The diversity of vascular disease: A clinician’s perspective

Passing through the portals of any vascular medicine clinic is an assortment of poor souls that manifest diverse signs and symptoms of vascular disorders and coexisting medical conditions. In the Vascular Medicine Clinic at Stanford University, the majority of these individuals are sent to us by their physicians with a presumptive diagnosis of “peripheral vascular disease,” a general term providing little information about the patient’s condition. Under the rubric of peripheral vascular disease fall a great variety of ailments that include arterial, arteriolar, venous, and lymphatic disorders. Each of these disorders may include developmental and=or acquired abnormalities of vascular function or structure, often complicated by coexisting derangements of hemodynamics, immune function, metabolism, or coagulation. A particular vascular disease may manifest in a variety of guises depending upon the age and gender of the afflicted, the chronicity of the condition, the concomitant medical disorders, and the interaction with environmental, behavioral, cultural, and genetic influences specific to the individual patient. Relevant to the focus of this volume, it is likely that the anatomic distribution, progression, and severity of vascular diseases are determined in part by phenotypic heterogeneity of the endothelium.