Under the influence of various adverse factors, atherosclerotic plaques are formed on the inner side of the walls of the vessels of the lower extremities. Against the background of this condition, the patency of the arteries worsens, due to which the degree of blood supply to the legs significantly worsens. In medicine, the pathology is called "atherosclerosis obliterans". The disease is accompanied by painful symptoms and significantly impairs the quality of life. With untimely treatment, its outcome may be amputation.
Development mechanism
Through blood circulation, the lower limbs are fed with oxygen and vital substances. Under the influence of provoking factors, atherosclerotic plaques begin to form on the walls of blood vessels, which can block the lumen both partially and completely. As a result, there is a violation of blood circulation, the lower limbs do not receive adequate nutrition and cease to function normally.
Against the background of the development of obliterating atherosclerosis of the vessels, the patient begins to appearalarming symptoms, the intensity of which increases every year. The danger of the disease lies in the fact that most patients at an early stage of the pathology attribute discomfort in the legs to age or overwork.
According to statistics, men over 60 years of age are most susceptible to the disease, but it can also be diagnosed in younger people of both sexes.
Reasons
In 90% of cases, obliterating atherosclerosis of the vessels of the extremities develops against the background of smoking. Nicotine causes spasm in the arteries, which prevents normal blood flow.
In addition, the following diseases and conditions are provoking factors:
- hereditary predisposition;
- excessive consumption of alcoholic beverages for a long time;
- high levels of "bad" cholesterol in the blood;
- a lifestyle that does not involve frequent physical activity;
- constantly being under stress;
- menopause in women;
- tuberculosis;
- diabetes mellitus;
- overweight;
- high blood pressure;
- hypothermia;
- all kinds of lower limb injuries;
- Above average;
- thyroid disorder.
Most patients diagnosed with atherosclerosis obliterans also suffer from cardiovascular disease. This is due to the systemic nature of the pathology.
Symptoms
For a long time, the disease may not be accompanied by any warning signs. Gradually appear pain and fatigue while walking. Their occurrence is explained by the fact that during motor activity in the lower extremities, the need for blood, which delivers oxygen, increases. Since in obliterating atherosclerosis the vessels are narrowed, they cannot provide the required volume of blood. As a result, oxygen starvation occurs in the lower extremities, which is manifested by pain and the rapid onset of a feeling of fatigue. After the cessation of motor activity, they subside, but return again when performing any physical activity. The more pronounced pain and fatigue, the more severe the stage of development of the disease.
In addition, the following conditions are symptoms of atherosclerosis obliterans:
- numbness in feet;
- increased level of susceptibility to negative temperatures;
- constant burning of the skin, it becomes denser;
- expressed discomfort in the calf area during long walks;
- limping;
- increased body temperature;
- cracked heels;
- at an early stage of the disease, the skin in the affected area becomes significantly pale, at a later stage, the toes become bluish or dark red;
- impotence in men;
- hair loss in the lower legs and thighs;
- delaminating toenails;
- ulcers that, even with minor damage or injury, canlead to gangrene;
- convulsions occurring during night rest;
- unequal temperature of the lower extremities (the affected leg is much colder than the he althy one).
Atherosclerosis obliterans is an insidious disease, since, according to statistics, in almost half of patients it is asymptomatic. In such cases, the pathology is detected, as a rule, during an examination prescribed for a completely different reason.
Classification
The disease has several stages of development, which depend on how long a person can walk without the onset of the main symptoms (pain and fatigue):
- Initial. The patient can travel more than 1 km without discomfort.
- Average. Pain occurs after about 500-1000 m.
- Critical. It is characterized by the appearance of symptoms after about 50 m of the distance traveled. In addition, the pain begins to disturb at rest or in a dream.
- Complicated. On the tips of the fingers and in the heel zone, the formation of areas of necrosis begins, which can lead to gangrene. This stage of obliterating atherosclerosis of the vessels of the extremities is characterized by constant pain.
Depending on the degree of spread, the disease can have the following types:
- First (pathology limited).
- Second (characterized by the spread of the lesion to the femoral artery).
- Third (poplitealvessel).
- Fourth (both arteries are affected simultaneously).
- Fifth (both the femoral and popliteal vessels are maximally involved in the pathological process).
Atherosclerosis obliterans has the following stages of development:
- Easy. At this stage, there are violations in the process of lipid metabolism. In this case, the disease is not accompanied by any symptoms.
- Medium. It is characterized by the appearance of the first alarming signs. The patient may feel pain, numbness, limbs become more susceptible to cold.
- Heavy. The severity of symptoms increases, the quality of life of a person deteriorates significantly.
- Progressive. This stage is characterized by the formation of weeping ulcers and gangrene.
Depending on the nature of the course, the pathology can be:
- Swift. The disease develops very quickly, pronounced symptoms appear almost immediately. The spread of the pathological process is rapid, and therefore the patient needs to be hospitalized as soon as possible. With this nature of the course of the disease, amputation of the limb is inevitable.
- Tuning. Episodes of exacerbation are followed by periods of complete disappearance of symptoms. All therapeutic measures are carried out in stationary conditions. Their task is to slow down the pathological process.
- Chronic. The disease may not make itself felt for a long time. In such cases, treatment is carried out with medications.
Diagnosis
If you experience alarming symptoms, you should contact your general practitioner or vascular surgeon. After collecting anamnesis and examination, the doctor will issue a referral for a thorough examination. If necessary, he will recommend contacting other narrow specialists for advice.
Diagnosis of obliterating atherosclerosis includes the following studies:
- Laboratory.
- Instrumental.
Laboratory methods include a blood test for the following indicators:
- Lipid levels. During the study, the amount of total cholesterol in the liquid connective tissue is revealed. In addition, the level of lipoproteins of both high and low density, as well as triglycerides, is determined. This study allows you to evaluate the ratio of "good" and "bad" cholesterol in the blood.
- Glycated hemoglobin. The analysis is necessary in order to confirm or exclude diabetes mellitus, which could cause obliterating atherosclerosis of the legs. In addition, constant monitoring of the level of glycated hemoglobin helps prevent the development of various complications.
If the patient or his relatives have previously been diagnosed with thrombosis and / or disorders in the blood coagulation process, a more thorough examination of the fluid connective tissue is indicated. A creatinine test may be ordered prior to some investigations and treatments.
Instrumental methods for diagnosing obliterating atherosclerosis (photo below) includethe following:
- Computer angiography. With the help of this study, the doctor receives a three-dimensional image that allows you to assess the state of the circulatory system. In addition, the method is used not only to diagnose the disease, but also to plan surgical treatment.
- Ankle pressure index measurement. The study allows you to determine the degree of circulatory disorders. The essence of the method is as follows: first, blood pressure is measured in the ankle area, then on the shoulder, after which these indicators are correlated. Normally, the result should be 1 or slightly more. The lower the index obtained, the stronger the degree of circulatory disorders. A score of 0, 4 or less is considered critical.
Previously, patients were also prescribed ultrasound, but at present the method is rarely used due to its low information content. Contrast aortography may be ordered prior to surgery.
Conservative therapies
Based on the results of the diagnosis, the doctor draws up a treatment regimen for obliterating atherosclerosis of the vessels. In addition, in advanced cases, the question of the advisability of surgical intervention is being decided.
Treatment of obliterating atherosclerosis of the arteries involves the following tasks:
- Relieve symptoms and prevent limb amputation in patients diagnosed with severe circulatory problems.
- Reducing the risk of complications fromof cardio-vascular system. This is due to the fact that approximately one third of patients with obliterating atherosclerosis die within 5 years from myocardial infarction and stroke.
The pathology treatment regimen includes the following items:
- Medication taking. Currently, doctors prescribe Trental or Cilostazol to eliminate or reduce the severity of lameness. The active substance of the first is pentoxifylline. The active ingredient reduces the blood viscosity index. "Trental" shows its effectiveness in only a third of patients. "Cilostazol" is a drug of a new generation and is prescribed more often. In addition, drugs that reduce blood cholesterol levels are shown, as well as medications that reduce the risk of myocardial infarction and stroke (they must be taken for life). It is important to understand that drug therapy does not eliminate the disease, it only eliminates the symptoms of the pathology and stops its further development.
- Control or elimination of triggers. The most important of these are diabetes and smoking. Giving up nicotine for the rest of your life is unconditional. Otherwise, the rate of progression of the disease will increase every day, worsening he alth and quality of life. Patients with diabetes must constantly regulate their blood glucose levels. In this case, the most informative study is the analysis of glycated hemoglobin, the rate of which should not exceed 7%. In addition, it is necessary to maintain a normal level of arterialpressure, that is, to take timely measures when it deviates in one direction or another.
- Physical activity. Patients suffering from obliterating atherosclerosis of the arteries are shown regular walking. Compliance with this rule helps to reduce the severity of lameness.
In some cases pre-press therapy is prescribed. The essence of the method is to massage the damaged limb using special equipment. The result is an expansion and strengthening of blood vessels.
Surgical treatment
Surgical intervention is indicated when conservative methods are ineffective, when weeping ulcers form and pronounced gangrene, as well as when the skin turns blue, which is characterized by severe vascular damage.
Currently, there are many methods of surgical treatment of atherosclerosis obliterans. The choice of method depends on the extent of the pathological process.
There are 3 main types of surgery for this disease:
- Endarterectomy. It involves the removal of cholesterol plaques from the vessel wall through a mini-incision, which is then sutured.
- Prosthetics. The affected area of the artery is replaced with a synthetic prosthesis. A vessel taken from another part of the limb may also be used.
- Bypassing. It implies the creation of an artificial vessel through which the limb will be fed (bypassing the affectedarteries).
Combined methods are often used in practice. At a very advanced stage, when the pathological process spreads rapidly, amputation is performed. In such cases, it is the only possible way to save a person's life.
If the standard surgical intervention is contraindicated for the patient, the treatment of obliterating atherosclerosis is carried out by X-ray endovascular methods. These include: vascular stenting, angioplasty, balloon dilatation. With their help, it is possible to normalize blood circulation without an open operation. Similar procedures are performed in the cath lab.
Folk methods
The use of non-traditional methods does not exclude the need to seek qualified medical help. In addition, their use should be agreed with the doctor in order to avoid worsening the course of the disease.
The most effective traditional medicine recipes for obliterating atherosclerosis:
- Chop and mix in equal proportions a string, chamomile, sage, plantain and St. John's wort. 1 st. l. the resulting collection pour 200 ml of boiling water, let it brew for several hours. Wash the affected limb thoroughly. Moisten gauze in the resulting infusion and wrap the leg from the groin to the fingertips. Wrap with plastic wrap on top and insulate with a cloth. The duration of the procedure should be 3-4 hours. Repeat it twice a day for 3 weeks.
- Buy hawthorn tincture at the pharmacy andtake it 30 drops half an hour before a meal three times a day. The course of treatment is 10 days. Every 1.5 weeks it needs to be repeated.
- Prepare 5 tbsp. l. pine needles, 3 tbsp. l. rose hips and 1 tbsp. l. onion husks. Mix all components thoroughly and pour 1 liter of water. Put the container on the fire and boil for 10 minutes. Let it brew for 12 hours. During the day, you need to completely drink the decoction.
Prevention
In order to prevent the development of the disease, the following rules must be observed regularly:
- Completely stop smoking, reduce the consumption of alcohol-containing drinks to a minimum.
- Perform a simple set of gymnastic exercises daily.
- Control body weight.
- Avoid cold extremities.
In addition, it is recommended not to ignore the need for preventive examinations 1-2 times a year.
In closing
In medicine, the term "atherosclerosis obliterans of the lower extremities" refers to a disease characterized by the formation of cholesterol plaques on the inner walls of blood vessels, which prevent normal blood flow. The main reason for the development of pathology is smoking.
Treatment of the disease involves the elimination of provoking factors and the use of medications. In advanced cases, surgical intervention is performed, and with the rapid spread of the pathological process, the affected limb is amputated.
