Buerger's disease is characterized by an inflammatory process in the vessels, which is caused by autoimmune disorders in the human body. This pathology arises as a result of obliteration or narrowing of the vessels, up to their complete blockage, which increases the likelihood of blood clots.
Pathology Description
The most common localization of Buerger's disease are limb veins, as well as small and large arteries. The scientific name for 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 timely measures are not taken 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 nature of the course. However, by contacting a doctor in a timely manner and carefully observing all the prescribed treatment regimens, it is possible to suspend the development of the disease and extend the life of the vessels. Vascular surgeons and rheumatologists are involved in the treatment of Buerger's disease, so if you experience symptoms, you should first contact these specialists.
The causes of this pathology
Pathology appears as a result of the development by the human immune system of antibodies to endothelial cells, that is, the inner walls of blood vessels in their own body. In addition, vascular spasms, which arise as a result of increased adrenal synthesis of hormones and specific disorders in the nervous system, contribute to the disease.
Who is at risk?
Most often, Buerger's disease affects smokers. Mostly pathology affects men, however, in connection with the prevalence of smoking among women, thromboangiitis obliterans recently affects women.
The first signs of the disease appear in patients under 45 years of age. In medical practice, this phenomenon is called the "disease of young smokers." Especially often this term is found in English-language medical literature.
Provocative factors
There are a number of factors that significantly increase the risk of developing Burger disease of the lower extremities, among them:
1. Genetic predisposition to the disease. Medicine does not exclude the presence of certain hereditary factors that provoke changes in the human immune system and lead to the development of pathology. Most often, the disease occurs in residents of Asia and the Mediterranean regions.
2. Intensive smoking from an early age. Some scientists adhere to the theory that thromboangiitis obliterans occurs as a result of intoxication of the body with components of cigarette smoke such as cotinine, that is, tobacco alkaloid and carbon monoxide or carbon monoxide.
3. Injuries due to cold. Many medical specialists note the fact that quite often Buerger's disease appears in patients who have had frostbite or hypothermia.
4. Arsenic poisoning in a chronic form, for example, in a chemical industry.
Types of disease
There are several types of Vinivarter-Burger disease. These include:
1. Distal. It occurs in 65% of cases. The disease affects small and medium 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 the large arteries, including the femoral, iliac, aorta, etc.
3. A mixed type occurs in every fifth patient. It is characterized by the simultaneous damage of both small and large vessels.
Consider the main stages of the disease of Vinivarter-Burger disease.
Stages of the disease
There are four stages of development of thromboangiitis obliterans. Each stage is characterized as the disease progresses with certain symptoms and signs.
1. Ischemic stage. It is characterized by rapid freezing of the legs, burning and tingling in the limbs. Fatigue of the legs also appears, that is, even after passing a kilometer, the patient begins to experience painful sensations in the legs and feet. The doctor, when handling the first thing, will pay attention to a weak pulse or its absence in the affected areas. The stages of Buerger's disease do not end there.
2. Trophic disorders. It is subdivided into subtypes.
2A stage is characterized by the fact that the patient can not even go a dozen steps without feeling bouts 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. Heels are overgrown with dry calluses and are covered with cracks. The nails become brown or dull, grow very slowly, and also become coarser and thicker. In addition, the amount of subcutaneous fat on the lower extremities is reduced. Then there is a gradual atrophy of the small ankle muscles and feet. Complete lack of pulse in the arteries of the feet. Symptoms of Buerger's disease are rather unpleasant.
3. Ulcerative necrotic stage.
3A stage is caused by pain in the feet, even at rest.
3B stage is characterized by edema in addition to pain in a calm state. The skin is thinning, it can easily be damaged. Minor injuries such as rubbing, bruises, cuts lead to the formation of cracks that heal for a long time. Atrophy of adipose tissue progresses at this stage.
4. Gangrenous stage.
4A stage is manifested by complete atrophy of the toes.
4B stage leads the patient to refuse 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, coldness, weak pulse, changes in muscles, nails and skin, the appearance of ulcers and gangrene at the last stage are characteristic of Buerger’s disease, which is localized on the hands.
Diagnosis of the disease
In order to diagnose thromboangiitis obliterans, the specialist conducts a number of functional tests:
1. Sample Oppel. It consists in lifting the affected leg up. In this case, 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 in such an amount that he can physically. Legs bend at the knee and hip joints. If blood circulation is impaired, then fatigue comes already after 10-20 times.
3. Sample Panchenko. The patient sits down and throws one foot on the other. If blood circulation is impaired, after a while a person will begin to feel soreness in the calves, numbness and goosebumps in the foot of that leg, which is located above.
4. Test Shamova. The foot should be freed from clothing. The patient lifts it up, while a special cuff is applied to the thigh. Air begins to be pumped into it until the pressure on the leg is higher than the systolic arterial. Next, the leg is laid horizontally. The cuff is on the thigh for about five minutes, then is sharply removed. Shortly after removing the cuff, the back of your fingers should turn red. If the fingers turned red after a minute and a half, then the patient has a mild blood flow disturbance, three minutes characterize the disease of moderate severity, more than three minutes mean a significant deficit in blood flow.
X-ray angiography
To clarify the diagnosis, the attending physician directs the patient to x-ray angiography, as well as duplex scanning by ultrasound. Both methods allow a high degree of accuracy to analyze the state of blood vessels. In addition, there is rheovasography, which allows you to evaluate blood circulation in the legs and arms and Doppler flowmetry, which is used to check microcirculation in small vessels. In addition, blood tests for circulating immune complexes are often performed .
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 "prednisone."
2. For the expansion of small arteries, as well as the normalization of blood circulation and the prevention of blood clots, drugs such as Iloprost and Vazaprostan are used.
3. Physiotherapeutic procedures are also used, for example, hemosorption and plasmapheresis, which are used to purify the blood.
4. In some cases, patients are prescribed the introduction of pertocarbons, such as Oksiferol and Perftoran. These drugs in the form of an emulsion act as a kind of blood substitutes, due to their ability to transport oxygen.
5. Quitting smoking is a prerequisite for successful therapy. The effectiveness of treatment is sharply reduced if the patient cannot give up this bad habit.
Operation as a treatment
There are also a number of surgical treatments for lower limb Burger disease. The following operations are most effective:
1. Sympatectomy of the lower back. This surgical procedure 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, the 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.