Angiology

The term was first introduced by Claudius Galen , who called angiology an operation to excise a part of a blood vessel, that is, a surgical operation on blood vessels.

The selection of angiology as an independent branch of medicine was dictated primarily by the prevalence of vascular diseases, which caused the death or disability of a large contingent of people both in peacetime and in wartime. Thus, according to B. V. Petrovsky and F. M. Plotkin , 32.9% of all vascular injuries during the Patriotic War of 1941-1945 were isolated lesions of the arteries , and 64.5% were combined lesions of the arteries and veins . According to statistics from Moscow prosektur, every tenth person among those over 30 years old dies from atherosclerosis of the arteries . According to I. A. Kostromov ( 1948 ), varicose veins were observed in 15.3% of the examined patients. Some foreign authors (Dodd and Kokkett (N. Dodd, F. Cockett), 1956 ) believe that every fifth woman and every fifteenth man suffers from varicose veins.

Signs of arterial and venous bleeding , methods of stopping them, as well as diseases such as varicose veins , spontaneous gangrene, etc. were known to the doctors of ancient Rome , Greece and Egypt . In 3–4 centuries of our era, operations were suggested by Antillus and Filagrius aneurysms , which remained almost unchanged until the 30s-40s of our century. Hippocrates suggested amputation of the limb in "spontaneous gangrene." In the works of the doctors of the Middle Ages, Vesalius Andreas and Ambroise Pare, a lot of space is devoted specifically to issues of temporary or permanent arrest of bleeding from the vessels.

Intensive development of angiology began in the 17th century . Knowledge of the anatomy and physiology of arteries, veins and capillaries is accumulated, previously unknown vascular lesions are described , 1702; Dupuytren (G. Dupuytren) , 1833; , 1879; NI Pirogov , 1866, Raynaud (M. AG Raynaud) , 1862) various, mainly physiotherapy , methods of treatment are proposed. The first classifications of vascular lesions appear and attempts are made to scientifically substantiate a number of surgical interventions on the vessels: ligation with regard to collateral circulation , removal of aneurysms, etc. ( V. Pelikan , 1817; I. V. Buyalsky , 1823; N. I. Pirogov, 1832) . In the same period, the first successful operation of suturing the brachial artery wound is done (Hallowel, 1759).

The introduction of methods of asepsis and antisepsis , anesthesia and radiology into medicine allowed in the mid- 19th century surgery, in particular angiology, to take a new approach to the surgical treatment of a number of vascular diseases. Attempts are being made to substantiate the possibility of imposing a vascular suture in the event of a lesion of the vessels and a variety of suture modifications are proposed. In 1902, A. Carrel published his foundational work on the vascular suture. In subsequent studies on auto-, homo-, and vascular heteroplasty, he laid the foundations for modern vascular reconstructive surgery.

In 1928, Dos Santos, Lamas and Caldas (R. Dos Santos, A. Lamas, P. Caldas) successfully applied in the clinic an improved technique of intra-arterial injection of contrast agents ( iopromid ) to clarify the nature of the lesion of peripheral arteries. The contrast image of small circle vessels was first obtained by Forssmann (W. Forssmann, 1929) . Angiography is widely used in angiography to diagnose lesions of the main arteries and veins. Improved equipment and research methods, improved contrast agents. All this led to the fact that angiography becomes the main diagnostic tool in angiology, which allows to accurately determine the nature of the lesion, its length and the degree of development of the collateral circulation. ^[2]

The modern interpretation was formulated by L. Heister. In addition to Galen, Vesalius , Malpighi and others made a great contribution to the formation of angiological knowledge. ^[3]

All vessels of the human body are divided into several types:

• Arteries ,
• Arterioles
• Veins ,
• Venules ,
• Capillaries ,
• Lymphatic ducts .

The section of angiology dealing with the treatment of venous and lymphatic vessels is called phlebology , and the study of diseases of the arteries is called arteriology . ^[four]

Types of blood vessels

1. The main vessels are the largest arteries in which the rhythmically pulsating, changeable blood flow turns into a more even and smooth. The walls of these vessels contain few smooth muscle elements and a lot of elastic fibers . The main vessels have little resistance to blood flow.

2. Resistive vessels (resistance vessels) include precapillary (small arteries, arterioles, precapillary sphincters) and postcapillary (venules and small veins) resistance vessels. The ratio between the tone of the pre- and postcapillary vessels determines the level of hydrostatic pressure in the capillaries, the magnitude of the filtration pressure and the intensity of fluid exchange.

3. True capillaries (exchange vessels) - the most important part of the cardiovascular system. Through the thin walls of the capillaries there is an exchange between the blood and tissues ( transcapillary exchange ). The walls of the capillaries do not contain smooth muscle elements.

4. Capacitive vessels - the venous compartment of the cardiovascular system. These vessels are called capacitive because they hold about 70-80% of all blood.

5. Shunting vessels - arteriovenous anastomoses, providing a direct connection between the small arteries and veins, bypassing the capillary bed. ^[five]

The cardiovascular system is a system of organs consisting of blood vessels and the heart, which is the main organ of this system. ^[6] The main vessels include:

• Common carotid artery .
• Subclavian artery .
• The aorta is the largest artery of the human body.
• Pulmonary artery .
• Pulmonary vein .
• Pulmonary trunk
• Lower vena cava .
• Superior vena cava
• The coronary arteries and veins supplying the heart muscle ( myocardium ) with oxygen and nutrients.

Arterial vessels of the upper limbs supply soft tissues and bones . Main arteries branch out to form a multitude of smaller vessels that form anastomoses at the elbow and wrist .

• The subclavian artery branches off from the aortic arch and passes behind the clavicle .
• The subclavian vein flows into the superior vena cava through the left brachiocephalic vein.
• Axillary artery enters the brachial artery.
• The axillary vein is the main vein, flows into the subclavian vein.
• The brachial vein is formed by combining the radial and ulnar veins.
• The anterior and posterior arteries surround the humerus .
• The lateral saphenous vein of the arm passes from the outside of the arm above the elbow joint, then overcomes the deep fascia of the shoulder , connecting with the axillary vein.
• The medial saphenous vein of the arm in the middle of the shoulder becomes the deep vein and is located along the brachial artery, then it joins the brachial vein, forming the axillary vein.
• The deep artery of the shoulder passes back around the humerus, accompanying the radial nerve in the same groove.
• The accessory vein of the forearm connects with the lateral saphenous vein of the arm above the elbow joint.
• The brachial artery from which the small branches depart, supplying the adjacent muscles and humerus.
• The median vein of the elbow is the main vein; it connects the lateral saphenous vein with the medial saphenous vein of the arm; used for venipuncture .
• The radial artery is located under the brachiocephalic muscle .
• The ulnar artery , which is a continuation of the brachial artery, extending from it in the ulnar fossa at the level of the coronoid process of the ulna.
• The deep palmar arch is a loop formed by the arteries supplying the hand with the arteries.
• The transverse anastomosis is a network of blood vessels that allows blood to flow from the hand and fingers.
• Finger arteries depart from the palmar arcs, supply blood to the fingers.
• Palmar finger veins provide blood flow from the fingers.

The blood vessels are located in the spongy substance - diploe ( diploe ), located between the outer and inner plates of a compact substance. ^[7] Blood supply to the brain and blood flow occurs through several arteries and veins:

• The anterior cerebral artery ( lat. Arteria cerebri anterior ) is a rather large artery that goes backwards over the corpus callosum and supplies the majority of the medial surface of the cerebral hemispheres . ^[eight]
• The anterior communicating artery ( lat. Arteria communicans posterior ) connects the anterior cerebral arteries with each other.
• The middle cerebral artery ( lat. Arteria cerebri media ) is the second terminal branch of the internal carotid artery. It passes between the frontal and parietal lobes in the lateral sulcus and supplies the greater part of the upper lateral surface of the cerebral hemisphere.
• The eye artery ( lat. Arteria ophthalmica ) is a large paired vessel that goes through the optic canal into the orbit , lying outward from the optic nerve .
• The internal carotid artery ( lat. Arteria carotis interna ) is a large paired artery of the neck and head.
• The external carotid artery ( Latin arteria carotis externa ), which departs from the internal carotid artery.
• The anterior choroidal artery departs from the supraclinoid portion of the internal carotid artery. ^[9]
• The posterior communicating artery ( Latin communicans posterior ) originates from the internal carotid artery and, going backwards and slightly inwards, approaches the posterior cerebral artery. ^[ten]
• The arteries of the bridge are arteries that lie in the pons and supply blood to the brain.
• The basilar artery ( lat. Arteria basilaris ) is an unpaired blood vessel, which is located in the basilar groove of the bridge .
• The anterior and posterior cerebellar arteries .
• Vertebral artery .
• Upper anastomotic vein .
• The frontal diploic vein ( Latin v. Diploica fronlalis ) lies in the thickness of the scales of the frontal bone , near the midline and carries venous blood partly in the upper sagittal sinus and partly in the supraorbital vein. ^{[11] [12]}

• The femoral artery ( lat. Arteria femoralis ) is a continuation of the external iliac artery and begins under the inguinal ligament in the vascular lacunae .
• The femoral vein ( Latin v. Femoralis ) is sometimes a steam room, accompanies the artery of the same name into the adductor canal ( lat. Canalis adductorius ), and then into the femoral triangle ( lat. Trigonum femorale ), passes under the inguinal ligament into the vascular lacuna ( lat. Lacuna vasorum ), where it passes into the external iliac vein ( Latin v. iliaca externa ). On its way, the femoral vein receives a number of veins that accompany the arteries of the same name.
• The deep femoral artery ( lat. Arteria profunda femoris ) is a large branch of the femoral artery.

Vessels through which an outflow of lymph occurs in the body from tissues and organs into the venous system; part of the lymphatic system . ^[13] Lymphatic vessels are absent only in cartilage , eyes , teeth , epidermis , brain, and spinal cord , but in 2015, University of Virginia officials reported that there was still a lymphatic system in the brain. ^[14]

It is in lymphatic vessels that pathogenic microbes, bacteria and other foreign particles are destroyed. All lymphatic vessels, connecting together, form two large ducts:

• Thoracic lymphatic duct ( lat. Ductus thoracicus ), which begins from the confluence of the right and left lumbar trunks.

• The right lymphatic duct ( lat. Ductus lymphaticus dexter ) is a short, 1–1.5 cm long, and a lymphatic vessel with a diameter of up to 2 mm, which lies in the right large supraclavicular fossa and flows into the right venous angle. ^{[15] [16]}

Angiology is also closely related to vascular surgery. Vascular surgery , in turn, is one of the medical directions in the United States (vascular surgery), Germany (Gefäßchirurgie) and other countries. It covers conservative (non-surgical), endovascular or operative vascular treatments, while angiology is the science and anatomy section that studies the vascular and lymphatic systems . ^{[17] [18]}

• Pokrovsky A.V. Clinical Angiology. - A practical guide in 2 volumes. - ISBN 5-225-04738-6
• Petrovsky B.V. Big Medical Encyclopedia - 3rd Edition. - ISBN 5-85270-324-9

• Interdisciplinary Internet portal ANGIOLOGIA.ru
• Russian Society of Angiologists and Vascular Surgeons