What's Angiology about?
Specialists in angiology are experts in all disorders related to the arterial, venous, lymphatic, and microcirculation vascular systems.
The specialty of angiology focuses on the physiopathology, epidemiology, screening, diagnosis, treatment and follow-up of vascular diseases as well as their primary and secondary prevention. The treatments include conservative and interventional therapies, as well as exercise therapy. Angiologists are at the forefront of vascular patient management because of their overview of the vascular system as a whole, unique and independent organ requiring specialized competencies.
Vascular Diseases
Diseases of the arteries
Arterial diseases include a variety of pathologies characterized by arterial narrowing or occlusion, dilatation or weakening of the arterial vessel wall. The most common arterial diseases are those secondary to atherosclerosis. This is a systemic disease inducing narrowing or occlusion of large and medium size arteries. Among these, the most frequent localization is that of the lower limbs. Therefore, the term Peripheral Artery Disease is generally used, referring to lower extremity atherosclerotic disease. This chronic disease’s prevalence increased about 25% in the last ten years affecting 76.1 millions of women and 37.3 millions of men worldwide. It has different clinical manifestations ranging from asymptomatic to critical limb ischemia. It is therefore crucial that this disease is been taken care by vascular specialists mastering early diagnostic tools, able to pose a proper diagnosis and design adequate treatment and prevention strategies.
The most frequent disease characterized by arterial dilation is abdominal aorta aneurysm, although this can occur in any arterial segment of the body. The prevalence of an abdominal aorta aneurysm is about 10% in patients >65 years. They are mostly asymptomatic and if they become symptomatic, rupture is the main manifestation. Therefore, angiological screening and regular follow-up are capital steps in the management strategy. Beyond aneurysms, angiologists have weakening expertise in carotid artery disease, upper arm arterial pathologies, renal and splanchnic arterial diseases.
Rare vascular diseases
Weakening or inflammation of the arterial wall leading to tearing, narrowing or dilatation characterizes several rare vascular diseases. These include among others Marfan syndrome, Vascular Ehlers Danlos, Loeys-Diez syndrome, vasculitis, Buerger disease. Because of their rarity, diagnosis and management of these diseases require a vascular expertise and because of their systemic nature they often necessitate a multidisciplinary approach.
Diseases of the veins
Venous diseases are common affecting about 29-30% of the general population and they include among others:
- chronic venous insufficiency like varicose veins or venous ulcers
- venous thromboembolism with pulmonary embolism or deep and superficial vein thrombosis
Diseases of the lymphatic vessels
The most frequent lymphatic disease is lymphedema. This is caused by reduction in lymph transport due to a disorder of the lymphatic vessels. Damage to the lymphatic system results in the accumulation of lymph and proteins in the extracellular space. Lymphedema is a chronic and disabling vascular disease that is poorly known and recognized and has multiple repercussions on patient’s personal, family, professional, and social life. Therefore, proper diagnosis and early management are essential in patient’s care.
Diseases of microcirculation
The microcirculation includes arterioles, capillaries and venules. These small vessels, disseminated throughout the tissues, form a network that lies between the arterial and venous systems. The most frequent microcirculation anomalies are acrosyndromes, which come from the Greek akros = extremity. These disorders cause changes in temperature and color of the skin of the hands and feet, sometimes accompanied by severe pain. The best-known disease is Raynaud's phenomenon. Other conditions, such as erythromelalgia or acrocyanosis, are also part of the acrosyndromes.
Vascular Medicine
Vascular exams
To manage patients with vascular diseases angiologists combine within their expertise the knowledge of vascular tools such as duplex ultrasound, contrast-enhanced ultrasound (CEUS), intravascular ultrasound (IVUS), angiography, Doppler, plethysmography, tcPO2, capillaroscopy, functional testing (treadmill among others) and the lymphofluoroscopy.
Interventional Angiology
Interventional angiology involves percutaneous, mostly x-ray-based endovascular catheter interventions for diagnostic and therapeutic purposes. This includes arteries and veins with the exception of intracerebral and coronary vessels. Because angiography and endovascular interventions are challenging and associated with risk, the SSA offers a high quality and structured postgraduate training with a certificate of proficiency in interventional angiology.