Buerger's disease is characterized by an inflammatory process in the vessels, which is caused by autoimmune disorders in the human body. This pathology occurs as a result of obliteration or vasoconstriction, up to their complete blockage, which increases the likelihood of blood clots.
Description of pathology
The most common localization of Buerger's disease are the veins of the extremities, as well as small and large arteries. The scientific name of the disease is thromboangiitis obliterans.
The main danger of the disease is that the tissues are not supplied with enough blood. A similar process in the future can lead to serious complications, such as metabolic disorders, tissue necrosis and gangrene. If you do not take timely measures for treatment, pathology can lead to disability.
It is quite difficult to completely cure this disease with modern medical methods. Most often, the pathology has a chronic course. However, by consulting a doctor in a timely manner and carefully observing allthe treatment regimens prescribed by him, it is possible to stop the process of the development of the disease and extend the life of the vessels. The treatment of Buerger's disease is carried out by vascular surgeons and rheumatologists, therefore, if symptoms occur, these specialists should be contacted first.
Causes of this pathology
Pathology appears as a result of the production of antibodies by the human immune system to endothelial cells, that is, the inner walls of blood vessels in one's own body. In addition, vascular spasms, which occur as a result of increased synthesis of hormones by the adrenal glands and specific disorders in the nervous system, contribute to the strengthening of the disease.
Who is at risk?
Most often Buerger's disease affects smokers. Mostly the pathology affects men, however, due to the spread of smoking among women, thromboangiitis obliterans has recently also affected the fair sex.
The first signs of the disease appear in patients under 45 years of age. A similar phenomenon is known in medical practice as the “disease of young smokers”. This term is especially common in English-language medical literature.
Provoking factors
There are a number of factors that significantly increase the risk of developing lower limb Buerger's disease, including:
1. Genetic predisposition to the disease. Medicine does not exclude the presence of certain hereditary factors,which provoke changes in the human immune system and lead to the development of pathology. The most common disease occurs in residents of Asia and the Mediterranean regions.
2. Heavy smoking from an early age. Some scientists adhere to the theory that thromboangiitis obliterans occurs as a result of intoxication of the body with such components of cigarette smoke as cotinine, that is, an alkaloid of tobacco and carbon monoxide or carbon monoxide.
3. Cold injury. Many medical experts note the fact that quite often Buerger's disease appears in patients who have suffered frostbite or hypothermia.
4. Arsenic poisoning in a chronic form, for example, in the chemical industry.
Types of disease
There are several types of Winivarter-Buerger's disease. These include:
1. Distal. Occurs in 65% of cases. The disease affects small and medium-sized vessels, most often localized in the hands, feet, forearms and legs.
2. proximal. It affects about 15% of patients. In this case, changes begin in large arteries, including the femoral, iliac, aorta, etc.
3. The mixed type occurs in every fifth patient. It is characterized by simultaneous damage to both small and large vessels.
Let's consider the main stages of the disease of Winivarter-Buerger's disease.
Stages of disease
There are four stages in the development of thromboangiitis obliterans. Each stage is characterized bydisease progression by certain symptoms and signs.
1. ischemic stage. It is characterized by rapid freezing of the legs, burning and tingling in the limbs. Also, there is a rapid fatigue of the legs, that is, even after walking a kilometer, the patient begins to experience pain in the legs and feet. The doctor, when contacting, first of all will pay attention to a weak pulse or its absence in the affected areas. The stages of Buerger's disease don't stop there.
2. trophic disorders. Divided into subtypes.
2A stage is characterized by the fact that the patient cannot walk even a dozen steps without feeling attacks of pain in the legs.
2B stage is expressed by pain in the legs when passing even a couple of steps. At the same time, the skin on the legs and feet loses elasticity, becomes dry and flaky. The heels are overgrown with dry calluses and covered with cracks. The nails become brown or dull, grow very slowly, and also coarsen and thicken. In addition, the amount of subcutaneous adipose tissue on the lower extremities decreases. Then there is a gradual atrophy of the small ankle muscles and feet. Complete absence of pulse in the arteries of the feet. The symptoms of Buerger's disease are quite unpleasant.
3. Ulcerative-necrotic stage.
3A stage is caused by soreness of the feet even at rest.
3B stage is characterized, in addition to pain in a calm state, by edema. The skin becomes thinner and can be easily damaged. Minor injuries such as chafing, bruising, cuts lead to the formation of cracks that last a long time.heal. At this stage, atrophy of adipose tissue progresses.
4. Gangrenous stage.
4A stage is manifested by complete atrophy of the toes.
4B stage causes the patient to stop walking. At the same time, ulcerative formations appear on the legs, covered with a dirty gray coating. The process ends with gangrene, which requires amputation of the limbs.
Similar symptoms, namely pain, chilliness, weak pulse, changes in muscles, nails and skin, the appearance of ulcers and gangrene in the last stage are characteristic of Buerger's disease, localized on the hands.
Diagnosis of disease
In order to diagnose thromboangiitis obliterans, a specialist conducts a series of functional tests:
1. Oppel test. It consists in lifting the affected leg up. At the same time, the distant part of the foot begins to turn pale.
2. Goldflam test. The patient lies on his back and does full flexion and extension of the legs as much as he can physically. The legs are bent at the knee and hip joint. If blood circulation is disturbed, then fatigue comes after 10-20 times.
3. Panchenko test. The patient sits down and crosses one leg over the other. If the circulation is disturbed, after a while the person will begin to feel soreness in the calves, numbness and goosebumps in the foot of the leg that is located on top.
4. Shamova's test. The leg should be free from clothing. The patient lifts it up, while a special cuff is applied to the thigh. Air is blown into it untilthe pressure on the leg will not become higher than the systolic arterial pressure. Next, the leg is laid horizontally. The cuff is on the thigh for about five minutes, then abruptly removed. Shortly after removing the cuff, the back of the fingers should turn red. If the fingers turn red after a minute and a half, then the patient has a slight violation of blood flow, three minutes characterize the disease of moderate severity, more than three minutes means a significant deficit in blood flow.
X-ray angiography
To clarify the diagnosis, the attending physician refers the patient to X-ray angiography, as well as duplex scanning by means of ultrasound. Both methods make it possible to analyze the state of vessels with a high degree of accuracy. In addition, there is rheovasography, which allows you to evaluate blood circulation in the legs and arms, and Doppler flowmetry, which checks the microcirculation in small vessels. In addition, a blood test for circulating immune complexes is often done.
Treatment of this pathology
It is almost impossible to cure Buerger's disease (ICD-10 I73.1). Conservative therapy includes the following measures:
1. Inflammatory autoimmune processes are removed by taking corticosteroids, most often prescribed "Prednisolone".
2. To expand small arteries, as well as normalize blood circulation and prevent blood clots, drugs such as Iloprost and Vazaprostan are used.
3. Physiotherapeutic procedures are also used, for example, hemosorption and plasmapheresis, with the help of which blood is purified.
4. In some cases, patients are prescribed the administration of pertocarbons, such as Oxyferol and Perftoran. These drugs in the form of an emulsion act as a kind of blood substitute, due to their ability to transport oxygen.
5. Smoking cessation is a prerequisite for successful therapy. The effectiveness of treatment is sharply reduced if the patient cannot give up this bad habit.
Surgery as a means of treatment
There are also a number of surgical treatments for Buerger's disease of the lower extremities. The following operations are most effective:
1. Lumbar sympathectomy. This surgical manipulation allows you to neutralize the nerve fibers that send impulses to the vessels, forcing them to narrow. This intervention makes it possible to expand the vessels of the legs, thereby normalizing blood circulation.
2. Sympathectomy of the chest. The principle of execution is the same as in the previous case, however, an operation is performed on other nerves. This procedure normalizes blood circulation in the hands.
If the patient begins to develop gangrene, amputation of the affected limb is required.
