Obliterating endarteritis of the lower extremities is a very dangerous disease, ignoring the symptoms of which can subsequently cause amputation. Unfortunately, in the initial stages, when drug treatment is most effective, the pathology practically does not manifest itself, which complicates the diagnosis. Endarteritis is easily confused with some other diseases, more often this problem occurs in men (it can even be said with certainty that mainly the stronger sex are sick with obliterating endarteritis).
Disease Description
Obliterating endarteritis of the extremities is an inflammatory disease of the blood arteries that has a chronic nature. As a result of pathological processes, the blood circulation process is disrupted, which eventually leads to the complete closure of the lumen of the artery and the formation of gangrene. As a rule, localized inflammation in the vessels of the legs and feet.
As the disease develops, 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 such a pathology. The ratio of male patients to women with the same diagnosis is 99: 1. Obliterating endarteritis of the lower extremities is one of the common causes of leg amputation in relatively healthy, young and able-bodied men.
In some cases, the disease is mistakenly confused with atherosclerosis obliterans. 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), localized in the arterial vessels of the legs and feet. Atherosclerosis obliterans is a manifestation of systemic atherosclerosis, it is determined in older patients, it affects mainly large vessels and is characterized by a widespread nature.
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 above diseases are successfully treated exclusively in the early stages. In later ones, only limb amputation can help.
Causes of Endarteritis
The medical community has not yet formed an exact list of causes or risk factors for the occurrence of obliterating endarteritis. It was not possible to find out what exactly caused the appearance of the disease in this or that person. It is known that the body simply begins to produce substances that damage the walls of its own vessels. Subsequently, an inflammatory process develops in them. Later, on the affected areas, connective tissue is formed, narrowing the lumens. The reasons for the production of such antibodies are also not yet completely clear.
There are only theories about the causes of obliterating endarteritis of the extremities. It is believed that pathology develops due to various infections that are not treated, against the background of atherosclerosis of the legs, various kinds of bleeding disorders or as a manifestation of nicotine allergy in heavy smokers. It is known that those who smoke are most prone to endarteritis.
Pathology may also develop against the background of prolonged or short-term, but very severe stresses, with constant hypothermia of the legs. At risk are those who have ever received frostbite on their feet. In addition, as already mentioned, men are subject to obliterating endarteritis. Chronic infections, injuries to the extremities, impaired adrenal and genital function, 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 the disease
At the earliest stage of the development of the disease, only vascular cramps develop. This is accompanied by a thickening of the inner lining of the vascular walls, pathological changes. Subsequently, trophic disorders, degenerative processes occur, which lead to a narrowing or even complete blockage of the lumen of the artery. The length of such a pathological site can be from two to twenty centimeters.
A network developing bypassing this damaged area ceases to provide the functional needs of tissues over time. In the future, lack of blood supply develops. A person suffering from obliterating endarteritis at this stage of the development of the disease begins to noticeably limp, severe pain occurs. If previously they were observed only with excessive load, now they can occur when walking (running, exercise), and at rest. Against the background of the underlying disease, neuritis (ischemic) develops.
In the case of obliterating endarteritis of the stages, doctors distinguish four. At the first, dystrophic changes in the neurovascular endings begin to develop. Symptoms are absent, so treatment of obliterating endarteritis of the lower extremities at this stage is still not possible to begin. All disorders that could draw a person’s attention to the development of the disease are compensated by blood circulation.
In the second stage, vasospasm is accompanied by a lack of blood supply and the inability to replenish it due to the internal resources of the body. This phase of the disease is characterized by such clinical manifestations as cold legs at almost any ambient temperature, fatigue, periodic pain and lameness occur.
The third stage is characterized by trophic disorders in the layers of the vascular wall. Ripple on the arteries is weakened. Pain now occurs in a calm position. The fourth phase is the complete thrombosis of blood 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. 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 do not differ much 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 quite slowly, which makes it possible to take appropriate measures in time. Generalized endarteritis affects not only the blood vessels, but also the branches of the aorta, cerebral and coronary arteries.
Based on how severe the pain syndrome is, four stages of limb ischemia are distinguished with obliterating endarteritis. At the first, easiest, the patient feels discomfort when walking at a distance of one kilometer or more. Before the onset of pain, more than 200 m (stage II A) or less (stage II B) can pass to the second patient. In the third degree, before the onset of pain, it is possible to walk a distance of up to 25 m. Pain at rest is also characteristic here. 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
We turn to the consideration of symptoms and treatment of obliterating endarteritis of the lower extremities. First, the patient begins to feel slight discomfort with excessive loads, fatigue appears, cramps in calves and feet, toes go numb. Many begin to freeze their feet severely. In some cases, thrombi in the veins of the lower extremities begin to form at this stage. In the future, all of the above symptoms intensify, pains appear while walking, sometimes lameness can be noticed. The patient is already forced to take breaks to rest when walking.
Usually the pain is concentrated in the fingers, soles of the feet, in the muscles of the leg. The skin can become very dry, peel off, acquire a bluish tint. Toenails begin to grow more slowly, deform, break, and exfoliate. Leg hair loss may occur. The pulsation of the arteries is felt weaker. Then the pain begins 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 palpation.
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 or wounds, a violation of the integrity of the skin) on an existing ulcer. Gangrene often affects the fingers and feet, sometimes spreading to the lower legs. Toxemia, which is rapidly developing with gangrene, requires mandatory amputation of the limb.
Diagnosis of the disease
Diagnosis of obliterating endarteritis involves several methods. The doctor will collect an anamnesis, conduct a series of tests to detect insufficient blood supply to the limb. Thermography, angiography, rheovasography, ultrasound scan, oscillography and the like methods help to establish the diagnosis. To identify vascular spasms, a parnephral blockade is performed.
Endarteritis Treatment
In the early stages, treatment of obliterating endarteritis of the extremities is possible with medication. Therapy, as a rule, aims to eliminate the inflammatory process, relieve spasm of the vascular wall, improve blood circulation and prevent thrombosis. They are used as part of an antispasmodic course (nicotinic acid or Drotaverinum), antibacterial and anti-inflammatory drugs, corticosteroids, vitamin complexes (vitamins E, C, B are especially useful), anticoagulants. Intraarterial injections of alprostadil are indicated.
Balneological treatment, physiotherapeutic procedures, oxygenation are also effective. At the spa treatment, hydrogen sulfide, coniferous, radon baths, foot baths, electrophoresis, ozokerite applications can be performed. A prerequisite for successful treatment is a complete refusal of the patient to smoke tobacco in any form.
Surgery for obliterating endarteritis is indicated for severe lameness, severe pain arising at rest. Intervention can be palliative, that is, improving the function of arteries, or reconstructive. In the latter case, doctors restore impaired blood circulation. Such operations may involve arterial prosthetics, but are rarely performed. An indication for amputation is progressive gangrene. If necrosis has a clear demarcation line, you can restrict yourself to necrectomy or to amputate a smaller part of the limb.
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.
For example, collecting from St. John's wort, chamomile, yarrow, corn stigmas and birch buds may help. Dry herbs (they can be purchased at any pharmacy) should be taken in equal shares. You will need a glass jar with a tight-fitting lid. A tablespoon of the collection should be filled with 0.5 liters of boiled water only. The mixture is infused for 30 minutes. In such herbal tea, honey is allowed to be added. Drink the cooled composition in the morning and in the evening, 30 minutes before eating. The best effect can be achieved if you drink the broth courses: one month to take the composition, the next month - a break.
To prepare another healing composition, you will need field horsetail (40 grams), hawthorn (100 grams) and bird highlander (60 grams). Half a tablespoon of such a dry mixture must be filled with a glass of water (boiling). An alternative medicine will be insisted for half an hour. After it you need to drink a course of one month. Eat one tablespoon 30 minutes before meals, three times a day.
Dill seeds, Japanese sophora, white mistletoe, immortelle cleanse blood vessels well. It is recommended to drink strong tea with milk every few hours to cleanse blood vessels for 3-5 days in a row. The usual potato broth and citrus mix will help. The latter is made from lemons and oranges. Citruses (one at a time) need to be chopped in a blender, add a teaspoon of honey in mashed potatoes, mix, transfer to a glass jar. Such a composition (three teaspoons) must be consumed once a day before meals.
The use of blue iodine is distinguished by good efficiency. 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 (approximately three quarters of a glass). When the medicine according to a popular prescription cools down, you need to add a teaspoon of iodine (5%). 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 defense. A similar composition should be used with caution, since it can cause the development of 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 eliminating the negative effects of provoking factors, minimizing injuries and various injuries of the lower extremities, the regularity of drug therapy and monitoring by a vascular surgeon. With a favorable set of circumstances, it is possible for a long time to maintain remission and to avoid the progression of the disease. Otherwise, amputation of the limb is inevitable.
Disease prevention
To prevent the development of the disease or significantly reduce the speed of its spread, it is necessary to adhere to several rules. Be sure to categorically refuse to smoke, it is desirable to exclude alcohol. It is impossible to prevent hypothermia or frostbite of the legs, do not stay in cold rooms for a long time.
Too salty, spicy and fatty foods should be excluded from the diet. In general, it is better to adhere to the rules of a healthy diet on an ongoing basis - this will help reduce the risk of many diseases. In addition, sports are useful, but you need to protect your legs from bruises and other injuries. As for physical activity, it is most useful to run, go swimming and ride a bicycle. Long walks are definitely recommended.
You need to pay attention to the choice of shoes. Feet should not freeze, sweat, be squeezed. The skin must 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 bedtime, and put on warm socks on top.
All of the above actions will help to slow down the development of the disease, if it already takes place. In addition, as soon as a diagnosis is established, appropriate treatment should be started immediately.