Diabetes

Atherosclerosis of vessels of the lower extremities: classification and treatment

Atherosclerosis obliterans is a severe pathological process of the cardiovascular system, which is manifested in the overlap of the lumen of the elastic and muscular-type vessels by swollen, filled with fat-protein infiltration cells.

This leads to the deterioration of the trophism of the area that feeds from the artery. Patients experience the greatest discomfort in late forms of lower limb atherosclerosis.

At the same time, circulation in the muscles is significantly reduced, lactic acid and metabolites are slowly eliminated, and therefore unbearable pain occurs. Consider the etiology and pathogenesis of this disease.

Causes and mechanism of development

There are a large number of causes of the disease. The trigger mechanism of atherosclerosis has not been studied, but in modern evidence-based medicine risk groups of this disease are formed. This means that if the patient has any of the following points, then the chance of atherosclerotic changes is increased.

These factors include:

  • Overweight. Overweight people are more prone to illness because of a disorder in a number of metabolic pathways. As free fats are debugged in adipose tissue, these same triglycerides, cholesterol, and lipid substances can penetrate into the endothelial cells of the vascular wall. In this same risk group can be attributed, and too fatty, high-calorie foods in combination with enzyme deficiency.
  • Age, gender Women are less susceptible to atherosclerosis due to the presence of estrogen, which inhibits the disruption of the cell membrane. Men get sick five times more often. Also, people over the age of 40 are subject to the disease due to the natural degeneration of collagen in the vascular wall and the loss of their elasticity.
  • Smoking. Nicotine and other components of tobacco smoke cause a strong reflex spasm of blood vessels, which weakens them over time. In such a wall cholesterol penetrate much easier than in the holistic.
  • Diabetes. In this case, the oxidation of lipids does not go to the end, and non-split substances have to circulate freely in the blood, where they penetrate through the tropic membrane.

High blood pressure, a sedentary lifestyle, heredity in the form of the presence of relatives of cardiovascular diseases - this is not a complete list of factors that lead to atherosclerosis.

What happens in the body? At first, the changes are minor, they can be diagnosed only by biochemical method. Cholesterol in the body is transported in high and low density transport forms. The first is the so-called "beneficial" cholesterol, in this form it is transported for the synthesis of hormones and the regulation of membrane permeability, as well as for utilization. The second type is a cholesterol transporter for storing. Normally, it should be four times smaller than the first, but sometimes the balance is disturbed. Then the fatty infiltration starts. This is called the dolipid stage.

There are several stages of disease progression.

  1. Stage one - lipoidosis. At this stage, you can detect only lipid spots and bands, which are the first sign of atherosclerosis.
  2. Atheromatosis - the plaque expands, closes the lumen even stronger, overgrown with capillaries and fibrin. The first symptoms of the disease appear now.
  3. The last stage is fibrosis or calcification. The plaque can be completely replaced with connective tissue, or soaked with salts and hardened, which narrows treatment options before a purely surgical intervention.

What types of atherosclerosis are there?

Atherosclerosis can affect any large and medium vessels throughout the body.

Dangerous forms are - coronary (blockage of blood vessels that feed the heart), cerebral (occlusion of the brachiocephalic trunk and common carotid artery basin), lower extremities (lesion of the femoral artery along its entire length).

Classification of obliterating atherosclerosis of the lower extremities is carried out according to a number of factors - symptoms, functional disorders and morphological signs.

Consider the main ones among them:

Dysfunction:

  • 1 - a person will not experience pain when walking, even at a distance of more than 1 kilometer. You may experience pain in severe physical exertion. Additional symptoms include tingling in the fingers, sensations of coldness of the limb, pallor of the skin on the foot, possibly numbness.
  • 2a - the pain will appear at a distance of 1 km. Fingers take on a bluish tint due to stagnant blood in the veins, hyperkeratosis (dry skin), brittle nails. At this stage, it is no longer possible to determine the pulsation of the distal vessels in the legs.
  • 2b - the patient will not be able to walk 250 m on foot without stopping due to the pain that has arisen, which pass after a short rest.
  • 3 - pain occurs spontaneously, and the patient barely passes 50 meters without stopping. This class corresponds to almost complete occlusion of the vessel. The hair on the leg falls out, because nutrition is insufficient. Cracks appear on the skin, it becomes thinner and takes on a marble color.
  • 4 - manifestation of external symptoms in the form of trophic ulcers and foci of necrosis. This is a dangerous condition, fraught with disability. The gangrenous stage is also characterized by terrible night pains, which are not relieved by painkillers. The fingers become red, and the foot swells.

By localization of the outbreak:

  1. The process involves the iliac artery and the abdominal aorta.
  2. With further development, the femoral artery and the first popliteal branches are included.
  3. The following are affected popliteal artery and vessels of the tibial segment.
  4. Complex defeat of the above segments.
  5. Multifocal disease - there are many foci throughout the body, the generalized form.

The classification of atherosclerosis of the lower extremities is also carried out according to the rate of progression of the disease (acute and chronic), according to the degree of preservation of the circulatory blood supply (compensated, subcompensated, decompensated).

How to detect the disease in time?

Any diagnosis begins with a subjective examination, that is, with the patient's complaints.

Typical anamnestic features of atherosclerosis of the lower extremities include acute, burning pain when walking in the lower leg area (if the abdominal aorta is damaged, pain in the back and buttocks, as well as impotence in 50% of cases), burning sensation, numbness of the limb, trophic exhaustion of the legs, change their colors, the disappearance of the pulse.

After the survey, you can proceed to the laboratory diagnosis:

  • Determination of the ankle-brachial index to assess blood flow in the lower extremities. It is calculated as the ratio of the maximum pressure in the tibial artery to that in the brachial artery. Normally equals one.
  • Ultrasound duplex examination. Using this method, the state of the desired artery is determined, the degree of obstruction, as well as the flow rate of the blood along with its rheological parameters — thickness, possible regurgitation. This is an arbitration method in the diagnosis.
  • Angiography - in combination with CT allows the surgeon to accurately visualize the course of the vessels and detect the damaged area. The disadvantages include invasiveness, because for the examination it is necessary to introduce intravenous contrast.

To check the condition of soft tissues, MRI and oxygen pressure measurement are used, if necessary, to determine which areas are still viable and which should be removed.

Treatment and prevention of disease

After setting the clinical diagnosis, the doctor proceeds to the choice of treatment.

In the case of atherosclerosis, there are only two - conservative (medical) treatment or surgery.

It should be understood that the first option is possible only if there are not running forms of the disease, which can still be remitted by pharmacological means.

These drugs include:

  1. The use of antiplatelet agents (Dextran, Rheopoliglyukin, Pentoxifylline (Trental), Aspirin, Ticlopidine) to prevent red blood cells from sticking together in narrow sections of the bloodstream - this further aggravates ischemia.
  2. Hypolipidemic therapy (consumption of lovastatin, simvastatin, atorvastatin, cyprofibrate, nicotinic acid).
  3. Antispasmodics (Drotaverine, No-Spa, Papaverine) are used to temporarily improve the blood circulation of the affected tissue. This somewhat soothes the pain and prolongs the pregangrenous stage of the disease, preventing the appearance of ulcers.
  4. With the threat of thromboembolism, thrombolytics and fibrinolytics are administered intravenously (Streptokinase, Heparin, Urokinase).
  5. Anesthesia is carried out perirephally or paravertebral.

Combined therapy involves the use of physiotherapeutic procedures (electrophoresis, magnetic therapy), hyperbaric oxygenation of tissues and ozone therapy.

The surgical methods of treatment of obliterating atherosclerosis of the lower extremities include retheno-endovascular intervention - this is a reconstructive surgery, during which, under the end-to-end x-ray supervision, the doctor reaches the stenotic site and applies:

  • Mechanical dilatation or long-term artery stenting.
  • Removal of thrombus or swollen wall.
  • Prosthetics of the affected vessel.
  • Introduction of a micro balloon to eliminate stenosis.

These methods are modern and receive the best reviews from both patients and specialists, as opposed to the outdated terrifying amputation.

Open surgery of the vessels of the lower limb is the complete removal of the affected vessel, indirect revascularization or amputation.

To prevent this disease, it is recommended to adhere to a strict diet, increase blood circulation by increasing physical activity, regularly go on massage and apply rubbing, eat less food, where there is a combination of fats + carbohydrates.

How to cure atherosclerosis of the legs will tell the expert in the video in this article.

Watch the video: Avoiding Leg Amputations Due to Peripheral Arterial Disease. Q&A (September 2019).