ABC of Vascular Disease

Microvascular Disease

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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 diseases.

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.

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S.R.Dodds 2001

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