Atherosclerosis of the vessels of the lower limbs is a chronic progressive disease of the cardiovascular system. The cause of its occurrence is the deposition of cholesterol and fat-like substances on the internal walls of the arteries.
As the pathology progresses, cholesterol plaques increase, narrow the lumen of the vessel( arterial stenosis) or cover it completely( occlusion).
Due to a decrease in the volume of blood entering the tissues, trophic tissue deteriorates, which leads to the development of secondary severe pathologies, which often result in disability.
- 1 General Information
- 2 Reasons for
- 3 Symptoms of
- 4 When to see a doctor?
- 5 Diagnosis
- 6 What should I do to recover?
- 6.1 Conservative therapy
- 6.2 Endovascular treatment
- 6.3 Surgery
In the early stages of development of atherosclerosis of the vessels of the lower extremities, a condition known as ischemia occurs. It is characterized by sensations of
The next stage of the disease is known as obliterating endarteritis. The characteristic symptoms of endarteritis are stable skin blanching and intermittent claudication .This pathology in the absence of timely treatment can lead to the development of gangrene and limb loss.
Atherosclerotic changes in vessels of varying degrees are common in most middle-aged and elderly people, but in the early stages of development the disease is asymptomatic. Pain during walking appears later, with a significant narrowing of the lumen of the vessels, and indicate a marked arterial insufficiency.
Obliterating atherosclerosis affects mainly men, the development of pathology contributes:
- Smoking .About 90% of patients with atherosclerosis are smokers with a long history.
- Insufficient physical activity of .Among people leading a sedentary lifestyle, vascular pathologies are more common.
- Alcohol .Systematic and excessive consumption of alcohol accelerates the course of the disease.
- Violation of the principles of healthy eating .The abundance of smoked, fried, fatty foods contributes to the formation of cholesterol plaques.
- Chronic stress and neuro-emotional overloads of are the cause of angiospasms that worsen blood circulation in tissues.
- Chronic diseases .Atherosclerosis can develop against the background of diabetes, obesity, rheumatism, tuberculosis, hypertension and other pathologies of the cardiovascular system.
Risk factors can be divided into two groups: they either lead to constant vasoconstriction, impede blood circulation and accelerate the deposition of cholesterol, or increase the cholesterol and associated lipoproteins in the blood.
Vascular pathologies are especially dangerous in that they can develop asymptomatically for a long time. The first noticeable signs of arteriosclerosis of the vessels of the legs indicate that the process has gone far enough and the patient needs urgent treatment.
first thing you usually pay attention to the sick - fatigue and pain that appears during exercise ( especially when walking, climbing stairs, running), accompanied by a tingling sensation on the skin. Some patients report increased sensitivity to cold.
The localization of pain depends on the location of the lesion. Usually the calf muscles suffer, the stenosis of the abdominal aorta and the iliac arteries are painful in the muscles of the thigh and buttocks. With the progression of atherosclerotic changes, the intensity of pain sensations increases, they spread to other muscles of the affected leg.
Patients complain of sensations of contraction, stiffness, numbness of .It is characteristic that with the removal of the load, and even more so after rest the pain passes, unpleasant sensations disappear. This symptom complex is known as intermittent claudication.
Intermittent claudication manifests itself in most cases on one leg, bilateral symptoms in the early stages are rare .With bilateral symptoms, the degree of expression is not the same on each of the legs.
further progression of the disease is accompanied by the increase of intensity of pain even at rest state and its extension to the distal limb until fingers. Painful sensations increase with the horizontal position of the affected limb. Due
violation trophism tissue on the affected leg gradually hair falls out, much slower growth of the nails and the healing of minor wounds, abrasions, scuffs .On the lower leg, fingers and foot there are necrosis, edema of the lower leg and foot develops, trophic ulcers are formed. The skin acquires a cyanotic shade, eventually turning into brown or black. The lack of treatment leads to gangrene.
The main feature for determining the stage of development of atherosclerosis is the distance of painless walking:
- 1 stage .The distance of painless walking exceeds 1 km, pain occurs with considerable physical exertion.
- 2a stage .Painful sensations appear after a distance of 250-1000 m.
- 2b stage .The patient is able to overcome without pain 50-250 m
- Stage 3( stage of critical ischemia) .The distance of painless walking is reduced even more, the pain does not subside even in a state of rest and intensifies at night.
- 4th stage .Trophic disorders.
These photo shows clear signs of lower extremities atherosclerosis running:
Disturbances of trophic legs due to atherosclerosis.
In the classic course of obliterating atherosclerosis, the disease progressively passes the stages of development, excluding cases complicated by acute arterial thrombosis. The thrombus blocks the artery lumen in the narrowest part of the , the affected leg suddenly becomes cold and becomes very pale. Arterial thrombosis is referred to as urgent conditions, when the patient immediately needs the help of a vascular surgeon.
When should I see a doctor?
If a person has more than forty years, guard should any unexpected sensations in the legs : stiffness, weight, acute sensitivity to cold, chill - especially if they are combined with rapid fatigue and muscle pain. Trouble, insignificant at first glance, in fact - a threatening warning from the vessels about the presence of a pathological process.
The clinical picture of vascular pathologies in the early stages of development resembles manifestations of other diseases not directly related to blood flow disorders. Therefore, the first symptoms of the prospective atherosclerosis of the vessels( veins and arteries) of the lower limbs - is the occasion for a visit to the therapist , which will send the patient to a specialist of the appropriate profile for treatment.
The pain that appears when walking is a direct indication that you can not postpone your visit to the phlebologist any more. Painful sensations, changes in local temperature and skin color indicate that pathological changes have gone far enough and pose a serious threat, up to the threat of life.
Very terrible phenomena - difficult healing of scratches, small wounds, slowing of nail growth, hair loss on the legs .If one or more symptoms are found, the endocrinologist should be consulted immediately( to exclude diabetes mellitus) or immediately to a vascular surgeon.
Diagnosis of obliterating diseases of arteries is performed with obligatory instrumental studies. The patient must send ultrasound duplex vascular scanning( ) to the .The ultrasound scanning technique allows you to see the features of the blood flow in the vessel, the condition of the walls and adjacent tissues, and to detect obstructions that disrupt the circulation.
For suspected surgical intervention, the radiopaque arteriography is performed. The radiocontrast agent is injected into the artery and a series of successive images are taken along the vessel. After this, the patient is left in the hospital and assigned to bed rest for 12 hours.
In case of dispute, additionally measures the oxygen partial pressure in the tissues of .
The clinical picture of atherosclerosis of the lower extremities vessels of the at early stages resembles the manifestations of other vascular pathologies of , in particular, thrombangiitis and obliterating endarteritis:
- Endarteritis affects people of young age and usually develops against frostbite, nervous overstrain or severe hypothermia. Pathological changes are usually localized in the distal parts of the limb.
- For , thrombangiite is characterized by a combination of symptoms characteristic of arterial insufficiency and thrombophlebitis of veins. Disease occurs in young men.
What should I do to recover?
Each case of atherosclerosis requires an individual approach. When developing the tactics of treatment, the presence of concomitant diseases, the degree of severity of the patient's condition, the extent of the vascular lesion, and some others are taken into account. Treatment of atherosclerosis can be:
Conservative treatment is possible if atherosclerosis is detected in the early stages. Conservative methods are used during the preparation for the operation of patients in an uncritical state, weakened by concomitant pathologies. Depending on the patient's condition, in addition to the course of medicamental treatment and physiotherapy procedures, dosed walking, exercise therapy, pneumospressotherapy, and certain folk remedies may be prescribed.
The course of drug therapy includes drugs that reduce blood viscosity, promote the normalization of peripheral circulation, and antispasmodics. Some medications the patient should take constantly, a full course of treatment is carried out several times a year.
Medical treatment in any way does not affect the cholesterol plaque, but only improves the blood circulation of in the small arteries of the affected basin, which compensate for circulatory failure.
Endovascular treatment of
Endovascular treatment is an minimally invasive alternative to surgical intervention of and is used in later stages of atherosclerosis development, when conservative methods are already insufficiently effective. In the affected area of the artery, a device is introduced to prevent further narrowing of the lumen of the vessel.
The methods of endovascular treatment include balloon dilatation, stenting and angioplasty .The procedures are performed in the X-ray room, after which the patient is given a pressure bandage and is assigned bed rest for 12-18 hours.
When a long blockage is detected, the patient is shown surgical treatment. The most common methods of surgical treatment are:
- Prosthetics of of a blocked area;
- Thrombenderterectomy - removal of cholesterol plaque;
- Shunting - installation of an artificial vessel bypassing the occluded portion of the artery. Less often as shunts, fragments of the patient's subcutaneous veins are used.
Surgical treatment of can be combined with endovascular and other types of operations depending on the patient's condition.
With severe gangrene and extensive necrosis, amputation of the affected limb is performed, as this is the only way to save the patient's life.
More on the disease and its prevention, see the video: