Blood vessel disorder: Difference between revisions
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=== Atherosclerosis === |
=== Atherosclerosis === |
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[[Atherosclerosis]] is a developmental disease in the large arteries, defined by the accumulation of lipids, macrophages and fibrous materials in the intima<ref name=":0" />. When the endothelial cell of blood vessel is damaged, it loses the ability to regulate itself<ref name=":0" />. |
[[Atherosclerosis]] is a developmental disease in the large arteries, defined by the accumulation of lipids, macrophages and fibrous materials in the intima<ref name=":0" />. When the endothelial cell of blood vessel is damaged, it loses the ability to regulate itself<ref name=":0" />. It results in inflammation as the [[Macrophage|macrophages]] irrupt the vessel wall<ref name=":0" />. Macrophages take up lipoprotein to form foam cells and release growth factor [[Cytokine|cytokines]] to attract more macrophages and smooth muscle cells<ref name=":0" />. A plaque is formed and proliferate to a larger size, gradually occluding the blood flow<ref name=":0" />. More importantly, it causes different complications that affect the whole body<ref name=":0" />. |
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=== Aneurysm === |
=== Aneurysm === |
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An [[aneurysm]] is a localized enlargement of arteries, characterized by a balloon-like bulge<ref>{{Cite journal|last=Mironov|first=A|date=2009-07-01|title=026 Pathogenetic factors and management of distal dissecting brain aneurysms|url=http://dx.doi.org/10.1136/jnis.2009.000851z|journal=Journal of NeuroInterventional Surgery|volume=1|issue=1|pages=83–83|doi=10.1136/jnis.2009.000851z|issn=1759-8478}}</ref>. It |
An [[aneurysm]] is a localized enlargement of arteries, characterized by a balloon-like bulge<ref>{{Cite journal|last=Mironov|first=A|date=2009-07-01|title=026 Pathogenetic factors and management of distal dissecting brain aneurysms|url=http://dx.doi.org/10.1136/jnis.2009.000851z|journal=Journal of NeuroInterventional Surgery|volume=1|issue=1|pages=83–83|doi=10.1136/jnis.2009.000851z|issn=1759-8478}}</ref>. It results from the abnormal weakening of blood vessel wall<ref name=":3">{{Cite web|url=http://dx.doi.org/10.1036/1097-8542.034100|title=Aneurysm|website=AccessScience|access-date=2019-03-22}}</ref>. Common types of aneurysm include [[Abdominal aortic aneurysm|abdominal aortic aneurysm]], [[Thoracic aortic aneurysm|thoracic aortic aneurysm]] and [[Intracranial aneurysm|intracranial aneurysm]]<ref name=":3" />. Most types of aneurysm, except intracranial aneurysm, are mainly caused by atherosclerosis<ref name=":3" />. |
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[[File:Raynauld.jpg|thumb|Symptoms of Raynaud's disease]] |
[[File:Raynauld.jpg|thumb|Symptoms of Raynaud's disease]] |
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[[Raynaud syndrome|Raynaud’s disease]] is a rare peripheral vascular syndrome that narrows blood vessels, generally in the hands and feet, due to cold or stressful emotion<ref name=":4">{{Cite journal|last=Cooke|first=John P|last2=Marshall|first2=Janice M|date=2005-11|title=Mechanisms of Raynaud’s disease|url=http://dx.doi.org/10.1191/1358863x05vm639ra|journal=Vascular Medicine|volume=10|issue=4|pages=293–307|doi=10.1191/1358863x05vm639ra|issn=1358-863X}}</ref>. It reduces blood flow to fingers and toes and results in a drastic color change to white or blue<ref name=":4" />. The [[etiology]] starts with the activation of sympathetic nervous system triggered by cold or the feeling of stress<ref name=":4" />. |
[[Raynaud syndrome|Raynaud’s disease]] is a rare peripheral vascular syndrome that narrows blood vessels, generally in the hands and feet, due to cold or stressful emotion<ref name=":4">{{Cite journal|last=Cooke|first=John P|last2=Marshall|first2=Janice M|date=2005-11|title=Mechanisms of Raynaud’s disease|url=http://dx.doi.org/10.1191/1358863x05vm639ra|journal=Vascular Medicine|volume=10|issue=4|pages=293–307|doi=10.1191/1358863x05vm639ra|issn=1358-863X}}</ref>. It reduces blood flow to fingers and toes and results in a drastic color change to white or blue<ref name=":4" />. The [[etiology]] starts with the activation of sympathetic nervous system triggered by cold or the feeling of stress<ref name=":4" />. |
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[[File:Erythromelalgia.jpg|thumb|Symptoms of erythromelalgia]] |
[[File:Erythromelalgia.jpg|thumb|Symptoms of erythromelalgia]] |
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| ⚫ | [[Venous thrombosis|Venous thromboembolism]] (VTE) is a common peripheral venous disease. It is defined by the occlusion of venous blood vessels by blood clots. There are two major types of VTE: deep-vein thrombosis (DVT) and pulmonary embolism<ref>{{Cite journal|last=Wolberg|first=Alisa S.|last2=Rosendaal|first2=Frits R.|last3=Weitz|first3=Jeffrey I.|last4=Jaffer|first4=Iqbal H.|last5=Agnelli|first5=Giancarlo|last6=Baglin|first6=Trevor|last7=Mackman|first7=Nigel|date=2015-05-07|title=Venous thrombosis|url=http://dx.doi.org/10.1038/nrdp.2015.6|journal=Nature Reviews Disease Primers|pages=15006|doi=10.1038/nrdp.2015.6|issn=2056-676X}}</ref>. DVT is often found in the calf, accompanies with the swelling of limbs along the deep vein while [[pulmonary embolism]] causes chronic [[pulmonary hypertension]]<ref name=":6">{{Cite journal|last=Furie|first=Bruce|last2=Furie|first2=Barbara C.|date=2008-08-28|title=Mechanisms of Thrombus Formation|url=http://dx.doi.org/10.1056/nejmra0801082|journal=New England Journal of Medicine|volume=359|issue=9|pages=938–949|doi=10.1056/nejmra0801082|issn=0028-4793}}</ref>. VTE is the third deadliest cardiovascular disease in the world<ref name=":6" />. [[Hemostasis|Haemostasis]] is the rapid development of blood clots for the purpose of reducing blood loss<ref name=":6" />. On a contrary, venous clots are formed much slower, in terms of several days or even weeks. Abnormality of coagulation during haemostasis, change in blood flow and endothelial failure may trigger VTE<ref name=":6" />. |
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=== Erythromelalgia === |
=== Erythromelalgia === |
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[[Erythromelalgia]] is a rare clinical disorder causing redness, burning sensation and intense pain in limbs<ref name=":5">{{Cite journal|last=Davis|first=Mark Denis P.|date=2004-03|title=Erythromelalgia|url=http://dx.doi.org/10.4065/79.3.298|journal=Mayo Clinic Proceedings|volume=79|issue=3|pages=298|doi=10.4065/79.3.298|issn=0025-6196}}</ref>. It is more common to be found in lower limbs than upper limbs<ref name=":5" />. Erythromelalgia initiated from dysfunction of peripheral nerves that thickens the blood vessel walls, resulting in hyperaemic flow in limbs<ref>{{Citation|last=Daniels|first=Justin|title=Erythromelalgia|date=2011-05-24|url=http://dx.doi.org/10.1002/9781444345384.ch166|work=Harper's Textbook of Pediatric Dermatology|pages=166.1–166.4|publisher=Wiley-Blackwell|isbn=9781444345384|access-date=2019-03-22}}</ref>. |
[[Erythromelalgia]] is a rare clinical disorder causing redness, burning sensation and intense pain in limbs<ref name=":5">{{Cite journal|last=Davis|first=Mark Denis P.|date=2004-03|title=Erythromelalgia|url=http://dx.doi.org/10.4065/79.3.298|journal=Mayo Clinic Proceedings|volume=79|issue=3|pages=298|doi=10.4065/79.3.298|issn=0025-6196}}</ref>. It is more common to be found in lower limbs than upper limbs<ref name=":5" />. Erythromelalgia initiated from dysfunction of peripheral nerves that thickens the blood vessel walls, resulting in hyperaemic flow in limbs<ref>{{Citation|last=Daniels|first=Justin|title=Erythromelalgia|date=2011-05-24|url=http://dx.doi.org/10.1002/9781444345384.ch166|work=Harper's Textbook of Pediatric Dermatology|pages=166.1–166.4|publisher=Wiley-Blackwell|isbn=9781444345384|access-date=2019-03-22}}</ref>. |
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| ⚫ | |||
| ⚫ | [[Venous thrombosis|Venous thromboembolism]] (VTE) is a common peripheral venous disease. There are two major types of VTE: deep-vein thrombosis (DVT) and pulmonary embolism<ref>{{Cite journal|last=Wolberg|first=Alisa S.|last2=Rosendaal|first2=Frits R.|last3=Weitz|first3=Jeffrey I.|last4=Jaffer|first4=Iqbal H.|last5=Agnelli|first5=Giancarlo|last6=Baglin|first6=Trevor|last7=Mackman|first7=Nigel|date=2015-05-07|title=Venous thrombosis|url=http://dx.doi.org/10.1038/nrdp.2015.6|journal=Nature Reviews Disease Primers|pages=15006|doi=10.1038/nrdp.2015.6|issn=2056-676X}}</ref>. DVT is often found in the calf, accompanies |
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=== Stroke === |
=== Stroke === |
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Stroke is a serious condition of blood vessel disorder caused by the stop of blood supply to the brain. |
[[Stroke]] is a serious condition of blood vessel disorder caused by the stop of blood supply to the brain. Brain cells with ceased oxygen supply from blood will die in millions per second<ref>{{Cite journal|last=Owens|first=Brian|date=2014-06|title=Stroke|url=http://dx.doi.org/10.1038/510s1a|journal=Nature|volume=510|issue=7506|pages=S1–S1|doi=10.1038/510s1a|issn=0028-0836}}</ref>. Not only it is one of the major causes of death around the world, it is also the cause permanent disability. Two major types of stroke include: ischemic stroke which is caused by atherosclerosis in the brain, and hemorrhagic stroke which is the bleeding in the brain due to weakened blood vessel wall inside the brain. |
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== Diagnosis == |
== Diagnosis == |
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== Risk factors == |
== Risk factors == |
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Various factors may affect one's susceptibility to blood vessel disorders, including behavioural (e.g. smoking), demographic (e.g. age) and genetic (family history) factors. Most of these risk factors first promote the increase of blood pressure, followed by other symptoms and signs. |
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These risk factors usually first causes hypertension, then result in various types of blood vessel disorders. |
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=== Age === |
=== Age === |
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=== Smoking === |
=== Smoking === |
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Both active or passive smoking may bring harm to the vascular system |
Both active or passive smoking may bring harm to the vascular system<ref name=":11">{{Cite web|url=https://www.sciencedirect.com/science/article/pii/S0033350612004702?via%3Dihub|title=ScienceDirect|website=www.sciencedirect.com|doi=10.1016/j.puhe.2012.12.021|access-date=2019-04-01}}</ref>. For instance, cigarette smoking, [[Cannabinoid|cannabinoids]] and smokeless tobacco use were all found to raise blood pressure and increase the risk of stroke<ref name=":11" />. Moreover, cigar and cigarette smoking may also causes arterial stiffness<ref name=":11" />. |
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=== Medication === |
=== Medication === |
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Revision as of 09:11, 3 April 2019
Blood vessel disorder generally refers to the narrowing, hardening or enlargement of arteries and veins. It is often due to the build-up of fatty deposits in the lumen of blood vessels or infection of the vessel wall. This can occur in various locations such as coronary blood vessels, peripheral arteries and veins. The narrowed arteries would block the blood supply to different organs and tissues[1]. In severe conditions, it may develop into more critical health problems like myocardial infarction, stroke or heart failure, which are the leading causes of death worldwide[2].
There are many causes contributing to blood vessel disorder including high blood cholesterol and calcium levels, blood clot formation and inflammation of arteries. It is found that sedentary lifestyle, diets rich in lipids, smoking, diabetes and family history of cardiovascular diseases are common risk factors[3]. A mild degree of blood vessel disorder may be asymptomatic[4]. Blood tests on cholesterol and calcium level can be performed to monitor the risk of having the disorder. Additionally, techniques such as angiography and ultrasound imaging are useful tools for diagnosis[5]. It can be treated by both medication or surgery, depending on the type of blood vessel disorder.
Signs and symptoms
It is often asymptomatic in the early stages of blood vessel disorder[4]. When the disease develops, a variety of signs can be observed in different body parts. For instance, patients may have pale skin, cold hands and feet, and numb fingertips. These are mainly due to the reduction in blood flow to the limbs, resulting in a decrease in heat distribution to these areas. Ulcers and wounds would also take a much longer time to heal because of the impairment in blood clot formation process. Muscle weakness and cramping may occur as well, especially in the legs, because of the insufficient oxygen supply to muscle cells for metabolism.
Types of Blood Vessel Disorder
Atherosclerosis
Atherosclerosis is a developmental disease in the large arteries, defined by the accumulation of lipids, macrophages and fibrous materials in the intima[1]. When the endothelial cell of blood vessel is damaged, it loses the ability to regulate itself[1]. It results in inflammation as the macrophages irrupt the vessel wall[1]. Macrophages take up lipoprotein to form foam cells and release growth factor cytokines to attract more macrophages and smooth muscle cells[1]. A plaque is formed and proliferate to a larger size, gradually occluding the blood flow[1]. More importantly, it causes different complications that affect the whole body[1].
Aneurysm
An aneurysm is a localized enlargement of arteries, characterized by a balloon-like bulge[6]. It results from the abnormal weakening of blood vessel wall[7]. Common types of aneurysm include abdominal aortic aneurysm, thoracic aortic aneurysm and intracranial aneurysm[7]. Most types of aneurysm, except intracranial aneurysm, are mainly caused by atherosclerosis[7].
Raynaud’s Disease
Raynaud’s disease is a rare peripheral vascular syndrome that narrows blood vessels, generally in the hands and feet, due to cold or stressful emotion[8]. It reduces blood flow to fingers and toes and results in a drastic color change to white or blue[8]. The etiology starts with the activation of sympathetic nervous system triggered by cold or the feeling of stress[8].
Venous thromboembolism
Venous thromboembolism (VTE) is a common peripheral venous disease. It is defined by the occlusion of venous blood vessels by blood clots. There are two major types of VTE: deep-vein thrombosis (DVT) and pulmonary embolism[9]. DVT is often found in the calf, accompanies with the swelling of limbs along the deep vein while pulmonary embolism causes chronic pulmonary hypertension[10]. VTE is the third deadliest cardiovascular disease in the world[10]. Haemostasis is the rapid development of blood clots for the purpose of reducing blood loss[10]. On a contrary, venous clots are formed much slower, in terms of several days or even weeks. Abnormality of coagulation during haemostasis, change in blood flow and endothelial failure may trigger VTE[10].
Erythromelalgia
Erythromelalgia is a rare clinical disorder causing redness, burning sensation and intense pain in limbs[11]. It is more common to be found in lower limbs than upper limbs[11]. Erythromelalgia initiated from dysfunction of peripheral nerves that thickens the blood vessel walls, resulting in hyperaemic flow in limbs[12].
Stroke
Stroke is a serious condition of blood vessel disorder caused by the stop of blood supply to the brain. Brain cells with ceased oxygen supply from blood will die in millions per second[13]. Not only it is one of the major causes of death around the world, it is also the cause permanent disability. Two major types of stroke include: ischemic stroke which is caused by atherosclerosis in the brain, and hemorrhagic stroke which is the bleeding in the brain due to weakened blood vessel wall inside the brain.
Diagnosis
Doctors may look for signs of narrowed, enlarged or hardened arteries by performing a physical examination[14]. If blood vessel disorder is present, there will be a weak or even absent pulse under the narrowed area of the artery. The blood pressure in the affected limb would be lowered and whooshing sounds can be heard over the affected arteries using a stethoscope[14]. After that, the following tests could be adapted to further locate the point of narrowing or enlargement of blood vessels.
Angiography
Angiography is a medical imaging technique used to visualize the lumen of blood vessels[15]. A catheter, which is a long and thin tube, is inserted into a large artery in the arm or groin area. It is then guided along the artery to the targeted blood vessel to be examined. An imaging dye is loaded into the blood vessel through the catheter and the movement of the dye in the blood vessel is recorded as an angiogram[15]. Doctors could determine if there are any abnormalities in the blood vessel using fluoroscopy, computed tomography (CT) angiography or magnetic resonance (MR) angiography. After the catheter is removed, some pressure is applied to the incision site for 10 to 20 minutes to prevent excessive bleeding.
Vascular ultrasound
Vascular ultrasound is a non-invasive imaging method to examine the circulation inside blood vessels. Sound waves are transmitted through the tissues of the targeted area and they reflect on the blood cells moving within blood vessels[16]. The waves recorded are displayed as an image of the blood vessel and the speed of waves detected can be used to calculate the speed of blood flow inside the vessel[17]. When the rate of blood flow is too low, there may be a blockage of vessel. By evaluating blood flow in vessels, the severity and specific location of blood vessel disorder can be determined[17].
Risk factors
Various factors may affect one's susceptibility to blood vessel disorders, including behavioural (e.g. smoking), demographic (e.g. age) and genetic (family history) factors. Most of these risk factors first promote the increase of blood pressure, followed by other symptoms and signs.
Age
The rise of blood pressure is correlated to ageing[3]. The arterial compliance - the amount of tension produced per stretch of arteries, decreases with age, and the stiffness of arteries increases with age[3]. The structural change in blood vessels causes the elderly to be more susceptible to hypertension, which leads to complications in arteries, the heart and even the brain.
Obesity
Having obesity would increase the risk of atherosclerosis[1]. A high-fat and high-cholesterol diet would result in an elevation of lipoprotein level, which is one of the constituents of plaque. Lipoprotein level above > 25-30 mg/dl is considered more susceptible by blood vessel disorders[1].
Family history
Some of the blood vessel disorders are inherited. For instance, erythromelalgia is caused by the mutation of the SCN9A gene, which alters the neural pathway to blood vessels[8]. Genetic disorders that affect the circulatory, immune or neural system may contribute to hereditary blood vessel disorder. If one’s family history shows records of vascular disorders, it is more likely to inherit the same disease.
Smoking
Both active or passive smoking may bring harm to the vascular system[18]. For instance, cigarette smoking, cannabinoids and smokeless tobacco use were all found to raise blood pressure and increase the risk of stroke[18]. Moreover, cigar and cigarette smoking may also causes arterial stiffness[18].
Medication
Some medications may have the side effect of increasing blood pressure and may even suppress the effect of anti-inflammatory drugs. Pain and anti-inflammatory drugs like Indomethacin, nonsteroidal anti-inflammatory drugs and piroxicam would retain water in the systemic circulation, raising the blood pressure[19]. Other types of medications like antidepressant, hormone and caffeine would also increase blood pressure.
Complications
The vascular system strongly influences the condition of the heart. It is also vital in the rest of the body as the blood vessels are in charge of carrying nutrients and the discard of metabolic wastes. Therefore, blood vessel disorder can cause serious complications in the whole body.
Coronary arteries are the blood vessels that supply to the heart for its normal function. Blood vessel disorders occur in coronary arteries would affect cardiac activity. For instance, in atherosclerosis, the plaque would obstruct and causes ischaemia - the reduction of blood flow through the arteries. Ischaemia would then result in the decrease in oxygen supply to the heart, hence weaken the heart. If the plaque suddenly ruptures in heart, it will cause a heart attack.
Treatment
Different kinds of treatment should be adopted according to the type and severity of blood vessel disorder. Medications are usually prescribed to relieve specific symptoms arisen from the disease while surgery like angioplasty can be performed to provide a more long-lasting effect.
Surgery
Angioplasty is a procedure used to widen narrowed blood vessels, especially in coronary arteries. A long and thin tube called catheter is inserted into a large artery through an incision in the wrist, arm or groin area. The catheter is guided to the affected artery using a real-time x-ray video. A thin wire is then introduced into the blood vessel, delivering a small balloon to the affected area. The balloon is inflated to stretch the blood vessel and compress the fatty deposits against the wall of artery[20]. Hence, the vessel is widened and blood can flow through it freely to maintain adequate blood supply to different tissues. Finally, the balloon is deflated and removed. A stent may also be placed to provide support to the vessel wall and prevent it from re-narrowing[21].
Medications
Beta blockers are drugs that inhibit the sympathetic nervous system by blocking the beta adrenergic receptors. They can be used to slow down heart rate and decrease blood pressure by inhibiting beta receptors in the heart[22]. These drugs also induce vasodilation by relaxing vascular smooth muscle. Examples of beta blockers include propranolol, timolol and atenolol.
Calcium channel blockers are medications that prevent the movement of calcium ions across calcium channels. They can be used to relieve hypertension by causing vascular smooth muscle relaxation[23]. They also reduce the heart rate and contractility to lower the cardiac output, which in turn lower blood pressure. Amlodipine, hydralazine and dihydropyridine are examples of calcium channel blockers.
Other drugs such as angiotensin-converting enzyme (ACE) inhibitors and diuretics can be used to relieve hypertension[24]. Statins and fibrates can also be prescribed to lower blood cholesterol level and hence reducing the risk of plaque formation in blood vessels[25]. Anti-platelet medications e.g. aspirin help reducing blood clot formation in vessels as well.
References
- ^ a b c d e f g h i Lusis, Aldons J. (2000-09). "Atherosclerosis". Nature. 407 (6801): 233–241. doi:10.1038/35025203. ISSN 0028-0836.
{{cite journal}}: Check date values in:|date=(help) - ^ "The top 10 causes of death". www.who.int. Retrieved 2019-03-14.
- ^ a b c Pinto, E. (2007-02-01). "Blood pressure and ageing". Postgraduate Medical Journal. 83 (976): 109–114. doi:10.1136/pgmj.2006.048371. ISSN 0032-5473.
- ^ a b Høyer, Christian (2014), "Diagnosis of Peripheral Arterial Disease Based on Distal Limb Pressures", Diagnosis of Peripheral Arterial Disease Based on Distal Limb Pressures, River Publisher, pp. 1–129, ISBN 9788793102781, retrieved 2019-03-22
- ^ Espinola-Klein, C. (2011-04-02). "Periphere arterielle Verschlusskrankheit". Der Internist. 52 (5): 549–561. doi:10.1007/s00108-011-2814-7. ISSN 0020-9554.
- ^ Mironov, A (2009-07-01). "026 Pathogenetic factors and management of distal dissecting brain aneurysms". Journal of NeuroInterventional Surgery. 1 (1): 83–83. doi:10.1136/jnis.2009.000851z. ISSN 1759-8478.
- ^ a b c "Aneurysm". AccessScience. Retrieved 2019-03-22.
- ^ a b c d Cooke, John P; Marshall, Janice M (2005-11). "Mechanisms of Raynaud's disease". Vascular Medicine. 10 (4): 293–307. doi:10.1191/1358863x05vm639ra. ISSN 1358-863X.
{{cite journal}}: Check date values in:|date=(help) - ^ Wolberg, Alisa S.; Rosendaal, Frits R.; Weitz, Jeffrey I.; Jaffer, Iqbal H.; Agnelli, Giancarlo; Baglin, Trevor; Mackman, Nigel (2015-05-07). "Venous thrombosis". Nature Reviews Disease Primers: 15006. doi:10.1038/nrdp.2015.6. ISSN 2056-676X.
- ^ a b c d Furie, Bruce; Furie, Barbara C. (2008-08-28). "Mechanisms of Thrombus Formation". New England Journal of Medicine. 359 (9): 938–949. doi:10.1056/nejmra0801082. ISSN 0028-4793.
- ^ a b Davis, Mark Denis P. (2004-03). "Erythromelalgia". Mayo Clinic Proceedings. 79 (3): 298. doi:10.4065/79.3.298. ISSN 0025-6196.
{{cite journal}}: Check date values in:|date=(help) - ^ Daniels, Justin (2011-05-24), "Erythromelalgia", Harper's Textbook of Pediatric Dermatology, Wiley-Blackwell, pp. 166.1–166.4, ISBN 9781444345384, retrieved 2019-03-22
- ^ Owens, Brian (2014-06). "Stroke". Nature. 510 (7506): S1–S1. doi:10.1038/510s1a. ISSN 0028-0836.
{{cite journal}}: Check date values in:|date=(help) - ^ a b "Arteriosclerosis / atherosclerosis - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Retrieved 2019-03-28.
- ^ a b Masters, Barry R. (2012-05-25). "Harrisons's Principles of Internal Medicine, 18th Edition, two volumes and DVD. Eds: Dan L. Longo, Anthony S. Fauci, Dennis L. Kasper, Stephen L. Hauser, J. Larry Jameson and Joseph Loscalzo, ISBN-13: 9780071748896 McGraw Hill". Graefe's Archive for Clinical and Experimental Ophthalmology. 250 (9): 1407–1408. doi:10.1007/s00417-012-1940-9. ISSN 0721-832X.
- ^ Abigail., Thrush, (2006). Peripheral vascular ultrasound : how, why, and when. Elsevier Churchill Livingstone. ISBN 0443072833. OCLC 475766794.
{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) - ^ a b Roman, Mary J; Naqvi, Tasneem Z; Gardin, Julius M; Gerhard-Herman, Marie; Jaff, Michael; Mohler, Emile (2006-08). "American Society of Echocardiography Report". Vascular Medicine. 11 (3): 201–211. doi:10.1177/1358863x06070511. ISSN 1358-863X.
{{cite journal}}: Check date values in:|date=(help) - ^ a b c "ScienceDirect". www.sciencedirect.com. doi:10.1016/j.puhe.2012.12.021. Retrieved 2019-04-01.
- ^ Johnson, Anthony G. (1994-08-15). "Do Nonsteroidal Anti-inflammatory Drugs Affect Blood Pressure? A Meta-Analysis". Annals of Internal Medicine. 121 (4): 289. doi:10.7326/0003-4819-121-4-199408150-00011. ISSN 0003-4819.
- ^ Serruys, Patrick W.; de Jaegere, Peter; Kiemeneij, Ferdinand; Macaya, Carlos; Rutsch, Wolfgang; Heyndrickx, Guy; Emanuelsson, Hakan; Marco, Jean; Legrand, Victor (1994-08-25). "A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease". New England Journal of Medicine. 331 (8): 489–495. doi:10.1056/nejm199408253310801. ISSN 0028-4793.
- ^ Kempczinski, Richard (1987-11). "Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty". Journal of Vascular Surgery. 6 (5): 533. doi:10.1016/0741-5214(87)90320-x. ISSN 0741-5214.
{{cite journal}}: Check date values in:|date=(help) - ^ Wiysonge, Charles S; Bradley, Hazel A; Volmink, Jimmy; Mayosi, Bongani M; Opie, Lionel H (2017-01-20). "Beta-blockers for hypertension". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd002003.pub5. ISSN 1465-1858.
- ^ Mason, R.P.; Marche, P.; Hintze, T.H. (2003-12). "Novel Vascular Biology of Third-Generation L-Type Calcium Channel Antagonists". Arteriosclerosis, Thrombosis, and Vascular Biology. 23 (12): 2155–2163. doi:10.1161/01.atv.0000097770.66965.2a. ISSN 1079-5642.
{{cite journal}}: Check date values in:|date=(help) - ^ Flather, Marcus D; Yusuf, Salim; Køber, Lars; Pfeffer, Marc; Hall, Alistair; Murray, Gordon; Torp-Pedersen, Christian; Ball, Stephen; Pogue, Janice (2000-05). "Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients". The Lancet. 355 (9215): 1575–1581. doi:10.1016/s0140-6736(00)02212-1. ISSN 0140-6736.
{{cite journal}}: Check date values in:|date=(help) - ^ "Intensive versus moderate lipid lowering with statins after acute coronary syndromes*". Obstetrics & Gynecology. 104 (1): 188. 2004-07. doi:10.1097/01.aog.0000133105.83326.47. ISSN 0029-7844.
{{cite journal}}: Check date values in:|date=(help)