vasospastic disorders and vasculitis

PRIMARY AND SECONDARY VASOSPASTIC DISORDERS AND VASCULITIS

A vasospastic disorder occurs when tiny blood vessels that reach the surface of the skin spasm and restrict blood flow. Vasospastic disorders are either primary or occur as a result of underlying conditions. Takayasu's arteritis, Buerger's disease and AV malformation are rare types of vasculitis. As soon as vessel walls weaken, thicken, scar or become narrow, blood moves slowly and in low doses to organs and tissue.

Takayasu's Arteritis

Takayasu's arteritis is a collection of disorders that causes inflamed blood vessels. Takayasu's arteritis affects the heart's primary artery, the aorta which delivers blood from the heart to other parts of the body. Due to restricted arteries and weak arterial walls, Takayasu's arteritis can lead to the formation of aneurysms.

Causes of Takayasu's Arteritis

Takayasu's arteritis occurs when major arteries which include the aorta start to thicken and become narrow. The exact cause of Takayasu's arteritis remains unknown, but an autoimmune disease may accidentally attack the arteries.

Symptoms of Takayasu's Arteritis

Signs of Takayasu's arteritis happen in stages. Symptoms of Takayasu's arteritis in the first stage include:

  • Lethargy
  • Unexplained weight loss
  • Muscle aches and pains
  • Fever and night sweats

As Takayasu's arteritis reaches stage two, organs and tissue receive a limited supply of oxygen, blood and nutrients.
Symptoms of Takayasu's arteritis in its second stage are:

  • Dizziness
  • Headaches
  • Reduced vision
  • Hypertension
  • Trouble concentrating
  • Diarrhoea

Diagnosis of Takayasu's Arteritis

Apart from a physical exam, vascular surgeons, Dr Botha and Dr Shone conduct additional diagnostic tests that include:

  • Angiography: The vascular surgeons thread a catheter into a vein or artery and inject a contrast dye into the device. As the dye moves through the vein or artery, x-rays are taken.
  • Magnetic Resonance Angiography/MRA: An MRA works similarly as an angiography but instead uses high-frequency sound waves to produce images of tissue slices.

Treatment of Takayasu's Arteritis

Anti-inflammatory corticosteroid medication is taken in gradual doses to relieve inflammation. If immune-suppressant medication and anti-inflammatories fail to ease inflammation, the vascular surgeons perform bypass surgery or a percutaneous angioplasty to regulate blood flow and improve circulation.

Buerger's Disease

Buerger's disease, also known as Thromboangiitis obliterans occurs when blood vessels start to swell and develop blood clots. Buerger's disease could eventually lead to gangrene, and if this is the case, amputation may be necessary.

Causes of Buerger's Disease

Genetics and autoimmune diseases are possible causes of Buerger's disease.

Symptoms of Buerger's Disease

  • Pins and needles sensation in the extremities
  • Blue-tinged hands and feet
  • Pain in the legs, arms and hands
  • Pale toes and fingers in the cold (Reynaud's phenomenon)
  • Exposed sores on the toes and fingers

Diagnosis of Buerger's Disease

Blood tests, Allen's test and an angiogram, are diagnostic procedures that are carried out to diagnose Buerger's disease. Blood tests detect immune system disorders, such as lupus and diabetes.

Treatment of Buerger's Disease

Medication for the dilation of blood vessels and anticoagulant therapy relieve symptoms of Buerger's disease. Also, compression of the lower and upper extremity stimulates blood circulation.

AV Malformation

Arteriovenous (AV) malformation is the abnormal connection between arteries and veins that disrupts oxygen and blood circulation. Usually, arteries deliver oxygenated blood from the heart to the brain. But veins distribute deoxygenated blood to the heart and lungs. AV malformation interferes with this vital process, and as a result, because tissues don't receive enough oxygen, blood cannot circulate properly. Due to a lack of oxygenated blood, veins or arteries weaken and may collapse.

Causes of AV Malformation

Genetics and a family history of AV malformation increase one's susceptibility to the condition.

Signs of AV Malformation

  • Headaches
  • Haemorrhage
  • Neurological deficits
  • Nausea
  • Seizures and fainting
  • Memory problems
  • Vision loss

Diagnosis of AV Malformation

Dr Botha and Dr Shone conduct a thorough physical exam and listen for bruits, which are sounds of the flow of blood through veins and arteries. A bruit is an abnormal sound that disrupts one's sleep and hearing. A bruit sounds like water that travels quickly through a constricted pipe.
Both vascular surgeons may conduct additional tests, such as:

  • Angiography: An angiography, also known as arteriography, utilises a contrast dye to highlight blood vessels.
  • MRA: A magnetic resonance angiography marks the speed of blood flow through arteries and veins.
  • Doppler ultrasound: A Doppler ultrasound utilises sound waves to capture images of blood flow and helps diagnose medium to large arteriovenous malformations (AVMs) as well as bleeding.

Treatment of AV Malformation

Endovascular embolisation and stereotactic radiosurgery are used to treat AV malformation.

For embolisation, the vascular surgeons thread a catheter through the artery to reach the AVM. Dr Botha or Dr Shone inject a substance which forms a blood clot in the centre of the AVM to restrict blood flow.

Stereotactic radiosurgery is a procedure that's suitable for the treatment of small AVMs that have not burst. Concentrated levels of radiation are directed to blood vessels to cut off blood supply to the AVM.

"A sound knowledge of pathology is the only safe guide for the hands of a Surgeon, no matter how skilled those hands may be. Indeed, the more skillful they are, the more dangerous they may become without this lantern to light the way. Unless he builds on that solid foundation, the Surgeon may be no better than a hewer of flesh and a drawer of blood"

- Boyd