05/13/2011 - Questions and Answers

Small Vessel Disease: What is small vessel disease?

By: Mark Castleden

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Small Vessel Disease

What is small vessel disease ? Small vessel disease (or SVD) is a cardiovascular condition that causes narrowing of the smaller blood vessels that provide blood flow to the heart
There are two major categories of blood vessel diseases: peripheral arterial diseases and peripheral venous diseases. Both lead to insufficient oxygen reaching the farthest parts of the blood circulation.
What causes small vessel disease? Can Small vessel disease be treated?

In this article:

What is Small Vessel Disease
Causes of Small Vessel Disease
Smoking with Small Vessel Disease
How is Small Vessel Disease treated

Question: What is small vessel disease?

My doctor has added to my diagnoses small vessel disease, but what is small vessel disease? What causes small vessel disease? Can it be treated?

Answer

What is small vessel disease?

Small Vessel Disease - Related Articles

Small vessel disease (SVD) is also known as coronary microvascular disease or small vessel heart disease.
There are two major categories of blood vessel diseases: peripheral arterial diseases, which are disorders of the vessels carrying blood from the heart to all parts of the body, and peripheral venous diseases, which are disorders of the vessels carrying deoxygenated blood back to the heart. Both lead to insufficient oxygen reaching the farthest parts of the blood circulation.

As the blood vessels travel away from the heart they become smaller and smaller. The smallest are found where the small arteries (arterioles) gradually form the veins (venules). Patients with small vessel disease have problems in this part of the circulatory anatomy. 

Causes of Small Vessel Disease

What are the risk factors for small vessel disease?
Small vessel arterial disease may result from obstruction, which hinders the flow of blood; from disorders of the muscles in the artery walls, causing them to either constrict or dilate; or from aneurysms, which are weakened vessel segments that fill with blood and balloon outward. The formation of atherosclerotic, or fatty, deposits along the inner arterial walls is the most common arterial disease.

Causes of Small Vessel Disease
Small vessel disease (SVD) is also referred to as small vessel heart disease or coronary microvascular disease. Women who have polycystic ovarian disease (or autoimmune disorders) are more likely to develop disease of the small vessels. Small vessel disease occurs when blood flow is blocked to a very small arterial vessel.

When these deposits seriously obstruct the coronary arteries, a heart attack or symptoms of coronary disease are the common result; when arteries supplying blood to the brain are blocked, a stroke may ensue. Similarly, arteries supplying other parts of the body may become partially or fully blocked, leading to a condition referred to as chronic occlusive arterial disease. When the lower limbs are affected by occlusive arterial disease from fatty deposits, the disorder is called arteriosclerosis obliterans. The typical patient is a man over 50 who smokes, has high blood cholesterol, and who may also have diabetes. There are, of course, exceptions; people with a family history of early arteriosclerosis and people with diabetes, high blood pressure, or very high blood lipids may develop arteriosclerosis obliterans at an earlier age.

In the early stages of arteriosclerosis obliterans, the major arteries carrying blood to the legs and feet become progressively narrowed. Smaller collateral (alternative) blood vessels branching off the major arteries increasingly take over the supply of blood to the limb. But these collateral vessels are often inadequate to meet extra demands, such as walking for more than a short distance. Thus, the early symptoms of arteriosclerosis obliterans are cramp-like pains, aching, or muscle fatigue in the calves that occur during exercise; these symptoms are referred to as intermittent claudication. The site of the pain is determined by which arteries are occluded.

As the disease progresses, discomfort may occur even at rest. This disease may also cause a decrease in hair on the extremities. Eventually, the skin that is chronically deprived of sufficient oxygen and nutrients will begin to break down, resulting in superficial ulcers. These ischemic ulcers are small in the beginning and are generally located on the foot, toes, or heel. In severe cases, gangrene may develop, resulting in amputation of the affected part.

Arteriosclerosis obliterans can be diagnosed by feeling the pulses and measuring the pattern of circulation to the lower limbs with various techniques. Treatment consists of drugs that widen the blood vessels (e.g. pentoxifylline) and anti-clotting drugs such as aspirin, thought this may be of little benefit in peripheral vascular disease. Co-existent diseases, such as diabetes or high blood pressure, must be treated too.

If medical measures are not effective, surgery or balloon angioplasty may be advised. There are 2 major types of operation: revascularization, in which the blocked arteries are bypassed with either healthy blood vessels taken from elsewhere in the body or synthetic material; or endarterectomy, which involves opening portions of the diseased artery and removing the atherosclerotic deposits. Balloon angioplasty, in which a catheter with a balloon tip is inserted into an artery and inflated to compress the fatty deposits, is most successful with small segments of blockage. However, the area becomes quickly re-blocked in about 30% of all cases, requiring repeated treatment within a year or two. Another technique, laser ablation, uses a laser instead of a balloon to open the blocked vessel. It has several advantages over conventional surgery: it's faster, needs a shorter hospital stay, and doesn't require a bypass graft.

Smoking with Small Vessel Disease
If the patient smokes, stopping completely is an essential first step, since smoking not only hinders the delivery of oxygen but also impairs development of collateral circulation. Proper weight control is also very important. Exercise is an integral part of the overall treatment program. A graduated walking program can improve collateral circulation and improve symptoms. Foot care is particularly important; comfortable, properly-fitting shoes and socks and protecting the feet from injury or infection are crucial.

How is Small Vessel Disease treated?

Most patients with small vessel disease are treated with long-term medications, such as medications that widen blood vessels or anti-clotting drugs, as well as medications that control blood pressure, cholesterol, or underlying medical conditions such as diabetes that increase the risk of small vessel disease. Treatment for small vessel disease also focuses on lifestyle changes targeted at reducing the risk factors for progression of blockages in the coronary arteries, such as stopping smoking, controlling blood pressure, and maintaining a healthy diet.

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If you are concerned about Small Vessel Disease, you might want to read the following articles

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How is Small Vessel Disease treated?
 

Created on: 02/05/2002
Reviewed on: 05/13/2011

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Dee wrote 1 year 41 weeks ago

Should I be on a diet of low carbs, low fats and low sugars and a moderate to high excerise regimen for small vessel inschemic disease? I was diagnosed a few yrs ago with it

Anonymous wrote 1 year 43 weeks ago

I just found out I have small vessel disease after having a MRI on by brain. I've always suffered from head aches, cramp-like pains, aching, or muscle fatigue in the calves that occur when walking. I also feel light headed at times and get flushed and red faced; could this be related to this disease?

Anonymous wrote 2 years 21 weeks ago

I read, not so long ago, that a research from 2009 emphasize the link between small blood vessel disease and diabetic peripheral neuropathy.

Anonymous wrote 2 years 23 weeks ago

A recent (2008) study reports that more than 30% of the risk of dementia stems from disease of small blood vessels in the brain. it's very impressive

Anonymous wrote 2 years 23 weeks ago

I remember an article in which I read that diabetes can accelerate the process of small vessel disease and the damage to organs and tissues, but I can't find other information about that

June Chen, MD wrote 2 years 23 weeks ago

The American Diabetes Association offers excellent resources for patients with diabetes, including information about the complications associated with diabetes, such as progression of small vessel disease. For more information, visit http://www.diabetes.org/type-2-diabetes/complications.jsp.

Anonymous wrote 2 years 24 weeks ago

I was recently diagnosed with cerebral small vessel disease at 48? Isn't 48 to young to have small vessel disease?

June Chen, MD wrote 2 years 23 weeks ago

Cerebral small vessel disease is more common in older people and may contribute to the development of dementia. Factors such as high blood pressure, diabetes, high cholesterol/hyperlipidemia, female sex, and cigarette smoking have been linked to progression of cerebral small vessel disease. Genetic factors may also contribute to earlier development of small vessel disease in the brain.

Anonymous wrote 2 years 15 weeks ago

Dr. Chen,
My wife is 51, non-smoker, high blood pressure, and was just diagnosed with Cerebral SVD. She is starting medication and life style changes. What is the general long term prognosis of SVD? She has read articles that seem to imply the inevitability of mental and physical degeneration. These are quite discouraging. Her doctor, who has an excellent reputation in our city, did not mention the inevitability of any of this. Are we facing an uphill battle with this desease?

Thank you for your help.

June Chen, MD wrote 2 years 26 weeks ago

Most patients with small vessel disease are treated with long-term medications, such as medications that widen blood vessels or anti-clotting drugs, as well as medications that control blood pressure, cholesterol, or underlying medical conditions such as diabetes that increase the risk of small vessel disease. Treatment for small vessel disease also focuses on lifestyle changes targeted at reducing the risk factors for progression of blockages in the coronary arteries, such as stopping smoking, controlling blood pressure, and maintaining a healthy diet.

Anonymous wrote 2 years 26 weeks ago

How is Small Vessel Disease treated?