This chapter offers an overview of the anatomical relationships between the circulatory and fascial systems and presents a few structural patterns that may originate from fascial restrictions of the peripheral vascular system. The circulatory system is enveloped in a layer of fascial tissue that interconnects with the fascia of surrounding anatomy including nerves and organs. These tissues interact mechanically and biochemically, so that changes in one system can affect others.

Blood vessels from the heart to the vascular beds follow the framework of the fascial network, which provides support and protection. Arteries and veins perforate through multiple fascial layers in the course of nourishing tissues, from the core of the body to the outer layers. To the extent that these fascial layers are healthy, the small vessels are mobile, supported by a loose web of hydrated connective tissue fibers that facilitates the gliding of the perforating neurovascular tract through the more densely structured fascia.

Fascia plays an important role in vascular regulation in the lower leg; the pressure created by fascia compartments and blood supply requires a stable balance. Blood vessels can be impinged upon or entrapped by fascia, similar to entrapment neuropathies. This can result in edema, occasional cramping, or, less commonly, in intermittent claudication. When surgical approaches are not indicated, and in addition to surgical treatment approaches, manual therapy approaches could be used to address fascial restrictions that affect circulatory structures.