ABC of Vascular Disease
1. What is microvascular disease?
Microvascular disease is a process through which the very small branches of arteries
throughout the body become damaged. Microvascular disease is a common
component of other conditions, such as diabetes mellitus and autoimmune
2. What causes microvascular disease?
The very small branches of the arteries are delicate but very important
structures. Damage to these vessels results in occlusion of the vessels
and impairment of blood flow. In many situations the small arteries can
re-grow and overcome the blockage, a process called angiogenesis. This is
part of the normal healing process. In microvascular disease the commonest
cause is chemicals within the blood that damage the very delicate lining of the
small arteries and causes the blood to clot in the artery and block it.
Sometimes these chemicals are produced by the body itself as part of the immune
response and is called an autoimmune microvascular disease. Occasionally
microvascular disease is the result of abnormalities in the cells that form part
of the blood.
3. What are the symptoms of microvascular disease?
The commonest symptoms are pain and discoloration of the extremities,
usually the fingers and toes, sometimes even leading to gangrene. These
symptoms are very similar to those cause by occlusion of the larger arteries
except that it is not associated with muscle pain on exercise (intermittent
claudication) and the blood pressure in the larger arteries is normal.
4. What are the complications of microvascular arterial disease?
Microvascular disease usually affects the whole body to some degree and the
most serious complications are caused by damage to the vital organs (e.g. heart,
brain, kidneys, liver).
5 What can I do to prevent microvascular disease from getting worse?
Treatment for microvascular disease is directed at the underlying cause.
Lifestyle changes to eliminate factors that aggravate the condition, such as
smoking, should be the first line of treatment. A complete medical
assessment is required to identify the underlying cause if possible. If
there is an autoimmune element to the condition, then referral to a
rheumatologist may be required. If there is an abnormality in the blood
referral to a haematologist is required. Surgery plays only a secondary role in
the management of microvascular disease.