Obliterating endarteritis of the lower extremities is a very dangerous disease, ignoring the symptoms of which can subsequently lead to amputation. Unfortunately, in the initial stages, when drug treatment is most effective, the pathology practically does not manifest itself, which makes it difficult to diagnose. Endarteritis is easily confused with some other diseases, such a problem occurs more often in men (it can even be said with certainty that predominantly the stronger sex suffers from obliterating endarteritis).
Description of the disease
Obliterating endarteritis of the extremities is an inflammatory disease of the blood arteries that is of a chronic nature. As a result of pathological processes, the blood circulation process is disrupted, which eventually leads to complete closure of the artery lumen and the formation of gangrene. As a rule, inflammation is localized in the vessels of the legs and feet.
As the disease progresses, less oxygen enters the legs, which inevitably leads to tissue damage, disruption of the normal functioning of body parts and their necrosis. Mostly men suffer from this pathology. The ratio of male patients to females with the same diagnosis is 99:1. Obliterating endarteritis of the lower extremities is one of the common causes of leg amputation in relatively he althy, young and able-bodied men.
In some cases, the disease is mistakenly confused with atherosclerosis obliterans. The symptoms of obliterating endarteritis and atherosclerosis are similar, but the diseases have different mechanisms of occurrence. So, endarteritis usually affects a group of people at a young age (from twenty to forty years old), localized in the arterial vessels of the legs and feet. Obliterating atherosclerosis is a manifestation of systemic atherosclerosis, it is determined in older patients, affects mainly large vessels and is widespread.
The closest disease to obliterating endarteritis of the extremities is thromboangiitis, or Buerger's disease. This pathology affects males of the middle age category. Most patients diagnosed with the disease are heavy smokers. The diseases listed above are successfully treated only in the early stages. In the later stages, only limb amputation can help.
Causes of endarteritis
Exact listThe medical community has not yet formed the causes or risk factors for obliterating endarteritis. It was not possible to find out what exactly caused the onset of the disease in a particular person. It is known that the body simply begins to produce substances that damage the walls of its own blood vessels. Subsequently, an inflammatory process develops in them. Later, connective tissue forms on the affected areas, narrowing the gaps. The reasons for the production of such antibodies are also not yet fully understood.
There are only theories about the causes of obliterating endarteritis of the extremities. It is generally accepted that pathology develops due to various infections that are not treated, against the background of atherosclerosis of the legs, various kinds of blood clotting disorders, or as a manifestation of an allergy to nicotine in heavy smokers. It is known that those who smoke are most susceptible to endarteritis.
Pathology can also develop against the background of prolonged or short-term, but very strong stresses, with constant hypothermia of the legs. The risk group includes those who have ever received frostbite on their feet. In addition, as already mentioned, men are prone to obliterating endarteritis. Chronic infections, injuries to the limbs, dysfunction of the adrenal glands and genital organs, and a decrease in the number of lymphocytes in the blood lead to a prolonged spastic state of the vessels (which is also a risk factor).
Pathogenesis of disease
At the earliest stage of the development of the disease, only vascular spasms develop. This is accompanied by a thickening of the internalmembranes of the vascular walls, pathological changes. Subsequently, trophic disorders occur, degenerative processes that lead to narrowing or even complete blockage of the lumen of the artery. The length of such a pathological area can be from two to twenty centimeters.
The network that develops around this damaged area ceases to provide the functional needs of tissues over time. Subsequently, circulatory failure develops. A person suffering from obliterating endarteritis, at this stage of the development of the disease, begins to noticeably limp, severe pain occurs. If earlier they were observed only with excessive load, now they can also occur when walking (running, physical exercises), and at rest. Against the background of the underlying disease, neuritis (ischemic) develops.
In the case of obliterating endarteritis, doctors distinguish four stages. At the first, dystrophic changes in the neurovascular endings begin to develop. There are no symptoms, so it is not yet possible to start treatment of obliterating endarteritis of the lower extremities at this stage. All disorders that could draw a person's attention to the development of the disease are compensated by blood circulation.
At the second stage, vasospasm is accompanied by a lack of blood supply and the inability to replenish it at the expense of the internal resources of the body. This phase of the disease is characterized by such clinical manifestations as cold feet almost atany ambient temperature, fatigue, periodic pain and lameness occur.
The third stage is characterized by trophic disturbances in the layers of the vascular wall. The pulsation in the arteries is weakened. Pain now occurs in a calm position. The fourth phase is the complete thrombosis of the vessels. This stage is irreversible, the patient develops tissue necrosis and gangrene of the limb. No medication or other non-radical therapy will stop the pathology. Only amputation of the limb will help in the fourth stage.
Disease classification
In a quantitative sense, the symptoms of obliterating endarteritis of the lower extremities differ little depending on the type of disease, but this affects the severity of the pain syndrome. With a limited form, only the arteries of the lower extremities are affected, the disease progresses rather slowly, which makes it possible to take appropriate measures in time. Generalized endarteritis affects not only blood vessels, but also branches of the aorta, cerebral and coronary arteries.
Based on how severe the pain syndrome is, there are four stages of limb ischemia with obliterating endarteritis. At the first, the easiest, the patient feels discomfort when walking a distance of one kilometer or more. On the second patient can walk more than 200 m (stage II A) or less (stage II B) before the onset of pain. In the third degree, before the onset of pain, it is possible to walk a distance of up to 25 m. It is also characterized by pain at rest. The fourth stage is characterized by the formation of necrotic defects and constant discomfort, which increases with the load on the legs. Photos of obliterating endarteritis in the advanced stage are shocking.
Symptoms of endarteritis
Let's move on to the symptoms and treatment of obliterating endarteritis of the lower extremities. At first, the patient begins to feel slight discomfort with excessive exertion, fatigue appears, cramps in the calves and feet, and the toes become numb. A lot of people get cold feet. In some cases, at this stage, blood clots begin to form in the veins of the lower extremities. In the future, all of the above symptoms intensify, pain appears during walking, sometimes lameness can be noticed. The patient is already forced to take rest breaks when walking.
Usually, the pain is concentrated in the area of the fingers, soles of the feet, in the muscles of the lower leg. The skin can become very dry, peel off, acquire a bluish tint. Toenails begin to grow more slowly, deform, break and exfoliate. There may be hair loss on the legs. The pulsation of the arteries is felt weaker. Then the pains begin to intensify at night, the muscles atrophy, the skin swells, trophic ulcers can form on the feet and fingers. The blood flow in the arteries on the feet is no longer determined by probing.
At the last stage of the development of the disease, gangrene of the lower extremities is diagnosed. The onset of pathology is associated with the negative impact of external factors (for example, caused by cuts orwounds, violation of the integrity of the skin) on the existing ulcer. Gangrene often affects the fingers and feet, sometimes spreading to the legs. Toxemia, which rapidly develops with gangrene, requires mandatory amputation of the limb.
Diagnosis of disease
Diagnosis of obliterating endarteritis involves several methods. The doctor will collect an anamnesis, conduct a series of tests to identify insufficient blood supply to the limb. Thermography, angiography, rheovasography, ultrasound, oscillography and similar methods help to establish the diagnosis. To detect vascular spasms, a parrenral blockade is performed.
Treatment of endarteritis
In the early stages, the treatment of obliterating endarteritis of the extremities is possible with medications. Therapy, as a rule, aims to eliminate the inflammatory process, relieve spasm of the vascular wall, improve blood circulation and prevent thrombosis. Antispasmodics (nicotinic acid or Drotaverine), antibacterial and anti-inflammatory drugs, corticosteroids, vitamin complexes (vitamins E, C, B are especially useful), anticoagulants are used as part of the course. Intra-arterial injections of alprostadil are shown.
Effective and balneological treatment, physiotherapy, oxygenation. Hydrosulfide, coniferous, radon baths, foot baths, electrophoresis, ozocerite applications can be carried out at the spa treatment. A necessary condition for successful treatment is the complete refusal of the patient to smoke tobacco.in any form.
Surgery for obliterating endarteritis is indicated for severe lameness, severe pain that occurs at rest. The intervention can be palliative, that is, improving the function of the arteries, or reconstructive. In the latter case, doctors restore impaired blood circulation. Such operations may involve arterial replacement, but are rarely performed. The indication for amputation is progressive gangrene. If the necrosis has a clear line of demarcation, necrectomy or amputation of a smaller part of the limb can be limited.
Folk remedies
Supportive treatment of obliterating endarteritis is possible with the help of alternative medicine. Really effective folk remedies will be only in the initial stages of the development of the disease, and even then they should be used exclusively in combination with the "official" drugs prescribed by the attending physician. Treatment of obliterating endarteritis at home is carried out with decoctions of medicinal herbs that have cleansing properties, prevent inflammation, restore the walls of blood vessels, strengthen them.
It can help, for example, a collection of St. John's wort, chamomile, yarrow, corn stigmas and birch buds. Dry herbs (they can be purchased at any pharmacy) should be taken in equal proportions. You will need a glass jar with a tight-fitting lid. A tablespoon of the collection should be poured with 0.5 liters of boiled water only. The mixture is infused for 30 minutes. Honey can be added to this herbal tea. Drink the cooled composition should be in the morning and evening, 30 minutes before meals. The best effect can be achieved if you drink the decoction in courses: take the composition for one month, take a break for the next month.
To prepare another healing composition, you will need horsetail (40 grams), hawthorn (100 grams) and mountaineer (60 grams). Half a tablespoon of such a dry mixture must be poured with a glass of water (boiling). The folk medicine will be infused for half an hour. After it you need to drink a course of one month. Consume one tablespoon 30 minutes before meals, three times a day.
Dill seeds, Japanese sophora, white mistletoe, immortelle clean blood vessels well. It is recommended to cleanse the blood vessels for 3-5 days in a row to drink strong tea with milk every few hours. Regular potato broth and citrus mixture will help. The latter is prepared from lemons and oranges. Citruses (one at a time) must be chopped in a blender, add a teaspoon of honey to the puree, mix, transfer to a glass jar. This composition (three teaspoons) should be consumed once a day before meals.
The use of blue iodine is very effective. A teaspoon of starch should be diluted in 50 ml of water, add a teaspoon of sugar, a pinch of citric acid to the mixture. Add 150 ml of boiling water (about three quarters of a cup). When the folk prescription medicine has cooled down, you need to add a teaspoon of iodine (5%) there. Drink one tablespoon once a day. Iodine removes cholesterol from the blood, cleanses blood vessels,strengthens the heart muscle and enhances the body's immune defenses. Such a composition should be used with caution, as it can cause an allergic reaction. If this happens, then you need to completely abandon this folk remedy.
Doctors forecast
The scenario for the development of obliterating endarteritis in each case depends on the elimination of the negative impact of provoking factors, minimization of injuries and various injuries of the lower extremities, the regularity of drug therapy and observation by a vascular surgeon. Under favorable circumstances, it is possible to maintain remission for a long time and avoid the progression of the disease. Otherwise, limb amputation is inevitable.
Disease prevention
To prevent the development of the disease or significantly reduce the rate of its spread, you must follow a few rules. Be sure to categorically refrain from smoking, it is desirable to exclude alcoholic beverages. Do not allow hypothermia or frostbite of the legs, do not stay in cold rooms for a long time.
Too s alty, spicy and fatty foods should be excluded from the diet. In general, it is better to adhere to the rules of a he althy diet on an ongoing basis - this will help reduce the risk of many diseases. In addition, sports are useful, but it is necessary to protect the legs from bruises and other injuries. In terms of physical activity, the most useful are running, swimming and cycling. Definitelylong walks recommended.
You need to pay attention to the choice of shoes. Feet should not freeze, sweat, be squeezed. The skin needs to breathe. If possible, you should choose high-quality shoes made from natural materials, comfortable. It is necessary to have at least two pairs of shoes per shift so as not to wear wet and dry boots not on central heating radiators, but in a natural way.
Every day you need to wash your feet with warm water and soap. From time to time it is advisable to use a nourishing foot cream. It is good to apply it before going to bed, and put warm socks on top.
All of the above actions will help to somewhat slow down the development of the disease, if it is already taking place. In addition, once a diagnosis is made, appropriate treatment should be initiated immediately.
