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Obliterating atherosclerosis of the lower extremities

We all know about atherosclerosis. This disease leads to unpleasant consequences: coronary heart disease, myocardial infarction. Atherosclerosis is also responsible for the development of ischemic stroke. This process is indirectly guilty of the occurrence of cardiovascular diseases and their complications.

Thus, atherosclerosis is the culprit of the most common cause of human death in the 21st century. One of its manifestations, which is no less dangerous, is the defeat of the vessels of the legs. Today we will talk about this process, the phenomenon of the obliteration of blood vessels, and we will dwell in detail on the diagnostic processes and methods for treating this serious disease.

Content

Atherosclerosis obliterans - what is it?

Obliterating atherosclerosis of the lower extremities

It is necessary to clearly understand that obliterating atherosclerosis of the lower extremities is not a separate disease with which the legs suffer, but simply a place of the “greatest rampant” atherosclerosis in the body.

Atherosclerosis in general is a pathological process that narrows the lumen of the arterial vascular: large arteries, in the walls of which there are elastic and smooth muscle elements.

Following this, target organs suffer: the brain, heart, intestinal loops. In the case of atherosclerosis of the vessels of the lower extremities are affected:

  • Lower abdominal aorta, before branching (bifurcation);
  • Iliac arteries;
  • Femoral arteries;
  • Popliteal arteries and vessels of the legs, which are less often affected, since their wall contains less muscular and elastic elements, and therefore it is more difficult to obliterate.

As a result of the disease, a significant narrowing of the vessel lumen occurs due to the deposition of cholesterol in the form of plaques on its walls. And if a heart attack and stroke often occur due to blockage of a smaller caliber by a blood vessel that has come off, obliteration is a process of slow "overgrowing" of the vascular wall with the development of chronic oxygen starvation (ischemia) of the respective tissues, up to the development of necrosis and gangrene, which often occurs during involvement in the process of leg vessels.

Causes of disease

Like the process of other localization, obliterating atherosclerosis of the vessels of the lower extremities occurs mainly in the elderly, but recently the process has begun to get younger. If you meet 100 random people, you will only see signs of illness in three of them. If you interview 100 people older than 55 years, the number of cases will increase to 18-20 cases.

The process often ends with persistent disability: high leg amputation at the hip level. Moreover, more than half of the patients who underwent this operation die in a year, as the process spreads higher and higher.

The factors that reliably lead to atherosclerosis of the vessels of the lower extremities are the following:

  • Male;
  • Age. This is also an unmodifiable factor.

All other factors are amenable to correction, and can significantly reduce the risk:

  • Long-term smoking experience;
  • Hypertonic disease;
  • High cholesterol, lipid metabolism;
  • Diabetes and other disorders of carbohydrate metabolism;
  • Obesity and overweight;
  • Hypodynamia. It is precisely because of the sharp growth of the sedentary lifestyle in the cities of young people that obliterating atherosclerosis in our century "gets younger".

In that case, if you lead a healthy lifestyle, monitor your weight, blood sugar and cholesterol, the risk of the disease is significantly reduced.

The development of atherosclerosis obliterans

Like any other disease, obliterating atherosclerosis of lower limb arteries in its development goes through several stages, which formed the basis of the most popular clinical classification.

The disease is divided into four stages. The first two are completely reversible with proper treatment:

  • In the first stage, “disruption of compensatory mechanisms” in the form of pain in the legs appears after a serious and prolonged load, for example, a walking route of 20-30 kilometers;
  • The second stage appears when it is impossible to pass more than one kilometer without the appearance of pain, and then this distance decreases to 250 meters, that is, in fact, to the nearest store or kiosk (in urban areas);
  • In the third stage, a critical reduction in blood flow and pain occurs in 30-40 steps, and even at rest, especially at night. In order to ease the pain and improve blood flow, the patient can lower his leg from the bed at night;
  • In the fourth stage, first appear small, and then more and more extensive trophic ulcers. The skin turns black, extensive fields of skin, fiber and muscle necrosis are formed. There is a sharp limitation of mobility, and then the inability to walk independently. Then a secondary infection joins, dry or wet gangrene of the fingers and heels occurs, in which only amputation can save. In advanced cases, sepsis occurs, infectious - toxic shock and death in cases of polyorgan failure.

How does this dangerous disease manifest itself, and what should be paid attention to?

Symptoms of obliterating atherosclerosis of the lower extremities

Symptoms of obliterating atherosclerosis of the lower extremities

All the symptoms of obliterating atherosclerosis of the lower extremities are different manifestations of the syndrome of acute and chronic ischemia of various organs and tissues: skin, muscles, fiber, bones, joints, and vascular wall, which occur both at rest and when moving.

We list them:

  • Pain in the muscles of the legs are the main symptom of obliterating atherosclerosis - sore thighs and calves. Unfortunately, no more blood can enter the muscles that are loaded when walking, and they respond with aching pain. A person is forced to limp, stop, wait for the cessation of pain and move on. This phenomenon is called claudicatio intermittens, or intermittent claudication. It is so named because a person limping impermanently, she “alternates” with periods of normal walking. Then the pain becomes permanent;
  • The decrease in blood flow in the distal regions leads to a cooling and numb feeling in the feet, also due to a violation of nervous sensitivity. Feelings also increase during exercise;
  • Hot-cold leg - because less blood gets into the diseased leg, a healthy leg seems hotter than the affected one;
  • The appearance in the lower parts of the leg and foot (where the vessels are smaller and the blood supply is worse) of non-healing ulcers, pronounced trophic disorders (brittle nails, hair loss);
  • The appearance of darkened areas of the skin, the absence of pulsation in the popliteal artery and the ankle indicates irreversible impairment of blood flow.

Diagnosis of atherosclerosis obliterans

The picture of disorders in obliterating atherosclerosis of the lower extremities is so obvious that clinical diagnosis is the main one.

It is only necessary to correctly and consistently identify the patient's complaints, their connection with physical activity, as well as conduct an inspection, determine the temperature, arterial pulse, and trophic extremities.

More sophisticated diagnostics are carried out by lesion levels. There is a high level (aorta and iliac arteries, with the development of Leriche syndrome, when there are pains in the buttocks and thighs, gas incontinence and impaired potency), and a low lesion level when the legs and feet ache.

It is important to single out the period at which critical limb ischemia occurs. It is characterized by the appearance of constant pain, with an increase in the night, with relief when lowering the legs down from the bed. Lifting back again intensifies the pain. At this time, the systolic pressure in the affected vessels falls below 50 mm.

Confirmation of the diagnosis is made using:

  • Treadmill - a test with increasing load on the treadmill. So determine the painless distance;
  • Ultrasound of the vessels of the legs. In this case, the ABI is calculated, or the ankle - shoulder index. This is the ratio of pressure in tibial pressure to pressure in the brachial artery, measured in systole. Normally, the index is greater than one, and it decreases with disease;
  • Pulse oximetry in the toes, both standing and lying;
  • For accurate localization spend color Doppler blood vessels of the legs. So the place of a critical stenosis and its extent is defined.

At the same time, we should not forget about checking the coronary and carotid arteries, since sometimes a much more serious problem is found there, which determines the sequence of treatment. For example, first requires coronary artery bypass surgery, and only then surgery on the vessels of the legs.

Treatment of obliterating atherosclerosis of the lower extremities, drugs

Treatment of obliterating atherosclerosis of the lower extremities, drugs

Conducting treatment of obliterating atherosclerosis of the lower extremities, we must not forget that atherosclerosis is a systemic process, therefore, in addition to restoring the local blood flow, attempts at “relapse” should be prevented.

At the first, second, and partly of the third stage, conservative treatment is possible, operations involve the restoration of arterial patency.

After achieving critical ischemia, palliative surgery is possible with excision of necrosis and even amputations, as the only radical means of saving the body.

The principles of conservative treatment are as follows:

  • Non-drug treatment: modification of all risk factors: effective treatment of hypertension, weight loss, smoking cessation, correction of diabetes . It is necessary to seek to reduce the level of systemic cholesterol with its increase, both diet and drugs;
  • Purpose of the vasoactive drugs reducing aggregation of erythrocytes in a vascular bed. These include pentoxifylline, trental. Reopoliglukine and Reomacrodex also have a good antiaggregation effect (with infusion);
  • Apply a means of reducing platelet aggregation. These are the well-known "heart" aspirins in the dosage from 100 to 325 mg per day. A more effective drug is Clopidogrel, aka Plavix.
  • Good effect has the drug Sulodeksid, which belongs to the derivatives of heparin, and is able to reduce the viscosity of the plasma, reducing the concentration of fibrinogen and some lipids;
  • Flogenzyme and Wobenzym are proteolytic enzymes. They are used to reduce the inflammatory component, reduce the severity of trophic ulcers;
  • Xantinol nicotinate is used as a means of dilating blood vessels.

In addition, in therapy can be used laser blood irradiation, the use of ultraviolet lasers. They stimulate the breakdown of fibrin, and reduce blood viscosity.

In addition to therapeutic methods of treatment, use and operational methods. X-ray endovascular stenting and balloon dilatation of the affected arteries are generally popular, especially if there are indications: an isolated site of a single stenosis in the narrow space of the vessel.

Somewhat less common are interventions such as:

  • Sympathectomy, which, being a symptomatic operation, protects against arterial spasm, dilates small vessels and restores blood flow;
  • Osteotomy with revascularization. After special damage to the bone, new small vessels appear in the limbs, which redistribute the blood flow.

Prevention

A serious disease of obliterating atherosclerosis of the lower extremities, the treatment of which we have described, is completely reversible in the initial stages. But almost no one goes to the doctor if his legs ache after going ten or twenty kilometers, but in vain.

The annual ultrasound of the vessels of the lower extremities will make it possible to take timely measures not only against this disease, but also against varicose veins, which often complicates the course of atherosclerotic lesions of the arteries.

A healthy lifestyle, proper nutrition, motor regimen, the absence of bad habits and ideal weight is the key to your freedom from vascular damage, and will allow you to remain active for many years.

Interesting
Tatyana Kravets
2017-12-18 08:26:07
My husband used to hurt his legs, and now problems with potency, even smart-smart all the worse helps, they say the vessels are to blame. Is it also atherosclerosis?
doctor Daria
2017-12-26 12:30:33
lower limb atherosclerosis is not a cause of erectile dysfunction. I recommend checking your husband's blood for sugar, as pain in the legs and signs of sexual dysfunction may be due to diabetes. Mandatory consultation of the urologist-andrologist.

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