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Obliterating atherosclerosis of lower limb arteries

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What is atherosclerosis of the lower extremities?

Atherosclerosis of the lower extremities is a group of pathological processes affecting the main blood vessels of the lower extremities, and represent a progressive disorder of tissue blood supply because of narrowing (stenosis) or blockage (occlusion) of the arteries. The term "occlusive" in relation to this disease it means a gradual but steady narrowing of the lumen of blood vessels.

The arteries are major blood vessels. In the normal state, the arteries are free and the blood freely circulates through the blood stream. However, in some cases, the lumen of narrowed vessels, and surrounding tissues receive less nutrients and oxygen needed to maintain stable operation, resulting in the development of ischemia and subsequent necrosis.

In short, the basis of the mechanism of formation of disease is the blockage of blood vessels or narrowing. Narrowing is a common cause, for example, for the body of a heavy smoker. Blockage can also occur if the walls of the arteries of the lower extremities is delayed fatlike substance cholesterol (LDL —lipoproteidnyi complex). However, the process of development of pathology is not so simple and requires more detailed explanation.

The mechanism of disease development

Most often, atherosclerosis of vessels of lower extremities is manifested in old age and is caused by disorders of lipoprotein metabolism in the body. The mechanism of development passes through the following stages.

  • Ingested cholesterol and triglycerides (which are absorbed in the intestinal wall) are captured by special transport proteins-proteins — chylomicrons and are transported into the blood stream.
  • The liver processes all the substances and synthesizes the particular fatty complexes — VLDL (cholesterol very low density).
  • In the blood by molecules VLDL affects enzymelipoproteinlipaza. In the first stage the chemical reaction goes into VLDL lipoproteins intermediate density (or LPP), and then in the second stage of the reaction LPPP transformirovalsya in LPN (low density cholesterol). LDL is the so-called "bad" cholesterol and that it is more atherogenic (i.e., able to induce atherosclerosis).
  • Fatty fraction originate in the liver for further processing. Here lipoproteins (LDL and LPP) is formed high-density cholesterol (HDL), which has the opposite effect and is able to cleanse blood vessels from cholesterol deposits. This so-called "good" cholesterol. Part of fatty alcohol is processed in the digestive bile acids, necessary for normal digestion and sent to the intestines.
  • At this stage, the liver cells can give "crash" (caused genetically or old age), in which HDL is at the output of the low-density fat fraction will remain unchanged and will go into the blood stream.

Not less than, and possibly more atherogenic and are mutated or otherwise modified lipoproteins. For example, oxidized under the influence of H2O2 (hydrogen peroxide).

  • Low density fat fraction (LDL) are deposited on the walls of the arteries of the lower extremities. Long-term presence of foreign substances in the lumen of blood vessels contributes to inflammation. However, neither macrophages or leucocytes to cope with cholesterol fractions can't. If the process is delayed, are formed of layers of fatty alcohol plaque. These deposits have a very high density and impede the normal flow of blood.
  • Deposits of "bad" cholesterol is encapsulated, and when rupture or damage the capsules the formation of blood clots. Blood clots have additional occlusive effect and further clog the arteries.
  • Gradually, cholesterol fractions, in conjunction with blood clots accept rigid structure due to deposition of calcium salts. The walls of the arteries lose their normal flexibility and become fragile, resulting in possible gaps. In addition, formed persistent ischemia and necrosis of the adjacent tissues due to hypoxia and lack of nutrients.

Atherosclerosis of vessels of lower extremities — pathology of insidious. In some cases it may not manifest or Express themselves non-specific symptoms. For example, a patient chilliness in the extremities or "tingling"can be explained by the fact that"spent"or"lain" limb.


Symptoms of atherosclerosis of lower extremities

Atherosclerosis of the lowerlimbs fairly easy to recognize even yourself, provided careful attention to their own health and feelings. It is system specific and common symptoms.

  • Itching, "ripples" in the limbs, chills , etc. patients differ in defining these feelings, but often the feeling is similar to the numbness of the limb as a result of prolonged stay in an uncomfortable position. When this symptom is present for no apparent reason.
  • Feeling cold in the lower extremities. There are no apparent reason. Can occur in the warm season.
  • Pale skin feet.
  • Thinning of the muscle and fat layer in the hips, legs and feet. Narrowing or blockage of the arteries that provide oxygen and nutrients to the tissues, leading to active degeneration of the tissues.
  • The complete or partial loss of hair ankles and shins without any further body hair. Is also associated with the development of degeneration of tissues. The system of capillaries in the affected limbs unnaturally growing, however, to compensate for the lack of blood supply can not.
  • Pain in the legs. Observed at rest, when walking and any physical activity increase.Specific symptom of atherosclerosis is intermittent claudication caused by severe paroxysmal pain.
  • In a "running" cases: darkening or redness of the feet and the toes (tissues become unnatural Burgundy or dark red color), indicating blood stasis and thrombosis. The symptom is a precursor of such terrible complications as necrosis.
  • The formation of leg ulcers (also called venous ulcers).

  • Tissue necrosis (gangrene). Manifested in the last stages of the process. Because the disease develops rapidly — the stage can come quickly.

Thus, when obliterating atherosclerosis of the lower extremities is observed complex of severe symptoms. Their appearance indicates the need for early medical care. In most cases, the delay and indecision of doctors and patients involve amputation.


The causes of atherosclerosis of the lower extremities

Obliterating atherosclerosis of the lower extremities can develop inmany reasons:

  • Floor. Equally hurt by both men and women. The age of the persons suffering from atherosclerosis, and ranges from 45 for males and 50 years for women. Men, as a rule, in 1.5-3 times more likely to acquire this disease. The reasons for the difference in incidence is unclear, but it is assumed that estrogen (female sex hormone) is able somehow to prevent the clogging of arteries.
  • Age. As mentioned, with age, the risk increases proportionately. During the menopause the activity of the production of sex hormones in the female body decreases, so after 50-55 years the number of cases among men and among women is approximately the same. In Russia, statistics on atherosclerosis, truly horrifying. ¾ Men and ¼ of women under the age of 40 years suffer from the disease. And in the above age the number is closer to 90%.
  • Elevated levels of cholesterol and triglycerides. Both substances have the ability to clog blood vessels and cause ischemia. How to reduce triglycerides in the blood?

  • Hypertension. Represents an elevated level of blood pressure. Normal values range from 120/80 to 130/85. Persistent or recurrent excess of these figures indicates the presence of hypertension. Vessels in hypertension very quickly lose their elasticity and become brittle. The inner side of the worn-out vessels lose their elastic smooth texture, becoming rough. In this condition, cholesterol plaques formed much more active.

  • Genetic causes. Atherosclerosis — disease polietiologic. Hereditary factor plays a role. Indulge in inherited characteristics of lipid metabolism in the body, particularly hormonal, as well as the specifics of the immune system, which atherosclerosis can go faster or slower.
  • Addiction. Nicotine, which is richly supplied to the body, soaked in blood, which is extremely atherogenic. However, in heavy smokers the mechanism of formation of atherosclerosis is different. Without a doubt, nicotine can affect lipoproteidnyi metabolism in the body, but most often the cause of acute insufficiency of blood supply to the tissues of the lower extremities is the stenosis of the arteries, not blockage. Drugs have the similar, but even more devastating effect, and their reception in the vast majority of cases would mean certain death or severe disability.Alcohol in small therapeutic doses, however, can have a positive preventive effect.

  • The presence of concomitant diseases and pathologies. Hand in hand with atherosclerosis is diabetes. In diabetes there are significant dysfunction of lipid and lipoproteina exchange, in connection with which 75-80% of diabetics atherosclerosis develops within the first 4-5 years or even faster.

  • The lack of thyroid hormones (hypothyroidism the thyroid gland) also affects the normal metabolism, increasing the risk of atherosclerosis of the lower extremities by 35-40%.

  • Stress. Especially if they are permanent and protracted.
  • Obesity. Itself often indicates the presence of metabolic disorders.
  • Inflammation in large blood arteries.

Diagnosis of atherosclerosis of the lower extremities

The symptoms are not always pronounced, for this reason, diagnosis of atherosclerosis is quite difficult without proper medical training. True diagnosis can only experienced doctor, meanwhile, the delay in diagnosis and timely treatment can cost a patient's affected limbs.

Of great importance in the diagnosis have three main methods:

  • Sample.
  • History collection.
  • Ultrasound examination of vessels of the lower extremities.

History

At the initial examination, the doctor suspects that the patient has atherosclerosis more needs to interview the patient and consider all the factors.

As a rule, in the anamnesis of patients is the combination of the following elements:

  • The "experience" of Smoking;
  • Increased body mass;
  • Absence of allergic diseases;
  • Age over 40 years;
  • Externally, the patient looks more than the actual age;
  • Complaints of pain and problems with both feet;
  • Frequent moderate or frequent attacks of intermittent claudication that capture many of the muscle of legs: from the buttocks to the calves.
  • The skin of the feet pale;
  • Pulse on large arteries is almost not felt. When listening to the affected areas of the detected noises.
  • Present:hypertension, ischemic heart disease and/or diabetes.

  • Symptoms are permanent. Not depend on the time of year or day.
  • In the family were patients of cardiovascular diseases. With high probability, and the patient has a problem with cholesterol.

Functional tests and tests

At the end of the collecting history doctor confirms your guess special functional tests:

  • Functional test Burdenko. Atherosclerosis is associated with stagnant processes in blood vessels. When bent leg at the knee, the foot (sole) is covered with marble of vascular pattern. This indicates poor blood flow to the limbs.
  • Hyperemic test Shamova/Sitenko. Because of the same congestive processes blood circulation in tissues is violated. For the detection of atherosclerotic disorders in the vessels for a time of 3-5 minutes on the upper arm or thigh is imposed special cuff. It compresses surrounding tissue, preventing normal circulation. Normal blood supply (and therefore pink) tissue in normal returned after 25-35 seconds. If the blood vessels affected by atherosclerosis may take up to a minute and a half or more, depending on the degree of narrowing of the channel of the blood vessel.
  • Function test Moshkovich to assess planetarnogo symptom. The patient takes a prone position. Then raises the legs straight up, not bending their knee joints. In this position the patient is asked to remain for two to three minutes. Then the patient takes a standing position. Normal, healthy human skin is pale in the first position, since the outflow of blood from the lower limbs, and as soon as there is blood flow is restored, and the skin again assumes its natural pinkish shade for 8-10 seconds or faster. In patients with atherosclerosis, this is not observed. Skin from 30 or more seconds is able to maintain a pale color marble vascular pattern, etc.

If violations were detected, the doctor will conduct the second, more profound test aimed at establishing the degree of insufficient blood supply (planetarnogo symptom). For this, the patient again lies down and pulls the legs up. But now he is asked in turn or together to bend and straighten the legs. Physical activity requires a flow of blood, and its deficiency will lead to rapid fatigue of the muscles. I suffer from atherosclerosis, there is a rapid fatigue and pallor of the soles of the feet. Depending on the intensity and speed of onset of these two factors, it is possible to establish the degree of lack of blood flow.

Ultrasound

To establish the severity of circulatory disorders resort to dopplerography of blood vessels. This study allows to establish the velocity of blood flow and degree of saturation of the tissues with essential nutrients and oxygen.

Other research methods

They are numerous and are assigned to confirm the diagnosis:

  • Laboratory studies (assays). As a rule, in atherosclerosis, there is increased concentration of triglycerides, LDL, and the most accurate and informative indicator is the so-called index (ratio) haemoglobin, which is determined based on the ratio between good and total cholesterol.
  • Radioisotope studies to determine the level and quality of the blood supply to the tissues and to establish the degree of anemia.

  • Radiography gives you the opportunity to establish the localization and size of occlusions in blood vessels.

Actively introduced and new diagnostic methods, like spectral scanning, whereby it is possible to study the contours of the affected vessels to determine the rate of blood flow and blood pressure, and others.

An inexperienced technician often risk not to see the disease. The reason lies in the high adaptability of the organism to various adverse factors. The patient developed collateral blood supply. Are formed and grow new vascular structures for tissue the necessary nutrients. Although this method is not able to replace the normal circulatory system in the affected area, partial compensation is still achieved. It lubricates the picture, confusing the doctor.

Treatment of atherosclerosis of the lower extremities

Treatment of atherosclerosis of the lower extremities represents a significant difficulty, because the disease, as has been said, politologichni. Therefore, it can be called a variety of reasons. Treatment consists in removing the root causes and getting rid of unpleasant and life-threatening consequences. To act doctor must correctly and efficiently. Atherosclerosis not only significantly reduces the quality of life, but also threatens the health of the patient.

The treatment for many.

Conservative methods include:

  • Drug therapy;
  • Physiotherapy.

In extreme cases resort tosurgical methods. Traditionally invasive surgery nowadays rather widely used, however, great importance is attached relatively low-invasive endoscopic interventions.

Drug therapy

Drug therapy is comprehensive. Treatments fractional, held for 1.5-2 months intervals up to 4 times a year, depending on the clinical picture. Drugs aimed at combating spasserovannye of the vessels and their narrowing. Used antispasmodics and drugs that extends the lumen of blood vessels (like Pepto, complain, etc.).

An important role is given to drugs that increase the rheological qualities of blood and thereby improves its circulation (in particular, a well-known aspirin, or, in its intolerance, a "good" drugs: chimes, etc.).

Many patients with atherosclerosis are predisposed to develop diabetes (or even more patients to already have it in history). Therefore, in the course of treatment included drugs and pancreas.

Learn more: List of drugs to improve the functioning of the brain

Physical therapy

Used in conjunction with drug therapy. The most effective are the following types:

  • Impact on the affected areas with combinations of AC and DC (inductothermy).
  • Deep introduction of drugs by means of electric current (electrophoresis).
  • Magnetotherapy.
  • UHF.

These therapies contribute full or partial reconstruction of the affected vessels.

In the complex these methods are highly effective at early or later stages of the disease. In 90% of cases in combination with effective gipoholesterinovu diet, or quitting bad habits conservative therapy produces the desired effect.

However, treatment does not always helps. Besides, the situation may arise where the process has gone too far and the vessels finally lost its function without the possibility of recovery. In this case, no surgery is necessary.

Surgical treatment

Traditionally, the main method is surgery vessels. Affected and lost their functions, the vessel is removed, replaced by a prosthesis. Modern vascular grafts are not much different from the natural tissue, and therefore perform their task adequately and allow the patient to return to a normal and fulfilling life.

Fortunately for patients, time does not stand still and amazed, but not entirely lost its functionalitythe vessel can be restored by means of angioplasty. It is minimally invasive, but highly effective endoscopic method to eliminate occlusion or stenosis of the blood vessel.

Its essence lies in the fact that the endoscopist under video control through a puncture in the femoral artery the catheter advances in the blood stream to the affected area. Upon reaching the affected area of the artery, the physician extends or eliminates foreign objects, making the function of the vessel is returned. Unlike traumatic surgery to place a prosthesis, angioplasty is less traumatic. Another question — not always, only she can do.

Learn more: 4 of the most needed product in atherosclerosis


Diet in atherosclerosis of the lower extremities

By itself a change in diet is not able to exert any therapeutic effect. It is effective either in conjunction with other treatment interventions or prevention.

Diet in atherosclerosis of the lower extremities is not just a one-time event. To achieve the desired effect it is necessary to adhere to for a long time. A new way of eating should become a kind of lifestyle. It will provide treatment, and at the same time and further prevention. However, in most cases, the initial stages of the disease to abandon the products for a long time it is rarely necessary.

In the diet of the patient with atherosclerosis should include:

  • Meat products. Lean meat, poultry (Turkey preference).
  • Fish. Allowed, including oily fish, because the fat affects the blood vessels rather positive effect.
  • Fresh fruit, vegetables and berries — without any restrictions.
  • Dairy products, including fat.
  • Eggs boiled and roasted (omelettes). They contain lecithin, as well as a large amount of cholesterol that with the right preparation go into a "good" shape, cleanse blood vessels from deposits.
  • Vegetable oil (olive and sunflower oil).
  • Cereals, pasta from wheat flour. As well as bran and bread.
  • Green tea.

  • Nuts (especially almonds and walnuts).

  • Beans and pulses crops (lentils,beans, peas).

  • Dry red wine.
  • Cheese (less than 30% fat).

It is necessary to limit consumption of the following foods:

  • Synthetic foods rich in TRANS-fats. It's a margarine spread.
  • To limit the intake of offal (brain, kidney, liver) and its products.
  • Sausages.
  • Mayonnaise, ketchup and other sauces, is made industrially.
  • Potatoes (fried) and fast food. Potatoes for example in small quantities and only boiled (in their jackets) or baked.

Adhering to such a diet in conjunction with medication and physiotherapy can alleviate the condition and get rid of the consequences of the disease.

Thus, obliterating atherosclerosis of lower limb arteries can be directly related to the level of cholesterol in the blood and may not have any relation to it. Anyway, this is an extremely dangerous disease, which in the absence of adequate treatment can lead to disastrous results. To identify it is difficult enough (independently — not impossible). To cope with the diagnosis and prescribe treatment can only be experienced doctor.

Fortunately, modern medicine has a full range of diagnostic procedures. Treatment is usually conservative in the early stages. In addition to traditional medical and physical therapy recommended total organism and using special diets. However, in more severe cases resort to surgery.