Angiology

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Human blood circulation scheme

The Angiology ( teaching of the vessels ; Greek ἀγγεῖον angeion , German , vascular ' and attached: -logie ) is a branch of internal medicine that deals with vascular employed. It deals with the development , epidemiology , diagnosis , conservative and interventional therapy , rehabilitation and prevention of diseases of the arteries , veins and lymphatic vessels .

The vascular surgery is a partial area of the surgery and not a part of Angiology; Coronary artery diseases are the domain of cardiologists ; in diseases of the venous vascular system such as varicose veins or post-thrombotic syndrome and the lymphatic vessels, there is an overlap with dermatology and phlebology ; Doctors in neurology and neurosurgery are also responsible for vascular diseases that affect the central nervous system . Accordingly, there is close cooperation with other medical specialties in many angiological disease patterns.

history

Angiology, as a term only spread after the Second World War, was founded in Germany by Max Ratschow (1904–1963), who was director of the Darmstadt Clinic from 1954 until his death in 1963 , where he established the world's first angiological clinic. Angiology is the youngest branch of internal medicine and originally dealt primarily with peripheral circulatory disorders . The German Society for Angiology - Society for Vascular Medicine currently has more than 1,200 members.

Clinical pictures

The corresponding clinical pictures are divided into the diseases of the afferent or arterial part of the circulatory system , thus the arteries and arterioles as well as the capillaries as a link to the draining part of the circulatory system, the veins and the lymphatic vessels (or the lymphatic system ).

Diseases of the arteries

About 90-95% of the arterial diseases are caused by arteriosclerosis with the formation of constrictions ( stenoses ) or occlusions. Due to the frequency and relevance for those affected, special mention should be made of:

The arteries of the shoulder girdle and the arms are rarely affected by arteriosclerotic constrictions.

In addition to the formation of constrictions, arteriosclerosis can also lead to widening of the vessels due to the weakening of the vessel wall structures, which is referred to as an aneurysm above a certain extent . Because of the danger of tearing the vessel wall ( rupture ) or the deposition of clotted blood in the aneurysm and subsequent detachment ( embolism ), especially widenings of the

Rare causes of arterial vascular diseases compared to arteriosclerosis are:

A special form of inflammatory vascular disease is thrombangiitis obliterans , which in the course of the disease usually changes into arteriosclerosis and

  • Vascular injuries.

"Functional circulatory disorders" are not the result of structural vascular damage (i.e. stenosis or occlusion), but rather the result of incorrect control of the vascular system for various reasons. Typical clinical pictures are:

Raynaud's symptoms can also occur in systemic diseases in the sense of accompanying vasculitis, such as lupus erythematosus or scleroderma . The intake of ergotamine-containing drugs, which are used in some forms of migraine, can lead to pronounced spasm of the arterial vessels, especially in the event of an overdose, which can result in irreversible damage.

The diabetic foot syndrome is only partly a result of impaired blood flow. It is mainly caused by nerve damage and damage to the foot skeleton. The mark perforans describes a special shape on the sole of the foot under the metatarsophalangeal joints.

Diseases of the veins

Frequent venous diseases that are significant not only for the individual but also economically are:

  • primary varicose vein disease (primary varicose veins ), about 70% of which is inherited
  • chronic venous insufficiency with congenital weakness of the deep vein system
  • the venous thrombosis ( thrombosis ) with the result:

As a result of varicose veins or as an external sign of another underlying disease, inflammation and clot formation in superficial skin veins can occur, which is known as thrombophlebitis .

Diseases of the lymphatic vessels

Essentially, a distinction must be made between primary and secondary lymphedema . Primary lymphedema is the result of an inherited weakness or non-predisposition ( atresia ) of the lymphatic tract and usually manifests itself in the third to fourth decade of life, while secondary lymphedema is the result of another disease that also damages lymphatic drainage. Lymphedema that is no longer reversible and massive is known as elephantiasis . Lymphangitis and erysipelas are relatively common inflammatory diseases of the lymphatic vessels.

Vascular malformations

Angiodysplasias are vascular malformations of arteries, veins or lymphatic vessels, which can be of enormous complexity and diversity.

Investigation methods

The physical examination per focuses on history and clinical picture on the inspection of veins , lymphatic vessels and tissue perfusion and palpation of the pulses in the affected regions.

For most circulatory disorders and venous diseases, an ultrasound examination of the arteries or veins, possibly including Doppler and color Doppler, already allows a reliable diagnosis and planning of the therapy . In cases of doubt and before planned operations, further diagnostic imaging is useful in some cases. Depending on the question, X-ray examinations with contrast media ( angiography , venography or computed tomography ) and magnetic resonance tomography ("angio MRT") can be used.

Plethysmography , capillary microscopy and light reflection rheography are used for special angiological questions .

literature

  • Hermann Berger, Peter Pickel, Wolfgang Weiß: Interventional Radiology . Volume 1. Endovascular revascularization of the pelvic circulation. Thieme, Stuttgart 2003, ISBN 3-13-105921-4
  • Hans-Christoph Diener : Stroke. 100 questions and 100 answers . Thieme, Stuttgart 2002, ISBN 3-13-132961-0
  • Ernst Pilger: Arterial Vascular Diseases. Standards in clinic, diagnostics and therapy . Thieme, Stuttgart 2002, ISBN 3-13-130631-9
  • Franz Aichner: Atherothrombosis. An interdisciplinary guide to basics, clinic and management . Thieme, Stuttgart 2002, ISBN 3-13-129861-8
  • Edward I. Bluth, Peter H. Arger, Carol B. Benson, Philip W. Ralls: Ultrasonography in Vascular Diseases. A Practical Approach to Clinical Problems . Thieme, New York 2003, ISBN 3-13-129141-9
  • Bettina Kemkes-Matthes, Gerd Oehler: Blood coagulation and thrombosis . Thieme, Stuttgart 2001, ISBN 3-13-104822-0
  • Kurt Huck: Course book Doppler sonography and duplex sonography . According to the guidelines of DEGUM and KBV. Thieme, Stuttgart 2001, ISBN 3-13-115371-7
  • Manfred Kaps, Gerhard-Michael von Reutern, Hans J von Büdingen: Ultrasound diagnostics of the arteries supplying the brain . Thieme, Stuttgart 2000, ISBN 3-13-731403-8
  • Hans-Wolfgang Menges, Hubert Mörl: Vascular diseases in practice . Thieme, Stuttgart 2000, ISBN 3-13-114657-5
  • Horst-E. Gerlach, Eberhard Rabe: Practical Phlebology. Recommendations for differentiated diagnosis and therapy of phlebological diseases . Thieme, Stuttgart 2000, ISBN 3-13-119231-3
  • Doris Neuerburg-Heusler, Michael G. Hennerici: Vascular diagnostics with ultrasound textbook and atlas . Thieme, Stuttgart 1999, ISBN 3-13-707503-3
  • Malte Ludwig: Angiology in clinic and practice . Thieme, Stuttgart 1998, ISBN 3-13-110191-1
  • Alexander Sturm, Jürgen Chr Reidemeister: Checklist angiology, hypertension, hypotension . Thieme, Stuttgart 1998. ISBN 3-13-617803-3
  • Bruce A. Perler, Gary J. Becker: Vascular Intervention . Thieme, New York 1998, ISBN 3-13-108041-8
  • Dieter Liermann, Johannes Kirchner: Angiographic diagnosis and therapy . Thieme, Stuttgart 1997, ISBN 3-13-108311-5
  • Axel W. Bauer : Angiology. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 64 f.
  • Peter Kolakowski: supply gap vascular sports. In: Deutschlandfunk Kultur. September 16, 2018 ( online text) . Awarded the journalist prize of the German Society for Angiology.

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