From this article you will learn: the essence of the disease of atherosclerosis of the vessels of the lower extremities, why there is pathology. Who is most often sick, how can you diagnose and cure ailment.
- Three main causes of the pathology of
- The insidiousness of the manifestations of the disease
- The three main symptoms of
- The treatment is how effective it is
- Forecast for
When atherosclerosis of the lower extremity vessels occurs, cholesterol plaques form on the walls of the arteries of the legs of these vessels that narrow themclearance. People are more than 40 years old, more often men.
The initial stages of the disease slightly disturb the person, showing only pain in the legs with pronounced stresses. The heavier the atherosclerosis, the more pronounced the pain, which disturbs even in rest. The launched forms end with a gangrene of the limb and its amputation at the hip level.
It is impossible to completely cure atherosclerosis. But modern medical and surgical treatment restores patency of the affected arteries and maintains blood circulation in the lower limbs at the proper level.
The vascular surgeon deals with this problem most widely. Primarily you can contact a general surgeon.
Characteristics of the disease
Arterial leg vessels provide oxygenated and nutrient-rich blood to all tissues in the lower extremities. Responsible for this final section of the aorta in the field of bifurcation, iliac, femoral, popliteal, artery of the legs and feet.
Click on photo to enlarge If deposits of cholesterol accumulate on the internal surfaces of the vessels walls of any of the segments of this arterial channel - over time these deposits increase and become dense atherosclerotic plaques. Narrowing the lumen of the arteries, they interfere with the free flow of blood and disrupt the blood circulation of the legs. Such a disease is called atherosclerosis of the vessels of the lower extremities.
How the vessels of
change The main characteristics of this pathology:
- Arteries lose elasticity and become densified due to inflammation and calcium deposition.
- As the plaque builds up, they narrow the internal lumen of the vessels.
- When the plaque reaches a large size, it ruptures with damage to the inner layer of the arteries.
- Blood clots form on the site of damage, which narrow the vascular lumen even more.
Another name for this pathology is obliterating atherosclerosis of the lower extremities. The term obliterating means - narrowing, overlapping - which more fully reflects the essence of the disease.
What is the Danger of Changes to
The arteries afflicted with atherosclerotic plaques are not able to provide the tissues of the lower limbs with the required amount of blood. There is a violation of the circulation of the legs - arterial insufficiency. Its danger is that the oxygen starvation of tissues negatively changes the metabolism in them, it breaks the structure and functional abilities. Atrophy( decreases, thinens) the skin, muscles, bones and joints of the legs, which disrupts the possibility of walking. Critical violations of blood circulation - trophic disorders in the form of ulcers, wounds, necrosis( gangrene) of the fingers, feet or the entire limb.
Three main causes of the pathology of
There are three main reasons for atherosclerosis of the vessels of the lower extremities:
- Long( for years) increase in the level of cholesterol in the blood( total and low density lipoproteins).
- Genetic predisposition( if the disease was with close relatives).
- Metabolic disorders( primarily, fat).
Who is more likely to suffer from
The most common disease occurs in people at risk. It includes people:
- obese;
- suffering from diabetes;
- suffering from hypertension;
- abusing fatty foods and strong coffee;
- smokers;
- constant supercooling feet;
- suffering from inflammatory processes in the arteries of the legs( arteritis);
- men after the age of 40 years.
The insidiousness of
manifestations By itself, atherosclerosis of the vessels of the lower extremities does not manifest itself by itself, until it causes more or less pronounced narrowing of the arteries that disrupt the blood circulation in the tissues of .This is the insidiousness of the disease. Atherosclerosis of the vessels of the legs is therefore called obliterating atherosclerosis, that if the patient already has characteristic symptoms, this indicates the presence of a narrowing or a complete closure of the arteries lumen.
Another point of the insidiousness of the disease is the inability to predict the course and symptoms. About 20% of patients over the age of 65 with pronounced atherosclerotic plaques do not present any complaints that would speak about atherosclerosis. At the same time in 25-30% of the disease immediately manifests itself as acute complications, threatening gangrene( necrosis) of the limb.
Severity of symptoms depends on the presence of collaterals - new vessels that are formed in response to insufficient blood supply. They, though small, but are able to meet the needs of tissues in nutrients in conditions of oxygen starvation. The more developed collaterals, the less manifested even launched atherosclerosis.
In people who are ill for years, circulatory disorders are less pronounced than in patients with a rapidly progressing atherosclerotic process, since they manage to form collateral blood flow. In this respect, the defeat of large arteries is less dangerous than small ones. In the second case, collaterals simply can not be formed.
Three main symptoms of
Suspected an atherosclerotic lesion of the lower extremities allow such symptoms:
- pain and a feeling of cold in the legs,
- intermittent claudication and weakness of the legs,
- trophic disorders.
1. Pain and other sensations
A typical localization of pain in circulatory disorders in the lower extremities due to atherosclerosis is the calf muscles of the shins. This is due to the fact that they have the greatest load, and the number of arteries is minimal. Therefore, the obstruction of any vessel causes pain in the legs. In the early stages, it appears only with heavy loads( running, long walking), accompanied by a feeling of chilliness, cold feet.
When atherosclerosis reaches a critical extent, not only the lower leg, but also the feet begin to ache. These pains are permanent, are so strong that they are not even taken off with pain medication. Characteristic of their presence is not only with loads, but also at rest.
2. Intermittent claudication
A mandatory criterion for atherosclerosis of the lower limbs is intermittent claudication. This symptom reflects the degree of impairment of the functional abilities of the leg muscles - the patients note a strong weakness of the legs, accompanied by pain when walking at different distances( from 1 km to 20-30 m).Having traveled a certain distance a person has to stop and stand for several minutes while the muscles rest. After that he continues walking until the next attack of weakness of the legs. This phenomenon is called intermittent claudication.
3. Trophic disorders
Disturbance of the structure of the leg tissues due to atherosclerosis and arterial insufficiency is called trophic disorders. They extend to:
- skin of the legs - it becomes pale, cold, hair growth worsens;
- muscles of the shins and thighs - they become thin, reduce the volume and mass( are hypotrophic);
- tissue complexes of the skin, subcutaneous tissue, fascia, bones - there are trophic ulcers( non-healing wounds) of various sizes( from 1 cm to circular defects on the entire shin), darkening, necrosis( gangrene) of the toes, part or all of the foot,and the entire limb.
Degree of atherosclerosis
The division of atherosclerosis of the lower extremities into degrees reflects the severity of pathological changes in the tissues. The higher the degree, the heavier the symptoms.
| Degree | Pain and weakness of feet when walking | Trophic disorders |
|---|---|---|
| First | Only with strong loads, walking more than 1 km | Externally tibiae and feet do not change |
| Second | From 200-300 m to 1 km | Pale skin, broken hair growth |
| Third | From 50 to 200-300 m | Hypotrophy, trophic ulcers |
| Fourth | Less than 50 m and at rest | Gangrene of the toe or foot |
Treatment - how effective is it
For atherosclerosis of the lower extremities, contact the vascular surgeon. He will determine the optimal amount of examinations and on their basis make up a treatment plan.
The standard diagnostic program assumes:
- of ultrasound of lower limb arteries( Doppler and duplex scanning);
- study of lipid spectrum of blood( concentration of LDL and cholesterol);
- study of blood clotting( coagulogram).
If necessary, the most reliable method is assigned - arteriography of the lower extremities.
Methods for diagnosing atherosclerosis of lower extremity vessels Conservative therapy
Complex conservative treatment is indicated absolutely for all patients, and for patients who can not undergo surgery this is the only way out. Includes:
- Diet, devoid of fatty foods of animal origin and cholesterol. Enriched with omega-3( vegetable oils, fish, vegetables).
- Dosage( moderate) physical exertion for the legs.
- Intravenous infusion treatment( droppers, injections) courses for 2 weeks at least 2 times a year, with medications: Trental, Tivomax, Actovegin, Solcoseryl, Clexane, Xanthinal nicotinate, Vazaprostan.
- Systematic or continuous intake of specific anti-atherosclerotic agents: Atoris, Simvastatin, Atorvastatin.
- Constant reduction in blood clotting: Atherocardard, Clopidogrel, Plestazolum, Magnikor, Cardiomagnet.
Preparations for atherosclerosis of the vessels of the legs It is impossible to completely cure of atherosclerosis of the lower extremities. It is really essential to slow down the process of formation and growth of cholesterol plaques, and also to support blood circulation in tissues, preventing irreversible trophic changes.
When an operation is needed
In 50% of the problem of atherosclerosis and impaired blood circulation can be cured surgically. This is possible with segmental lesions of large arteries and preserved lumen of vessels of medium and small caliber below the narrowed sections. Perform such surgical treatment:
- Endarterectomy - removal of the inner layer of a small fragment of the artery along with plaques( about 5 cm).
- Shunting - replacement of an extended arterial segment( from 10 to 50 cm) with an artificial prosthesis( shunt).
- Lumbar sympathectomy is the removal of nerve nodes that support spasm( contraction) of the arteries.
- Endovascular surgery - the introduction of a lumen of the arteries of stents - springs, which expand and maintain the lumen of the narrowed section.
Click on the picture to enlarge The efficiency of operations is good: in 75-85% of cases the blood circulation is completely restored on average by 6-8 years.
Prognosis for
The prognosis for life in atherosclerosis of the vessels of the lower limbs is favorable. If at the appearance of the first symptoms to consult a specialist and adhere to all treatment recommendations, 85-90% manage to avoid irreversible circulatory disorders.
Started and rapidly progressing forms of the disease in 90-95% result in various gangrenes and amputations on the lower limbs, as well as the death of patients from intoxication against their background.
