5 Early and Often Overlooked Signs of Vascular Disease.

Your heart is a hard-working engine that pumps life-giving blood to every corner of your body. But an engine can only do its job if its fuel lines remain open and clear. 

In the human body, those fuel lines are a vast, intricate network of blood vessels that stretch for thousands of miles. If this complex circulatory system becomes narrowed, blocked, or damaged, the consequences can be devastating. Vascular disruptions can lead to severe issues such as heart attack, stroke, kidney failure, nonhealing wounds, loss of limb, or ruptured blood vessels. 

Vascular changes happen gradually. It’s easy to miss subtle warning signs until the disease has progressed. Conditions such as plaque buildup (atherosclerosis) develop very slowly over many years. Pain, numbness, and fatigue of the legs are signs of vascular conditions that can be easily confused with diabetic neuropathy, sports injuries, or osteoarthritis. 

My vascular surgery colleagues and I help patients identify the root cause of their symptoms and get on track for better cardiovascular health. We care for the network of blood vessels located outside the heart to keep blood flowing effectively throughout the body. Vascular surgeons are the experts on taking care of arteries and veins all over the body outside of the heart. 

The sooner we can act to manage your vascular health, the better your chances at an excellent outcome. That’s why keeping track of related—and seemingly unrelated—symptoms can make a big difference.

Top 5 overlooked symptoms of vascular disease.

1. Leg fatigue or calf cramping that disappears with rest.

This symptom is a classic indication of peripheral artery disease (PAD). Gradual buildup of plaque restricts needed blood flow to the limbs, most often the legs and feet. It happens when narrowing and plaque buildup inside the leg arteries restricts the flow of oxygen-rich blood. 

At rest, the calf muscles don’t need much blood flow. But when you begin to walk, the muscles require a sudden surge of oxygen. With arteries narrowed by PAD, that blood can’t get through causing the muscle to tire out and cramp. You might notice your calf cramping up during a walk to the mailbox or the grocery store. Usually, the discomfort goes away after sitting down for a few minutes. 

Related: Read “Peripheral Artery Disease (PAD): Symptoms, Causes, and Treatments.”

2. Leg heaviness or aching that worsens in the evening.

A persistent, heavy ache in your legs may signal a problem with your venous or return circulation, which can lead to a condition known as chronic venous insufficiency. 

The veins in your legs are equipped with a series of tiny one-way valves designed to snap shut and prevent blood from flowing backward as it travels against gravity to your heart. These valves can stretch, weaken, or fail to close properly due to genetic or environmental factors.

When this happens, blood struggles to return to the heart and begins to pool in the lower legs under increased pressure. This pooling creates an exhausting ache that grows heavier after hours spent sitting at a computer or standing on your feet.

3. Chronic ankle swelling that goes away at night.

Venous insufficiency can progress, and as blood continues to pool in the lower extremities the increased pressure forces fluid to leak out of the veins and into nearby tissues. 

This creates a predictable pattern of swelling. Patients usually wake up in the morning with unswollen ankles. As they go about their day, fluid steadily builds up and the ankles swell. 

One way to check for this at home is called the sock test. If you remove your socks at the end of the day to find deep indentations in the skin around your ankles it’s a clear sign of fluid buildup.

4. Visible varicose veins and skin color changes.

It’s a common myth that bulging varicose veins are just unsightly, or a harmless sign of getting older. Varicose and spider veins are dark colored, bulging veins that look like cords on the legs and can be a sign of deeper vein trouble and valve failure.

If chronic blood pooling goes unaddressed, iron from trapped red blood cells can leak into surrounding tissues. This causes inflammation and permanent staining, turning the skin around the lower legs and ankles dark, rusty, or discolored. 

Related: Read: “What’s the Difference Between Varicose Veins and Spider Veins?”

5. Foot wounds that won’t heal, or pain at night.

Patients can experience a severe, burning discomfort known as nighttime rest pain. This pain usually strikes when they’re lying flat in bed, forcing patients to wake up and hang their legs over the edge of the mattress so gravity can pull blood down into the foot. It’s a sign of advanced arterial disease in which the tissues are starved of oxygen even at rest.

Minor cuts, blisters, or scrapes on the feet that don’t heal properly are a big red flag, too. Patients with diabetes are at high risk of these non-healing leg and foot ulcers. Blockages can develop in the microscopic blood vessels below the knee, increasing the danger of severe infection or limb loss. 

Related: Read “How Team Care Helps Patients Treat, Prevent, and Recover from Non-healing Wounds.”

How a vascular surgeon can help.

Patients sometimes think that scheduling an appointment with a surgeon means you’re automatically headed to the operating room. Most of my work involves non-invasive diagnostic testing, lifestyle management, medicines, minimally invasive procedures, and routine monitoring. Vascular surgeons are uniquely trained to offer the full array of treatments (from minimally invasive to complex surgical) to treat both arterial and venous diseases. 

Vascular surgery specialists manage a wide array of conditions, including:
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• Aneurysm: Dangerous, abnormal ballooning or weakening of a blood vessel wall that requires careful monitoring to prevent a rupture

• Carotid artery disease: Narrowing of the main blood vessels supplying the brain, which can significantly raise the risk of a stroke

• Deep vein thrombosis/Pulmonary embolism: Blood clots in the legs and arms that can travel through the bloodstream and to the lungs

• Chronic venous insufficiency: Leaky valves in the leg veins that impede proper return circulation from the legs and cause varicose veins, swelling, and heaviness in the legs.

• Peripheral arterial disease: Blocked arteries in the legs causing nonhealing wounds or leg pain.

• Dialysis access: Making sure dialysis patients get a functional arteriovenous fistula or graft in their arm so they can get their blood cleaned.

Vascular surgeons focus on advanced, minimally invasive endovascular procedures instead of only traditional, open operations.

Next steps: What to expect during an evaluation.

Acting early gives us the best opportunity to protect your long-term mobility and health. If you recognize any of these warning signs in your own legs, talk with your primary care doctor. They’ll begin by evaluating your overall health and ruling out other causes.

Don’t delay scheduling an appointment; the process isn’t stressful or painful. An initial evaluation by a vascular specialist relies on simple, non-invasive tools like checking your pulse, using sound waves to take pictures of your blood flow, and special blood pressure cuffs to measure how your blood moves. 

Trusted care for vascular conditions.

Circulation problems share the same system-wide risk factors as other serious conditions such as heart attack and stroke. That’s why choosing an integrated health network with multidisciplinary teams is important for your long-term wellness.

At MedStar Health, our heart and vascular program features collaborative teams of specialists who consider the health of the whole patient. To help you manage your overall cardiovascular health, we partner closely across specialties, including cardiologists and hematologists, primary care providers, and vascular testing specialists.

Our board-certified care providers in our Vascular Surgery and Endovascular Program ensure your care meets the highest standards of clinical evidence and patient safety. Working together, we can help you identify symptoms of vascular conditions, manage your medications and lifestyle, and provide minimally invasive treatment options when needed that help you achieve the best outcomes.