiologist may diagnose vascular disease that the surgeon must operate on. Similarly, problems of the coronary arteries are mainly the responsibility of the cardiologist. If the angiologist detects a pathological change in a vessel of the nervous system, he refers the patient to the neurologist. There is overlap with dermatology where varicose veins are concerned. Sometimes the radiologist must be on hand to answer questions about the evaluation of imaging procedures. This colleague can also perform more extensive examinations.
Treatments and therapies
The angiologist is most often confronted with the consequences of atherosclerosis in daily practice. Deposits in the blood vessels lead to narrowed areas in this common disease. Often a “smoker’s leg” is the result or a diabetic foot. The resulting necroses (death of tissue) must be treated urgently. If these open wounds are localized on the lower leg, the angiologist speaks of “ulcus cruris”. Thrombosis belongs to the group of functional vascular diseases: A blood clot, medically “thrombus” has formed and can completely block a blood vessel. The doctor then speaks of an “embolism“. Post-thrombotic syndrome occurs after deep-seated thrombosis and leads to congestion of backflow in the vascular system. An aneurysm is a dilatation on an artery wall where it is thinned and can burst. The result is internal bleeding. Brain arteries and the aorta (central aorta) are often affected, or a coronary vessel. The subject of angiology is also varicose veins. The specialist distinguishes between primary (genetically determined) and secondary (acquired, e.g. due to tumor) varicosis. Raynaud’s syndrome is pronounced when fingers and toes are no longer supplied with sufficient blood. Vascular spasms (cramps) of idiopathic (unknown) origin trigger the circulatory disorder. The blood vessels are covered by a layer of muscle which, like other muscles, can exhibit phases of uncontrolled tension. A rare condition of functional vascular disorders is erythromelalgia. The vascular regulatory disorder is associated with redness of the skin and edema (swelling due to water retention). Often, the angiologist cannot determine the cause. In the course of acrocyanosis, insufficient oxygen supply to the fingers and toes occurs. The cause is a decreased oxygen saturation of the hemoglobin. This is always a result of mixing of arterial and venous blood due to pathological connection of arteries and veins (anastomosis). Problems of the lymphatic vessels present themselves to the angiologist in the form of lymphedema. Elephantiasis is associated with degradation of lymphatic structures in the legs, as a result of which such lymphedemas are formed. Inflammatory diseases of the vessels are arteritis and lymphangitis, which results from blood poisoning.
Diagnosis and examination methods
To make a diagnosis, the angiologist will first take a history (medical history) and ask about symptoms. He or she will then examine the patient, noting skin changes and swelling. By palpating (feeling) the vessels, the physician assesses the pulse and thus blood flow and vascular abnormalities. Often this is not enough and angiography follows. This is a radiological procedure that in most cases involves the use of contrast media. More gentle for the patient is a sonography (ultrasound).Doppler sonography registers the direction of blood flow, while color-coded Doppler sonography can distinguish between arterial and venous blood flow. This is important for localizing circulatory disorders. Another specialized procedure is plethysmography, which is used to visualize volume fluctuations. Light reflection rheography shines infrared light into the area under examination and measures the reflected light. With capillary microscopy, the angiologist looks at the finest vessels at the nail root. Computed tomography (CT) is used to produce X-ray images of individual optical planes. In addition, the angiologist may use magnetic resonance imaging (MRI). A therapeutic acute intervention is balloon dilatation. The physician enters a vessel with a catheter, at the end of which a small balloon can be inflated. In this way, he removes constrictions in the vessel. A stent can also be inserted using this technique. The tubular vessel support maintains the dilation. The surgeon can surgically bridge constrictions using removed endogenous vessels. Injections of a concentrated saline solution are used to obliterate varicose veins. Drug treatment is aimed at improving blood flow. The pharmaceuticals commonly referred to as “blood thinners” have different mechanisms of action. Coumarin derivatives block vitamin K, which is involved in blood clotting. Heparin binds a number of other clotting factors in the blood. Platelet aggregation inhibitors prevent blood platelets (thrombocytes) from forming clumps. Platelets are specialized blood cells that serve only to clot blood. To lower blood pressure, the angiologist prescribes antihypertensives. ACE inhibitors, which have a hormonal effect, are particularly common for vascular diseases. Draining drugs (diuretics) must be taken by the patient if he suffers from edema. Infectious diseases of the vessels are treated with antibiotics. Conservative treatment methods of the angiologist are physiotherapeutic measures such as Kneipp applications and lymphatic drainage, a massage technique. In addition, the doctor advises the patient to change his behavior. He should remain or become a non-smoker, eat a moderate diet and exercise.
