Under the influence of various adverse factors, atherosclerotic plaques form 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 worsens significantly. In medicine, the pathology is called "obliterating atherosclerosis." 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 extremities 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 extremities do not receive proper nutrition and cease to function normally.
Against the background of the development of obliterating atherosclerosis of the vessels, the patient begins to have alarming symptoms, the intensity of which increases every year. The danger of the disease is that most of the patients at an early stage of the pathology attribute the uncomfortable sensations in the legs to age or overwork.
According to statistics, the disease is most susceptible to men over 60, but it can also be diagnosed in younger people of both sexes.
Causes
In 90% of cases, obliterating atherosclerosis of the vessels of the extremities develops on the background of smoking. Nicotine provokes the appearance of spasm in the arteries, which interferes with the normal flow of blood.
In addition, the following diseases and conditions are provoking factors:
- hereditary predisposition;
- excessive use of alcohol-containing drinks for a long time;
- high level of "bad" cholesterol in the blood;
- lifestyle that does not imply frequent motor activity;
- constant stress;
- menopause in women;
- tuberculosis;
- diabetes;
- overweight;
- high blood pressure;
- hypothermia;
- all kinds of lower limb injuries;
- age above average;
- thyroid dysfunction.
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 alarming signs. Gradually, pain and fatigue appear while walking. Their occurrence is explained by the fact that with motor activity in the lower extremities, the need for blood that delivers oxygen increases. Since vessels with constricted atherosclerosis are narrowed, they cannot provide the necessary amount 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 any physical activity is performed. The more pronounced pain and fatigue, the harder the stage of development of the disease.
In addition, the following conditions are symptoms of atherosclerosis obliterans:
- feeling of numbness in the feet;
- increased susceptibility to freezing temperatures;
- constant burning of the skin, it becomes denser;
- pronounced discomfort in the calf during long walks;
- lameness;
- increase in body temperature;
- the appearance of cracks in the heels;
- at an early stage of the disease, the skin in the affected area turns significantly pale, in the late toes, the toes become cyanotic or acquire a dark red hue;
- impotence in men;
- hair loss in the legs and hips;
- exfoliation of toenails;
- ulcers, which even with minor damage or injury can lead to gangrene;
- cramps that appear during a night's rest;
- unequal temperature of the lower extremities (affected leg is much colder than a healthy one).
Atherosclerosis obliterans is an insidious disease, since, according to statistics, in almost half of patients, it is asymptomatic. In such cases, 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 occurrence of the main symptoms (pain and fatigue):
- Initial. The patient can cover a distance exceeding 1 km without the appearance of discomfort.
- Medium. 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, pain begins to bother at rest or in sleep.
- Complicated. At the fingertips and in the calcaneal zone, the formation of areas of necrosis begins, which can lead to gangrene. This stage of obliterating atherosclerosis of the vessels of the limbs is characterized by constant pain.
Depending on the degree of spread, the disease can be of the following types:
- The first (pathology is limited).
- The second (characterized by the spread of damage to the femoral artery).
- The third (popliteal vessel is involved in the pathological process).
- Fourth (both arteries are affected at the same time).
- 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.
- Moderate It is characterized by the occurrence 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 human life deteriorates significantly.
- Progressive. This stage is characterized by the formation of weeping ulcers and gangrene.
Depending on the nature of the course, pathology can be:
- Swift. The disease develops very quickly, pronounced signs appear almost immediately. The spread of the pathological process is rapid, and therefore the patient needs early hospitalization. With this nature of the course of the disease, amputation of the limb is inevitable.
- Subacute. Episodes of exacerbation are replaced by periods of complete disappearance of symptoms. All medical measures are carried out in stationary conditions. Their task is to slow down the pathological process.
- Chronic The disease for a long time may not make itself felt. In such cases, treatment is carried out with medication.
Diagnostics
If disturbing symptoms occur, consult a physician or vascular surgeon. After collecting an anamnesis and examination, the doctor will draw up a referral for a thorough examination. If necessary, he will recommend contacting other specialized specialists for advice.
Diagnosis of obliterating atherosclerosis includes the following studies:
Laboratory methods include a blood test for the following indicators:
- Lipid level. During the study, the amount of total cholesterol in the liquid connective tissue is detected. In addition, the level of lipoproteins of both high and low density, as well as triglycerides, is determined. This study allows us 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 the appearance of 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 abnormalities in the process of blood coagulation, a more thorough examination of liquid connective tissue is indicated. Before conducting some research and treatment, an analysis may be prescribed for creatinine levels.
Instrumental methods for the diagnosis of obliterating atherosclerosis (photo below) include the following:
- Computer angiography. With the help of this study, the doctor receives a three-dimensional image, which allows to assess the state of the circulatory system. In addition, the method is used not only for the diagnosis of the disease, but also for planning surgical treatment.
- Measuring ankle pressure index. 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 zone, then on the shoulder, after which these indicators are correlated. Normally, the result should be 1 or a little more. The lower the index obtained, the greater the degree of circulatory disturbance. 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. Prior to surgery, contrast aortography may be prescribed.
Conservative Therapies
Based on the diagnostic results, the doctor draws up a treatment regimen for arteriosclerosis obliterans. In addition, in advanced cases, the question of the feasibility of surgical intervention is resolved.
Treatment of arteriosclerosis obliterans arteries involves the following tasks:
- Elimination of symptoms and prevention of limb amputation in patients diagnosed with severe circulatory disorders.
- Reducing the risk of complications from the cardiovascular system. This is due to the fact that approximately a third of patients with obliterating atherosclerosis die within 5 years from myocardial infarction and stroke.
The pathology treatment regimen includes the following items:
- Taking medication. Currently, Trental or Cilostazolum is prescribed by doctors to eliminate or reduce the severity of lameness. The active substance of the first is pentoxifylline. The active ingredient decreases the blood viscosity index. Trental shows its effectiveness in only a third of patients. “Cilostazol” is a new generation drug and is prescribed more often. In addition, there are shown drugs that reduce blood cholesterol, as well as medications that reduce the risk of myocardial infarction and stroke (they should 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 provoking factors. The most important of these are diabetes and smoking. Refusal of nicotine for the rest of life is unconditional. Otherwise, the rate of disease progression will increase every day, worsening well-being and quality of life. Patients with diabetes should constantly adjust their blood glucose levels. In this case, the most informative study is the analysis for glycated hemoglobin, the rate of which should not exceed 7%. In addition, you need to maintain a normal level of blood pressure, that is, take timely measures when it deviates in one direction or another.
- Physical exercise. Regular walking is indicated for patients suffering from arteriosclerosis obliterans arteriosclerosis. Compliance with this rule helps to reduce the severity of lameness.
In some cases, premopress therapy is prescribed. The essence of the method is to massage the injured limb using special equipment. The result is the expansion and strengthening of blood vessels.
Surgical treatment
Surgical intervention is indicated with the ineffectiveness of conservative methods, with the formation of weeping ulcers and pronounced gangrene, as well as with a blue skin that is characterized by severe vascular damage.
Currently, there are many methods of surgical treatment of obliterating atherosclerosis. The choice of method depends on the degree of prevalence of the pathological process.
There are 3 main types of surgical intervention 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 by a synthetic prosthesis. A vessel taken from another part of the limb can also be used.
- Bypass surgery. It implies the creation of an artificial vessel through which the extremities will be nourished (bypassing the affected artery).
Often, combined methods are used in practice. At a very advanced stage, when there is a rapid spread of the pathological process, amputation is performed. In such cases, it is the only possible way to save a person’s life.
If standard surgical intervention is contraindicated for the patient, treatment of obliterating atherosclerosis is carried out by endovascular methods. These include: vascular stenting, angioplasty, balloon dilatation. With their help, it is possible to normalize blood circulation without conducting an open operation. Similar procedures are carried out in x-ray.
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 recipes of traditional medicine for obliterating atherosclerosis:
- Grind and mix in equal proportions a string, chamomile, sage, plantain and St. John's wort. 1 tbsp. 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 tips of the fingers. Wrap 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 a hawthorn tincture in a pharmacy and take 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 must be repeated.
- Prepare 5 tbsp. l pine needles, 3 tbsp. l rose hips and 1 tbsp. l onion peels. 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 broth.
Prevention
In order to prevent the development of the disease, the following rules must be regularly observed:
- Stop smoking completely, minimize the use of alcohol-containing drinks.
- Daily perform a simple set of gymnastic exercises.
- Control body weight.
- Avoid hypothermia of limbs.
In addition, it is recommended not to ignore the need for routine examinations 1-2 times a year.
Finally
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 that interfere with the normal flow of blood. 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, surgery is performed, and with the rapid spread of the pathological process, the affected limb is amputated.