Atherosclerosis and its treatment. Obliterating atherosclerosis - treatment

Obliterating atherosclerosis is a chronic disease that consists of systemic damage arteries, caused by narrowing or complete blocking of the lumen of the vessel.

The main cause of obliterating atherosclerosis is increased level lipids and/or lipoproteins in the blood

Most often, obliterating atherosclerosis affects large and medium-sized vessels - the aorta at the site of its bifurcation (division into two branches), the superficial femoral artery, the tibial, and popliteal arteries. Obliterating atherosclerosis lower limbs caused by atherosclerosis, which affects the carotid, coronary and other arteries, leading to progressive circulatory disorders of the lower extremities. In case of development of obliterating atherosclerosis upper limbs The subclavian artery is often affected.

Men make up 90% of all patients with obliterating atherosclerosis; most often the disease is registered in people over forty years of age. Obliterating atherosclerosis is one of the most common diseases that lead to blockage of the aorta and main arteries. IN age category Over 65 years of age, this disease is registered in approximately 10% of cases.

With the development of obliterating atherosclerosis, the main pathological changes occur in the intima of the arteries (the inner layer of the blood vessel, which is located under the elastic membrane and muscular layer). Most early manifestation diseases are fatty streaks (accumulations of macrophages, foam cells and fibrous tissue), which can appear already in childhood, however, then the pathological process usually stops. An atherosclerotic plaque begins to form with the accumulation of lipids in the intima, proliferation of intima and smooth muscle fibers, followed by the formation of a plaque. Fibrous plaques, which consist of extracellular lipids, parts of necrotic cells and the fibromuscular layer, protrude into the lumen of the artery and narrow it. Further development pathological process leads to thrombosis and obliteration of the blood vessel. The frequent localization of atherosclerotic lesions in the arterial bifurcation zone is explained by the peculiarities of hemodynamics in these areas (the main blood flow in the arterial bifurcation zone deviates from a straight trajectory, which contributes to intimal damage and the formation of atherosclerotic plaques).

Causes and risk factors

The main cause of obliterating atherosclerosis is an increased level of lipids and/or lipoproteins in the blood (hypercholesterolemia). Most often, the disease develops in individuals with high levels of atherogenic lipoprotein fractions. In addition, changes in condition contribute to the development of the disease vascular wall, genetic predisposition, as well as disorders of the receptor apparatus.

Risk factors for the development of obliterating atherosclerosis include:

menopause period;
elderly and senile age;
nervous tension;
overweight;
lower limb injuries;
smoking;
alcohol abuse;
unbalanced diet.

In addition, obliterating atherosclerosis often occurs against the background of arterial hypertension, hypothyroidism, diabetes mellitus, rheumatism, and tuberculosis.

Men make up 90% of all patients with obliterating atherosclerosis; most often the disease is registered in people over forty years of age.

Forms of the disease

Depending on the location, obliterating atherosclerosis of the aortoiliac, femoral-popliteal, popliteal-tibial segments, as well as multi-story arterial lesions are distinguished. Depending on the nature of the lesion, occlusion and stenosis are determined.

Depending on the prevalence of obliterating atherosclerosis of the femoral and popliteal arteries, there are following forms diseases:

segmental (limited) occlusion (type I);
widespread lesion of the superficial femoral artery (type II);
widespread lesion of the superficial femoral and popliteal arteries, trifurcation zone popliteal artery at the same time it is passable (type III);
complete obliteration of the superficial femoral and popliteal arteries, while the deep femoral artery is patent (type IV);
occlusive-stenotic lesion of both the femoropopliteal segment and the deep femoral artery (type V).

Based on the prevalence of obliterating atherosclerosis in the popliteal tibial segment, the following forms of the disease are distinguished:

obliteration of the distal part of the popliteal artery (type I);
obliteration of the arteries of the leg, while the popliteal artery in the distal part and the tibial arteries are patent (type II);
obliteration of the popliteal and tibial arteries; individual segments of the arteries of the foot and leg are patent (type III).

Stages of the disease

Depending on the indicator of pain-free walking (the distance that a person walks without pain), 4 stages of obliterating atherosclerosis of the lower extremities are distinguished:

Stage I – pain in the lower extremities appears with significant physical activity, the distance of pain-free walking at a normal pace exceeds 1 km;
Stage IIa – the distance of pain-free walking at a normal pace is from 250 m to 1 km;
Stage IIb – the distance of pain-free walking with a normal step is 50–250 m;
Stage III – pain in the lower limb can occur at rest, including at night, the distance of pain-free walking does not exceed 50 m;
Stage IV - pain is constant, areas of necrosis appear on the skin of the fingers and heel area, and gangrene may develop.

Symptoms

Obliterating atherosclerosis may have an asymptomatic course throughout long period. In some cases, the disease debuts with acute thrombosis or embolism. Occlusive-stenotic lesions of arteries, as a rule, develop gradually.

In case of damage to the arteries of the lower extremities initial symptoms The diseases include a feeling of numbness and chilliness in the feet, increased sensitivity of the lower extremities to cold, a crawling sensation, and a burning sensation of the skin. The affected limb is colder to the touch than the healthy one. As the pathological process develops, patients begin to experience pain in the calf muscles that occurs during long walks. After a short rest, the pain subsides. In addition, intermittent claudication is an early sign of atherosclerosis obliterans. As the disease progresses, the pain-free walking distance decreases, and intermittent claudication worsens when climbing stairs. In the future, the pain can constantly bother the patient and interfere with night sleep.

Differential diagnosis is carried out with neuritis of the sciatic nerve, calcification of the medial membrane of the aorta and large arteries (Monckeberg sclerosis), obliterating endarteritis, obliterating thromboangiitis.

Treatment of obliterating atherosclerosis

The choice of treatment regimen for obliterating atherosclerosis depends on the prevalence of the pathological process, the stage of the disease and the characteristics of its course.

In the initial stages of the disease, it is enough to eliminate risk factors (weight correction, diet, blood pressure control, giving up bad habits, etc.). With further progression of the pathological process, the success of the treatment largely depends on the elimination of unfavorable factors.

Drug treatment of obliterating atherosclerosis includes medicines, reducing erythrocyte aggregation, antithrombotic drugs, antispasmodics and vitamin complexes. To relieve pain, analgesics, paravertebral and paranephric blockades are used. In some cases, it may be necessary to administer anticoagulants (subcutaneously or intravenously) and thrombolytic drugs (intravenously).

If necessary, treatment is supplemented with hyperbaric oxygenation, electrophoresis, ultra-high frequency therapy, magnetic therapy, as well as pine, hydrogen, radon baths, local and systemic ozone therapy and intravenous laser irradiation blood (ILBI).

Surgical treatment of obliterating atherosclerosis is carried out using open or endovascular methods. For the purpose of revascularization in obliterating atherosclerosis, dilatation and stenting of the affected vessels, bypass surgery, endarterectomy, thromboembolectomy, prosthetics of the affected blood vessel, and profundoplasty are used.

If radical surgical treatment is impossible, lumbar and/or periarterial sympathectomy and revascularizing osteotrepanation can be performed to enhance collateral circulation in the limb.

At stage IV, as well as with the development of complications, amputation of the affected limb to the optimal level may be required.

Of great importance in treatment and rehabilitation is physiotherapy(training walking, swimming pool, exercise bike). In this case, patients are recommended to gradually adequately increase physical activity. Spa treatment is indicated.

Possible complications and consequences

The progression of the pathological process in obliterating atherosclerosis of the lower extremities and the lack of timely therapy can lead to the development of trophic disorders, necrosis, as well as gangrene of the affected limb with the need for amputation.

Obliterating atherosclerosis is one of the most common diseases that lead to blockage of the aorta and main arteries.

Forecast

Obliterating atherosclerosis ranks third in the overall structure of mortality from cardiovascular diseases. vascular diseases. However, when timely diagnosis In the early stages of the pathological process and adequate treatment, the prognosis is generally favorable.

In patients with concomitant diabetes mellitus, as well as other forms of atherosclerosis (coronary, cerebral), the prognosis worsens.

Prevention

In order to prevent the development of obliterating atherosclerosis, a number of measures are recommended:

sufficient physical activity;
avoiding excessive physical activity;
wearing comfortable shoes;
avoiding hypothermia;
correction of excess weight;
rejection of bad habits.

Obliteration of blood vessels is the cessation of blood movement. Non-obliterating atherosclerosis occurs only in the early stages of the disease. A complication of complete cessation of nutrition to the tissues of the lower extremities is gangrene. For treatment is carried out surgery followed by intensive drug therapy.

Read in this article

Causes of complications of atherosclerosis

Development in the vessels of the lower extremities occurs in the presence of the following risk factors:

alcohol abuse;
smoking;
genetic predisposition;
high levels of cholesterol in the blood;
poor physical activity;
frequent psycho-emotional overload;
menopause or other hormonal disorders.

If these conditions are combined or present in patients with concomitant diseases(diabetes, hypothyroidism, obesity, rheumatism), then the course of the atherosclerotic process, as a rule, becomes severe.

With a complete cessation of tissue nutrition, ischemia passes into the necrotic stage - gangrene of the lower extremities develops.

Local causes of complications may be:

fractures,
burns,
operations on the lower extremities,
frostbite,
electrical injury,
injuries,
prolonged compression,
infectious tissue lesions.

Emergence severe forms atherosclerosis is most likely in elderly, weakened patients, with exhaustion, blood diseases, vitamin deficiency, poisoning, congenital features structure of the vascular network.

Signs of gangrene development

About the possibility of starting something like this severe complication, like gangrene, may indicate the transition of atherosclerotic lesions of the vessels of the legs to the third clinical stage. This is called the critical ischemia stage. Patients with such changes in the arteries cannot walk even 30 meters without experiencing severe pain, forcing them to stop. Then pain syndrome occurs even at rest.

The skin changes color and turns from pale to bluish with a purple tint. Subcutaneous fatty tissue atrophies, hair growth on the legs stops, the skin of the feet thickens, calluses and cracks appear on the heels, and the nail plates become layered.

One of the signs of beginning gangrene is the appearance of ulcerative defects at the site of any microtrauma (abrasion, corn, scratch). Trophic ulcers are localized on the lower third of the leg or on the feet; they do not heal, their surface becomes necrotic (necrotic).

Dry gangrene

In this form of the disease, tissue necrosis occurs due to the gradual cessation of blood flow. Patients experience severe pain in the leg, the skin becomes cold, the pulse is no longer detectable, sensitivity is impaired, but the pain syndrome does not completely disappear even after late stages. This is due to the fact that they are saved nerve endings at the source of decay.

An interface is formed at the border with intact tissue. There is practically no intoxication observed, the general condition of the patients is relatively satisfactory.

Wet gangrene

The picture of the disease changes if dry gangrene turns into wet, or if this form appears from the very beginning. This course of obliterating atherosclerosis is typical for patients with a dense build with a tendency to tissue swelling, with a sudden cessation of blood flow due to embolism.

Toes damaged by gangrene

Symptoms of wet gangrene:

formation of a zone of tissue rotting;
absorption of toxins into the blood;
severe intoxication (fever, lethargy, drop in blood pressure);
severe pain syndrome;
infection of dead tissues by microbes;
rapid spread to surrounding tissues;
significant swelling;
dark red blisters on the skin;
blackening of tissues,
decay with a fetid odor.

Intoxication and infection lead to the development of a septic condition, a decrease in the ability of the immune system to resist infection. In patients with diabetes mellitus it is especially noted severe course gangrene due to concomitant generalized damage to blood vessels and nerve trunks. In the absence of immediate medical assistance, death occurs.

Watch the video about atherosclerosis and its complications:

Diagnosis of obliterating and non-obliterating atherosclerosis

In the early stages of atherosclerotic lesions of the lower extremities, it is carried out to determine the extent and extent of the process. Load tests are used only if there is no threat of complete cessation of blood flow, that is, at the non-obliterating stage.

The following methods are used:

(treadmill: speed 3 km/h, incline angle 10 degrees). Can be combined with duplex scanning or performed independently. It is prescribed to determine the ability to walk a given distance without pain (relative distance) and the overall ability to walk (absolute).
(Ultrasound) and measurement of pressure in the arteries allows us to identify the risk or presence of vascular blockage and evaluate the results of treatment. For the onset of gangrene diagnostic sign is a drop in pressure at the ankle to 50 mm Hg. Art. and below. When scanning, you can see the formation of plaque and the degree of blockage of the vessel, examine the speed of blood flow, and the presence of turbulence.
Measuring oxygen content - special sensors determine the partial pressure of gas through the skin to detect critical ischemia. This method allows you to delimit the area of healthy tissue, which is important when determining the extent of amputation or planning sympathectomy.
Magnetic resonance imaging with angiography shows the state of blood flow, its speed and volume, the patency of arteries up to the final segments in the toes, and the presence of bypass paths (collaterals).

Treatment of lower extremities

To prevent complications, patients undergo endovascular operations - stent installation, bypass surgery, replacement of the affected artery with a prosthesis or their own vein, removal and plastic expansion of its lumen (profundoplasty).

Balloon angioplasty in the treatment of atherosclerosis

If it is impossible to carry out such revascularization (restoration of blood flow), they try to increase the bypass movement of blood by removing sympathetic nodes. The indirect technique (osteotrepanation) involves creating holes in the bone. After it, reserve capillaries open, small vessels dilate, and blood pools form in the muscles.

With the development of wet gangrene, urgent amputation of the leg is performed within the limits of healthy tissue. In the dry form, drug treatment can be prescribed until the formation of a dividing (demarcation) shaft. Patients are given intravenous administration:

solutions (Reopoliglyukin, Voluven);
blood products (Albumin, red blood cells);
antibiotics (Meronem, Vancomycin);
vasodilators (Vazaprostan, Alprostan);
means for improving microcirculation (Trental, Xanthinol nicotinate);
antiplatelet agents (Dipyridamole, Ilomedin);
thrombolytics (Streptokinase, Urokinase).

In case of poor effectiveness of drugs, it is prescribed surgical treatment– removal of dead tissue or amputation.

Prevention of complications of obliterating atherosclerosis

For warning irreversible changes in tissues, it is recommended that patients contact specialists early if they experience pain in their legs while walking. If blood flow disorders are detected, long-term complex drug treatment and dosed physical activity (hiking, swimming, therapeutic exercises) are recommended.

If indicated, surgical treatment cannot be delayed, since in the early stages amputation can be avoided and blood supply can be restored using non-traumatic methods.

The success of any type of treatment of lower extremity vessels depends on how much the patient can change their lifestyle, namely:

quit smoking and alcohol;
exclude fatty meat and sugar from food;
reduce weight in case of obesity;
increase physical activity;
monitor and adjust cholesterol and blood glucose levels, blood pressure;
undergo routine treatment for identified diseases.

Complications of obliterating atherosclerosis appear in advanced forms of the disease, the presence of several risk factors, and non-compliance with recommendations for lifestyle correction. Complete cessation of blood flow through a blocked artery leads to the development of gangrene. Most dangerous wet form. Such patients are indicated for urgent amputation.

It is possible to avoid severe consequences in the early stages with complex drug treatment, radical revascularization operations or palliative methods that bring temporary relief.

Mechanism of disease development

Cholesterol on artery walls

Arteries are quite large and elastic vessels. Normally, they are clean in the lumen, blood circulates easily and freely through them. But the onset of atherosclerosis narrows the vessels, the tissues begin to starve, there is not enough oxygen, ischemia develops, then necrosis. This picture occurs as a result of disorders of lipoprotein metabolism, when cholesterol (LDL - low-density lipoproteins) is deposited on the walls of the arteries. The mechanism itself looks like this: incoming fats are absorbed from the intestines with the help of special proteins, the liver first processes them into bad cholesterol, it passes through enzymatic transformations in the blood into LDL, which is the culprit of atherosclerotic plaques. Then it goes back to the liver, and if it works normally, then LDL is converted into HDL (lipoproteins high density), which themselves cleanse blood vessels and are not harmful to the body.

If the liver’s work is insufficient, then LDL remains and is deposited in the vessels, clogging them. They are foreign to the vessels, in response to the prolonged presence of LDL in the vessels, an inflammatory reaction develops, the immune system cannot cope with them, cholesterol fractions are layered on top of each other, connective tissue and platelets grow in them, calcium salts settle, which together make up the content of sclerotic plaques and interfere with blood flow. Gradually, a capsule forms around them; when it is damaged, the contents of the plaque are released into the blood, which aggravates the situation. The arteries lose and lose their elasticity, become fragile, and rupture easily.

Stages of obliterating atherosclerosis

In obliterating atherosclerosis of the arteries of the lower extremities, there are 4 clinical stages:

Stage 1 - preclinical. On inner wall arteries there are rare lipid spots, stripes, fatty alcohols are being deposited.
Stage 2 - atherosclerosis is already present, but its severity is weak.
Stage 3 - changes on the wall are very pronounced, the wall is changed.
Stage 4 - pronounced atherosclerosis. The plaque can ulcerate, the vessel dilates pathologically, plaque particles migrate through the vessels and can descend into the lower extremities, and acute or chronic disorder blood circulation of the legs.

Disturbances of blood flow in the arteries during atherosclerosis of the vessels of the legs are divided into 4 degrees or stages depending on the pain-free distance traveled:

The first stage, or A-stage - the pain-free distance is more than 1 km, pain can appear only after this.
The second stage, or 2a - the appearance of pain when walking 250-1000 m, which stops with rest; Stage 2b: a person can only walk 50-250 meters without pain.
The third stage - pain when walking even 50 m, at rest and at night the pain does not go away, it persists. This classification is convenient for clinical assessment of symptoms.

Causes of pathology

Among the causes and factors, changeable and unchangeable factors are divided. Unchangeable: heredity, cardiovascular diseases in one family, aneurysm abdominal region aorta, elderly age, male gender. Modifiable: regular hypertension, obesity, myxedema, gout, diabetes, dys- and hyperlipidemia, ischemic heart disease, not proper nutrition, alcoholism, smoking more than a pack of cigarettes a day, physical inactivity, various bruises and other leg injuries, stress, frostbite of the extremities, vasculitis, increased blood clotting.

Symptomatic manifestations

The process of atherosclerosis is slow, so for a long time There are no symptoms, the disease is not diagnosed, and does not manifest itself in any way. Later, only a tendency to paresthesia, numbness in the legs, “crawling goosebumps”, increased chilliness appears, the legs often get cold, even in summer, then periodic lameness appears (especially in smokers), trophic disorders of the skin, and muscle pain. The following symptoms then develop:

Pain often and quickly appears in the calf muscles, even 500 meters cannot be walked without pain, so as not to stop, because this causes leaden heaviness and full-on soreness in the legs.
When walking, the chilliness of the legs intensifies, the affected leg is noticeably colder, the skin on it peels off, alopecia is noted, the nail plates grow very slowly and thicken, and paresthesia is constant.
Continuous pain begins both at rest during the day and during sleep, the lower parts of the legs often have non-healing ulcers after any damage to the skin, the skin on the affected leg darkens, necrosis can turn into gangrene. Even small wounds, scratches on the legs, bruises take a very long time and heal poorly; swelling of the feet appears; when the limb hangs from the bed, the patient experiences relief, because at the same time the pain decreases slightly. When lowering the leg, it turns red, when raising it, it turns sharply pale, and there is a constant feeling of frozen, icy fingers and feet; the affected limb begins to “lose weight”, its muscles atrophy.
Stage 4 - various trophic ulcers appear, blackened necrotic areas on the fingers, heels, without treatment they turn into gangrene; the pulse disappears on the ankle, under the knee, on the thigh on the affected side. Certain areas of ischemia give their own symptoms: for example, when the iliac artery is damaged, pain occurs in the gluteal muscles, upper third hips; there may be manifestations of impotence due to impaired blood supply to the genital organs in a third of patients; with lesions of the femoral artery there is pain throughout the thigh.

All pain is provoked by the fact that due to blood flow disturbances, the muscles are depleted of oxygen, this manifests itself in the form of pain.

Due to pain, a person is forced to periodically stop, then the pain stops due to the restoration of blood flow, when walking resumes, pain appears, this is intermittent claudication. Obliterating atherosclerosis of the arteries of the lower extremities and occlusive vascular lesions are inextricably linked: one progresses and the other always inevitably and steadily grows.

Diagnostic measures

Ultrasound

The research algorithm consists of 3 main points: anamnesis, functional tests and ultrasound. Complaints, detailed medical history, examination of the patient. On the affected leg, the skin is thick, shiny, may be pale or red, there is no hair, the nails are thick, brittle, there are trophic disorders, ulcers, the muscles are quite often atrophied. The sore leg is always colder, there is no pulse in the arteries. Having assessed these data, the doctor measures ABI - the ratio of systolic pressure at the ankles to the brachial pressure; normally it is more than 0.96; in patients with OASNK it is reduced to 0.5. When auscultating narrowed arteries, it is always determined systolic murmur, when an artery is occluded below its location, the pulse is weak or absent.

Then a complete blood biochemistry and ECG are prescribed, and systolic pressure is measured in the digital arteries and the lower part of the leg. Standard arteriography is performed to determine the patency of the main arteries.

CT angiography is considered the most precise method diseases, MR angiography, Dopplerography determine the speed of blood flow, the degree of saturation of muscle tissue with oxygen and nutrients, duplex scanning large vessels The leg determines the degree of blood supply to the affected leg, the condition of the artery wall itself, and the presence of compression. All of the above studies should reveal the presence of leg ischemia.

Functional tests are carried out:

Burdenko test. If you bend the affected leg at the knee, a reddish-bluish pattern appears on the foot, which indicates impaired blood flow and outflow.
Shamov-Sitenko test. Apply and compress the thigh or shoulder with a cuff for 5 minutes; when the cuff is loosened, the limb turns pink after it for half a minute; in case of pathology, it takes more than 1.5 minutes.
Moshkovich test. Sick in horizontal position raises straight legs for 2-3 minutes, while normally the feet turn pale due to drainage of blood, then the patient is asked to stand up. Normally, the foot turns pink within 8-10 seconds; with atherosclerosis, it remains pale for a minute or more.

Consultation is required vascular surgeon.

Treatment of pathology

Treatment of obliterating atherosclerosis of the vessels of the lower extremities always involves individual character, because the presence of other concomitant diseases is taken into account, as well as the stage and degree of development of atherosclerosis.

Types of treatment used today include:

conservative;
operational;
endovascular.

Conservative therapy always begins with the use of medications, they are prescribed comprehensively, aimed at reducing increased blood clotting, thinning it, stimulating the work of collaterals, relieving pain and vascular spasms, activating microcirculation, strengthening the condition of the vascular wall, activating metabolic processes, leveling immune disorders. In addition to the medications, physiotherapy, pneumopressure therapy, and a complex of therapeutic dosed walking are included.

Treatment of obliterating atherosclerosis of the arteries with medications is prescribed systematically, but there are drugs that patients take for life: anticoagulants, antihypertensive drugs. So, drug therapy includes the following drugs:

Used to relieve pain various localizations novocaine blockades, analgesics are administered intra-arterially.
In order to reduce vascular spasms, antispasmodics are used: Doverin, Nikoshpan, Nosh-bra, Avisan, Halidor, Librax, etc. Anticoagulants: Cardiomagnyl, Aspirin, Thrombo-ASS, Heparin, Warfarin, Tiklid. Angioprotectors that improve blood microcirculation.
To activate metabolism: Complamin, Actovegin, Solcoseryl, Trental, Pentoxifylline, Curantil.
From vitamins: nicotinic acid, A, E, C, B vitamins, Enduracin.
ACE inhibitors dilate blood vessels and reduce blood pressure: Prodectin, Parmidine. To thin the blood, infusions of plasma-substituting drugs and enzymes for defibrinogenization are prescribed. Desensitizing drugs: Tavegil, Suprastin, Diazolin.
To reduce various disorders of the immune system: immunomodulators, ultraviolet irradiation of the blood.
In order to cleanse the blood, plasmapheresis is performed, the patient takes statins, which help reduce cholesterol levels: Leskol, Mevacor, Cholestide, Atoris, Simvastatin, etc.

Pneumopresstherapy

For atherosclerosis of the lower extremities, treatment can be pleasant - pneumopressure therapy. The patient lies down on the horizontal surface of a special apparatus, a special soft cuff is put on the affected leg, it is inflated with air and periodically deflated, creating alternating pressure. This creates a gentle massage of the muscles of the affected limb, while the peripheral vessels also expand and contract, a rush of blood is felt in the leg, the work of collaterals is stimulated, and blood flow is restored.

When obliterating atherosclerosis is diagnosed, treatment in the hospital includes therapeutic walking in its complex. The patient should walk for 30-45 minutes every day, which helps collateral vessels get involved in work, helps build muscle strength and mass. Cycling tracks and swimming are also useful, but they cannot replace walking. Such classes are carried out three times a week, the time is increased to 60 minutes, this reduces mortality by 24%.

Physiotherapeutic procedures may include UHF, electrophoresis, ozone therapy, microcurrents, laser therapy, hyperbaric oxygen therapy, magnetic therapy, SMT on the lumbar region, balneological procedures (coniferous, radon, pearl baths, etc.).

Artery stenting

Stanning

Endovascularization - under the control of angiography, a catheter with a balloon is inserted into the affected artery through a puncture, which is brought into the area of the vessel affected by the plaque, the balloon is inflated with a cuff, the vessel expands and blood flow is restored. This is called arterial stenting or balloon dilatation. The method has become widespread due to its minimally invasive nature. But in case of long-term vascular lesions, bypass surgery (surgical method) is required.

Surgical methods of treatment

Treatment of obliterating atherosclerosis of the lower extremities necessarily involves surgical methods. There are many methods of operations, the main 3:

Prosthetics of the affected area with an artificial vessel (alloprosthesis).
Thrombendarterectomy (the vessel is cut at the site of the existing plaque, it is “pulled out” from the vessel, removed and the incision is sutured.
Bypassing is the formation of “bypass” paths. The blood is forced to move through a “shunt” - through an artificial vessel or a segment of your own saphenous vein. In case of multi-level vascular damage (a combination of plaques with trophic ulcers), the methods are combined, the damaged trophism is covered with the patient’s own skin in the form of a flap (autodermoplasty).

If the use of bypass surgery and removal of ulcers is impossible, a lumbar sympathectomy is performed (intersection of the nerve plexuses responsible for spasm - the arc of the pathological reflex is interrupted and spasm of peripheral vessels is relieved). In case of gangrene, the limb is amputated.

Disease prevention

Lost health due to atherosclerosis is the result of your attitude towards yourself at random, therefore, already having such a disease, you must at least now be more attentive to yourself and be sure to carry out prevention. In case of OASNK, it is necessary to choose spacious, comfortable shoes to avoid calluses, bruises, avoid any injuries to the legs, and when sitting, do not cross your legs over each other, because At the same time, the vessels are pinched and the blood supply to the affected leg is disrupted. It is necessary to take walks every day; it is very good for your legs. This also includes proper nutrition with the exception of animal fats, salt, smoked meats, fried, red meat, full-fat milk, and cream.

It is necessary to normalize weight and control blood pressure - the numbers should not exceed 140/85. Reducing blood lipids will protect you from myocardial infarction; eliminating physical inactivity from your daily routine and introducing moderate physical activity will also be useful.

Quitting smoking is mandatory (this alone reduces the mortality rate from 54% to 18%). It is better to avoid alcohol in any dose.

It is necessary to promptly treat any chronic diseases, control blood sugar levels, avoid stress, regularly visit a doctor for examinations, and systematically conduct courses conservative treatment. The prognosis is determined by the presence of other forms of atherosclerosis in the vicinity: cerebral, coronary - which, of course, do not improve health.

Video

Treatment of obliterating atherosclerosis of the lower extremities should be carried out comprehensively and begin immediately after identifying signs of the disease. If therapy is not started in a timely manner, it may result in leg amputation. This unpleasant outcome is observed in approximately 25% of cases. Disability of patients can be prevented with the help of special pharmaceutical drugs and some folk remedies.

Obliterating atherosclerosis of the lower extremities develops gradually:

First, cholesterol deposits appear on the walls of blood vessels. Usually they look like flat formations, but over time their volume increases and they protrude above the surface.
As atherosclerotic plaques grow, there is a disturbance in blood flow in the lower extremities. The lumen of the artery narrows significantly, which impedes normal blood circulation.
When the diameter of the artery in a certain place is reduced by more than half, the surrounding tissues feel a lack of oxygen and other nutrients.
If the fabric long time experience hypoxia, they begin to gradually die. This leads to the development of gangrene, which is most often treated surgically.
Sometimes it happens that cholesterol plaques break off from the walls of the arteries and enter the bloodstream. They can clog small vessels, leading to stroke or heart attack.

First signs

Obliterating atherosclerosis manifests itself the following symptoms:

Gradually, the lower limbs lose sensitivity and begin to go numb. You may also experience tingling or goosebumps. This effect often appears on the entire leg or in individual areas.
The problematic limb is usually cold to the touch. The patient complains that he is constantly freezing.
Against the background of impaired blood circulation in the tissues, the skin on the problem leg becomes pale and gradually acquires a bluish appearance. On the affected limb, hair may fall out and the epithelium may peel off. Even when small wounds they take a long time to heal.
As the disease progresses, the pulse in the affected limb weakens significantly.
Gradually, the person feels pain in the legs, may limp, and it becomes difficult for him to move.

Causes of pathology

Obliterating atherosclerosis, developing in the lower extremities, can appear due to various reasons:

When atherosclerosis is detected that affects the lower extremities, a person is diagnosed with the same problems in other parts of the body (in the brain, heart).

Diagnostic methods

To identify obliterating atherosclerosis, the patient is recommended to undergo comprehensive diagnostics, including:

Laboratory blood test. The level of cholesterol and platelets is determined, the increase of which indicates the development of the disease.
Ultrasound of vessels with Doppler. As a result of the study, it is possible to identify any disorders in the blood circulation and the degree of their development.
Angiography. Variety x-ray examination, where an x-ray substance is additionally used. It fills the vessels, which makes it possible to identify narrowing of their lumen or blockage.
Rheovasography. Using a special device, any changes in blood flow are recorded.
Tomography. This diagnostic method is mainly used before surgery.

Common Therapies

Can obliterating atherosclerosis of the vessels of the lower extremities be treated at home? It all depends on the severity of the pathological changes and general condition sick. To get rid of pathology, doctors most often recommend following methods treatment:

Drug therapy. Drugs are prescribed that help reduce cholesterol levels in the patient’s blood, prevent the formation of blood clots and dilate the lumen of blood vessels. Patients are also additionally prescribed mineral and vitamin complexes to restore vitality.
Physiotherapy. All procedures with a pronounced therapeutic effect are used only after consultation with a doctor and in parallel with taking medications. To improve blood circulation, laser, electro, barotherapy and ozone therapy are most often used.
Surgical intervention. The operation is performed as a last resort when the patency of the vessel cannot be restored in any other way.

Atherosclerosis is treated by highly specialized specialists - a phlebologist or a vascular surgeon.

Traditional methods

Is treatment with folk remedies effective for atherosclerosis? This method of therapy will give the desired result if combined with medications or physical procedures. In the absence of serious pathological changes in the vessels, doctors advise using the following drugs for treatment:

Application traditional methods treatment usually gives positive result. But before using these products, it is imperative to consult a doctor who will give additional recommendations.

Pain in the legs that gets worse when walking, the appearance of lameness - a person can attribute it to fatigue or the consequence of hard work. But if you have persistent symptoms, you should consult a therapist as soon as possible. You may have obliterating atherosclerosis of the vessels of the lower extremities.

IN last years- This is a fairly common pathology, caused by blockage of the artery responsible for blood circulation in the legs. Its danger lies in the fact that in the early stages it does not manifest itself in any way, and progression leads to serious complications, including the removal of limbs.

If for other diseases it is possible to quickly select effective treatment, then in this case early diagnosis is necessary to identify the causes and then prescribe proper therapy. Do not put off visiting the doctor until later; it is better to protect yourself in advance. It is useful for the curious to know what obliterating atherosclerosis of the vessels of the lower extremities is, signs of manifestation, methods of diagnosis and treatment. Let's look at all this below.

Obliterating atherosclerosis of the vessels of the lower extremities - description and mechanism of development

Obliterating atherosclerosis of the vessels of the lower extremities

Obliterating atherosclerosis of the vessels of the lower extremities is a chronic disease of the arteries of the legs. Atherosclerotic artery disease develops due to narrowing (stenosis) or complete blockage (occlusion) of the artery that supplies blood to the muscles.

As a result, tissues do not receive the nutrients and oxygen necessary for their normal functioning. Atherosclerosis of the arteries of the lower extremities is a consequence of the progression of atherosclerosis affecting the carotid, coronary and other arteries of the human body.

Therefore, the risk factors for obliterating atherosclerosis are the same as for atherosclerosis of other localizations. Most often, the aorta is affected at the site of its division (bifurcation) with a transition to one or both iliac arteries (Leriche syndrome), the superficial femoral and popliteal arteries, which leads to progressive circulatory failure of the lower extremities.

Affecting mainly men over 40 years of age, it often causes severe circulatory failure in the extremities, dooming patients to painful suffering and incapacity for work. The process is localized mainly in large vessels (aorta, iliac arteries) or medium-sized arteries (femoral, popliteal).

Atherosclerotic lesions of the arteries are a manifestation of general atherosclerosis. The main changes in atherosclerosis develop in the inner lining of the arteries. Cholesterol and fatty inclusions (lipids) begin to be deposited here, forming yellowish spots on the inner wall of the vessel.

Young connective tissue appears around these lesions, the maturation of which leads to the formation of a sclerotic plaque. Platelets and clots of fibrin and calcium salts settle on the plaques. With an abundant accumulation of lipids and calcium, blood circulation in the plaques is impaired, the necrosis of which causes the appearance of atheroma cavities filled with disintegrating masses.

The artery wall in the area of such a plaque is rock hard and crumbles easily. Crumb-like masses are rejected into the lumen of the vessel. Getting through the bloodstream into the underlying blood vessels, pieces of crumbled atherosclerotic plaque can cause blockage (embolism) and lead to thrombosis of the arteries of the limb with the development of gangrene (death).

In addition, narrowing of the vessel by a large plaque leads to a significant disruption of blood flow, which reduces the delivery of oxygen to the tissue. During physical activity, muscles that do not receive adequate nutrition refuse to work, pain occurs, which disappears only after rest.

A large plaque promotes the development of a blood clot at the site of narrowing of the vessel, which can lead to acute failure blood supply to the limb and gangrene. Arteries are fairly large and elastic vessels. Normally, they are clean in the lumen, blood circulates easily and freely through them.

But the onset of atherosclerosis narrows the vessels, the tissues begin to starve, there is not enough oxygen, ischemia develops, then necrosis. This picture occurs as a result of disorders of lipoprotein metabolism, when cholesterol (LDL - low-density lipoproteins) is deposited on the walls of the arteries.

The mechanism itself looks like this: incoming fats are absorbed from the intestines with the help of special proteins, the liver first processes them into bad cholesterol, which, through enzymatic transformations in the blood, passes into LDL, which is the culprit of atherosclerotic plaques.

Then it goes back to the liver, and if it works normally, then LDL is converted into HDL (high-density lipoproteins), which themselves cleanse the blood vessels and are not harmful to the body. If the liver’s work is insufficient, then LDL remains and is deposited in the vessels, clogging them.

They are foreign to the vessels, in response to the prolonged presence of LDL in the vessels, an inflammatory reaction develops, the immune system cannot cope with them, cholesterol fractions are layered on top of each other, connective tissue and platelets grow in them, calcium salts settle, which together make up the content of sclerotic plaques and interfere with blood flow.

Gradually, a capsule forms around them; when it is damaged, the contents of the plaque are released into the blood, which aggravates the situation. The arteries lose and lose their elasticity, become fragile, and rupture easily.

The main symptom of obliterating atherosclerosis of the lower extremities is intermittent claudication, manifested by pain in the calf muscles, which bothers when walking and disappears after a short rest. The more narrowed the arteries are, the less work a person can do before pain appears.

Place of origin painful sensations depends on which vessel is affected. Smokers are most likely to suffer from intermittent claudication. As atherosclerosis progresses, pain occurs not only when walking, but also at rest, especially in a lying position, and night pain.

Often noted:

intermittent claudication - pain that intensifies when walking;
absence of pulse (no pulse can be felt in the popliteal fossa, ankle or thigh);
feeling of numbness in the leg;
uncontrollability of movements in the ankle or knee joint, “alien legs”;
trophic phenomena (hair loss on the legs, layering of the nail plates, the appearance of ulcers on the fingers and heels);
skin cyanosis, trophic ulcers and gangrene.

Atherosclerotic damage to the vessels of the lower extremities is a manifestation of systemic atherosclerosis, which most often develops under the following conditions:

obesity;
hypertension;
kidney and liver diseases;
vasculitis;
systemic lupus erythematosus;
persistent herpes infections;
hypercholesterolemia (blood cholesterol levels exceed 5.5);
diabetes mellitus;
blood clotting disorders;
hyperhomocysteinemia;
dyslipidemia (LDL level above 2);
aneurysm of the abdominal aorta;
physical inactivity;
hereditary predisposition;
smoking;
alcoholism;
frostbite of the feet;
injuries of the lower extremities;
excessive physical activity.

For several years, obliterating atherosclerosis of the lower extremities can be asymptomatic, but from the moment of the first clinical manifestations it often progresses rapidly. In some cases, due to associated thrombosis, the clinical manifestations of the disease occur suddenly.

The main symptom of obliterating atherosclerosis of the lower extremities is intermittent claudication, manifested by pain in the calf muscles, which appears when walking and disappears after a short rest.

For atherosclerotic lesions abdominal aorta and iliac arteries (Leriche syndrome), pain is localized not only in the legs, but also in the gluteal muscles, lumbar region and thigh muscles. Intermittent claudication worsens when going up stairs or uphill.

Chilliness is common, increased sensitivity lower extremities to cold, sometimes a feeling of numbness in the feet. The color of the skin of the legs changes, which in the initial stages of the disease become pale and have an ivory color in patients with Leriche syndrome.

In later stages, the skin of the feet and fingers becomes purple and bluish in color (trophic disorders). The development of trophic disorders leads to hair loss and impaired nail growth.

When there is blockage (occlusion) of the femoral-popliteal segment, hair growth is usually absent on the lower leg; when the aortoiliac region is affected, the baldness area extends to the distal third of the thigh.

One of the manifestations of atherosclerosis of the aorto-iliac segment is impotence caused by circulatory disorders in the system of internal iliac arteries. This symptom occurs in 50% of patients.

Essential information about the nature of the pathological process is provided by palpation of the vessels of the leg. With obliterating atherosclerosis of the lower extremities, the femoral-popliteal segment is most often affected, therefore, starting from the origin of the deep femoral artery, pulsation in the vast majority of patients is not detected either in the popliteal artery or in the arteries of the feet.

Constant pain at rest, requiring pain relief for 2 weeks or more, trophic ulcer or gangrene of the fingers or foot, arising from chronic arterial insufficiency lower extremities are a sign of critical limb ischemia. The very name of this condition mentions crisis.

If steps are not taken to improve arterial blood supply, amputation becomes inevitable in the vast majority of patients. And often it is not the doctor who persuades the patient to amputate, but on the contrary, the patient, exhausted from pain and insomnia, begs the surgeon to take away the sore leg.

Indications for performing reconstructive operations on the vessels of the extremities are, in order of importance:

Signs of impending gangrene of the limb and its first signs (death of the fingers, ulcers on the foot);
Constant pain in the foot at rest. Relief is possible with the leg constantly lowered. Patients can sleep sitting up for months;
Reducing the distance of pain-free walking to less than 200 meters, if courses of conservative treatment do not increase the distance walked, and this distance does not suit the patient.

The natural history of this disease is one of progressive deterioration. Typically, the increase in symptoms of ischemia occurs slowly, but this is only true until thrombosis occurs. Then the clinical course may worsen sharply.

Conservative treatment does not stop the progression of the disease and, in approximately 25% of patients, ends in amputation of the limbs. The process of atherosclerosis is slow, so there are no symptoms for a long time, the disease is not diagnosed, and does not manifest itself in any way.

Later, only a tendency to paresthesia, numbness in the legs, “crawling goosebumps”, increased chilliness appears, the legs often get cold, even in summer, then periodic lameness appears (especially in smokers), trophic disorders of the skin, and muscle pain. The following symptoms then develop:

Pain often and quickly appears in the calf muscles, even 500 meters cannot be walked without pain, so as not to stop, because this causes leaden heaviness and full-on soreness in the legs.
When walking, the chilliness of the legs intensifies, the affected leg is noticeably colder, the skin on it peels off, alopecia is noted, the nail plates grow very slowly and thicken, and paresthesia is constant.
Continuous pain begins both at rest during the day and during sleep, the lower parts of the legs often have non-healing ulcers after any damage to the skin, the skin on the affected leg darkens, necrosis can turn into gangrene.

Even small wounds, scratches on the legs, bruises take a very long time and do not heal well; swelling of the feet appears; when the limb hangs from the bed, the patient experiences relief, because at the same time the pain decreases slightly.

When lowering the leg, it turns red, when raising it, it turns sharply pale, and there is a constant feeling of frozen, icy fingers and feet; the affected limb begins to “lose weight”, its muscles atrophy.

Stage 4 - various trophic ulcers appear, blackened necrotic areas on the fingers, heels, without treatment they turn into gangrene; the pulse disappears on the ankle, under the knee, on the thigh on the affected side.

Certain areas of ischemia give their own symptoms: for example, when the iliac artery is damaged, pain occurs in the gluteal muscles, the upper third of the thigh; there may be manifestations of impotence due to impaired blood supply to the genital organs in a third of patients; with lesions of the femoral artery there is pain throughout the thigh.

Stages of obliterating atherosclerosis

In obliterating atherosclerosis of the arteries of the lower extremities, there are 4 clinical stages:

Stage 1 - preclinical. On the inner wall of the artery there are rare lipid spots, stripes, and fatty alcohols are being deposited.
Stage 2 - atherosclerosis already exists, but its severity is weak.
Stage 3 - changes on the wall are very pronounced, the wall is changed.
Stage 4 - pronounced atherosclerosis. The plaque can ulcerate, the vessel dilates pathologically, particles of plaque migrate through the vessels and can descend into the lower extremities, and an acute or chronic circulatory disorder of the legs develops.

Disturbances of blood flow in the arteries during atherosclerosis of the vessels of the legs are divided into 4 degrees or stages depending on the pain-free distance traveled:

The first stage, or A-stage - the pain-free distance is more than 1 km, pain can appear only after this.
The second stage, or 2a - the appearance of pain when walking 250-1000 m, which stops with rest; Stage 2b: a person can only walk 50-250 meters without pain.
The third stage - pain when walking even 50 m, at rest and at night the pain does not go away, it persists. This classification is convenient for clinical assessment of symptoms.

Obliterating atherosclerosis of the vessels of the legs leads to disruption of their trophism and the development of serious complications:

Impaired function of the lower limb, up to the inability to walk due to severe pain.
Development of a trophic ulcer - due to insufficient nutrition, even the slightest wound on the skin of the leg does not heal, but on the contrary increases. Then joins bacterial infection with development purulent process.
Gangrene is a serious complication in which the death of leg tissue occurs below the obliteration of the artery atherosclerotic plaque. With this complication there is a high risk fatal outcome, due to intoxication of the body by tissue decay products.

The only treatment for gangrene is amputation of the leg, so it is very important to start treatment in a timely manner and prevent this complication.

Leriche syndrome - atherosclerosis of the aorta and iliac arteries

Atherosclerotic plaques narrow or block the lumen of large vessels, and reduced blood circulation occurs through small lateral vessels (collaterals).

Clinically, Leriche syndrome is manifested by the following symptoms:

High intermittent claudication. Pain in the thighs, buttocks and calf muscles when walking, forcing you to stop after a certain distance, and in the later stages constant pain at rest. This is due to insufficient blood flow in the pelvis and thighs.
Impotence. Erectile dysfunction is associated with cessation of blood flow through the internal iliac arteries, which are responsible for blood supply to the cavernous bodies.
Pale skin of the feet, brittle nails and baldness of the legs in men. The reason is a sharp violation of skin nutrition.
The appearance of trophic ulcers on the tips of the fingers and feet and the development of gangrene are signs of complete decompensation of blood flow in the later stages of the development of atherosclerosis.

Leriche's syndrome - dangerous condition. Indications for amputation of one leg occur in 5% of cases per year. 10 years after diagnosis, 40% of patients have had both limbs amputated.

Treatment of obliterating atherosclerosis of the iliac arteries (Leriche syndrome) is only surgical. In the majority of patients in our clinic, it is possible to perform endovascular or hybrid surgery - angioplasty and stenting of the iliac arteries.

Stent patency is 88% at 5 years and 76% at 10 years. When using special endoprostheses, results improve up to 96% within 5 years.

In difficult cases, with complete blockage of the iliac arteries, it is necessary to perform aorto-femoral bypass, and in weakened patients, cross-femoral or axillary-femoral bypass. Surgical treatment for atherosclerosis of the iliac arteries avoids amputation in 95% of cases.

Atherosclerosis of the superficial femoral artery leads to pain in the calf muscles when walking. Depending on the level of circulatory failure, the disease is divided into 4 stages:

Pain-free walking distance of more than 1000 meters. Only required drug treatment atherosclerosis and therapeutic walking.
Pain when walking occurs at shorter distances (a) from 200 to 1000 meters, (b) less than 200 meters. In stage 2a surgery not shown, but in stage 2b it is possible to offer restoration of blood flow if a person’s occupation requires him to walk more.
At this stage, leg pain appears at rest and when walking less than 50 meters. Sleep is disturbed. This stage is called critical ischemia and requires the intervention of a vascular surgeon, as it inevitably leads to amputation of the leg.
Necrosis, trophic ulcers or gangrene of the fingers and feet are added to the complaints characteristic of stage 3. Urgent intervention is needed to save the leg from amputation.

Modern vascular surgery in Innovative vascular center suggests endovascular and open surgeries for the treatment of this syndrome, depending on the situation. Vascular interventions allow saving the leg in 90% of cases of critical ischemia and gangrene against the background of obliterating atherosclerosis of the femoral and popliteal arteries.

Atherosclerosis of the arteries of the leg and foot

Atherosclerosis of the arteries of the leg and foot can be isolated, but is more often combined with obliterating atherosclerosis of the iliac and femoropopliteal segment, significantly complicating the course of the disease and the possibility of restoring blood flow.

With this type of atherosclerotic lesion, gangrene develops more often and faster. The development of critical ischemia against the background of lesions of the arteries of the leg and foot requires immediate surgical intervention.

The most effective is the use of microsurgical bypass with an autologous vein, which allows in 85% of cases to save the leg from amputation. Endovascular methods are less effective but can be repeated. Amputations should be carried out only after all methods of saving the limb have been exhausted.

The sore leg is always colder, there is no pulse in the arteries. Having assessed these data, the doctor measures ABI - the ratio of systolic pressure at the ankles to the brachial pressure; normally it is more than 0.96; in patients with OASNK it is reduced to 0.5.

When auscultating narrowed arteries, a systolic murmur is always detected; when an artery is occluded below its location, the pulse is weak or absent. Then a complete blood biochemistry and ECG are prescribed, and systolic pressure is measured in the digital arteries and the lower part of the leg.

Standard arteriography is performed to determine the patency of the main arteries. CT angiography is considered the most accurate method of the disease, MR angiography, Dopplerography determine the speed of blood flow, the degree of saturation of muscle tissue with oxygen and nutrients, duplex scanning of large vessels of the legs determines the degree of blood supply to the affected leg, the condition of the artery wall itself, and the presence of compression.

All of the above studies should reveal the presence of leg ischemia. Functional tests are carried out:

Burdenko test. If you bend the affected leg at the knee, a reddish-bluish pattern appears on the foot, which indicates impaired blood flow and outflow.
Shamov-Sitenko test. Apply and compress the thigh or shoulder with a cuff for 5 minutes; when the cuff is loosened, the limb turns pink after it for half a minute; in case of pathology, it takes more than 1.5 minutes.
Moshkovich test. The patient in a horizontal position raises his straight legs for 2-3 minutes, while normally the feet turn pale due to the draining of blood, then the patient is asked to stand up. Normally, the foot turns pink within 8-10 seconds; with atherosclerosis, it remains pale for a minute or more.

Consultation with a vascular surgeon is mandatory. Ultrasound examination of blood vessels helps to identify pathological changes in them. If the above symptoms are detected, the patient should seek advice from an angiosurgeon, who, after examining the patient, will prescribe a course of examination.

To diagnose this pathology, the following types of laboratory and instrumental examinations may be prescribed:

blood test for lipid structure, fibrinogen and glucose concentrations;
analysis to determine the duration of bleeding;
Vascular ultrasound with Doppler ultrasound;
angiography with contrast agent;
rheovasography;
CT scan with contrast agent.

After determining the stage of the disease, the patient is offered comprehensive treatment.

Patients with atherosclerosis of the arteries of the extremities, as a rule, need to change their lifestyle. First of all, it is necessary COMPLETE refusal from smoking. Reducing the number of cigarettes smoked, of course, has a positive effect on the course of the disease, but the risk of damage to the vascular wall still remains. Patients with overweight need to lose weight.

An important factor in reducing blood cholesterol levels (especially its dangerous fractions - LDL) is following a diet with low content animal fats.

Patients suffering from hypertension and diabetes mellitus need to be monitored by an appropriate specialist (therapist, endocrinologist) to correct these diseases.

Against the background of drug correction, training for the development of collateral circulation is desirable. The fact is that with obliterating atherosclerosis, the main vessels are affected. In this case, blood circulation begins to occur through small bypass (collateral) vessels.

At good development collateral circulation, limb ischemia can be minimized even with complete closure of the lumen main artery. Along with medications that help improve collateral circulation (they will be discussed below), training walking is used using special techniques on a treadmill and just on foot.

They start by selecting a walking speed along the path that does not cause fatigue in the legs for at least 10 minutes of continuous walking. Then increase the speed by 0.5 km/h. At this speed they begin to walk; when fatigue and pain in the lower leg appear, they rest until it disappears completely. discomfort, then walking is resumed again until discomfort appears.

The average walking time on the path is 30-40 minutes per day. The goal is to increase the distance of pain-free walking to 1.5 km, after which the walking speed is increased by another 0.5 km/h, etc. Training should be done under the supervision of a doctor.

To combat the disease, drugs are used that have an antiplatelet and anticoagulant effect and have a positive effect on the circulatory system in these areas, as well as drugs aimed at reducing cholesterol levels in the blood and improving blood circulation in general.

Antiplatelet drugs (for example, Aspirin) prevent the formation of blood clots, which in turn is the prevention of strokes and heart attacks. Anticoagulant drugs (such as Heparin or Warfarin) prevent blood clotting in the vessels and also prevent the formation of blood clots.

Also, during the therapeutic treatment atherosclerosis, drugs such as Cilostazol and Pentoxifylline may be indicated. Cilostazol increases physical activity. Thanks to this drug, walking is practically painless, which, of course, has great importance for the patient.

In turn, the drug Pentoxifylline helps improve overall blood flow in the lower extremities. But all these medications, of course, should not be taken without the recommendation of a doctor.

It should be noted that atherosclerosis can manifest itself not only in the limbs, but also in other human organs (in the vessels of the heart, neck and brain; in the vessels of the abdominal region, etc.). Mentioning other types of atherosclerosis, we can designate a form of atherosclerosis, characterized by location, as cerebral atherosclerosis, the treatment of which is carried out through complex treatment measures.

The list of such measures may include the selection of a special course drug treatment, the use of traditional medicine and the preparation of a special diet for the patient. Since cerebral atherosclerosis can lead to serious consequences, including stroke, its treatment must be taken seriously.

There are many medicines, which are used for obliterating atherosclerosis of the lower extremities. They can be divided into several groups:

Antiplatelet agents - thrombo ACC, cardiomagnyl, trental, plavix, reopoliglucin.
Drugs that reduce blood viscosity - vesel due f (sulodexide), phlogenzyme, wobenzym.
Agents that improve peripheral blood circulation and microcirculation - alprostan (vasoprostan), nicotinic acid, xanthinol nicotinate.
Agents that promote the development of collateral circulation - Actovegin, solcoseryl.
Drugs that lower blood cholesterol levels - Torvacard, Crestor, etc.
Other medicines – chimes, analgesics (for pain), antibiotics (for purulent-necrotic ulcers), etc.

Typically, patients are permanently prescribed one of the acetylsalicylic acid drugs for life - thrombo-ass or cardiomagnyl. Other drugs are prescribed in courses, depending on the stage of the disease and clinical manifestations.

It is believed that patients require hospitalization in the department twice a year vascular surgery for courses conservative therapy – intravenous infusions, hyperbaric oxygen therapy, physiotherapy.

Treatment of obliterating atherosclerosis of the lower extremities necessarily involves surgical methods. There are many methods of operations, the main 3:

Prosthetics of the affected area with an artificial vessel (alloprosthesis).
Thrombendarterectomy (the vessel is cut at the site of the existing plaque, it is “pulled out” from the vessel, removed and the incision is sutured.
Bypassing is the formation of “bypass” paths. The blood is forced to move through a “shunt” - through an artificial vessel or a segment of one’s own saphenous vein. In case of multi-level vascular damage (a combination of plaques with trophic ulcers), the methods are combined, the damaged trophism is covered with the patient’s own skin in the form of a flap (autodermoplasty).

Among people who are diagnosed with obliterating atherosclerosis of the vessels of the lower extremities, treatment with folk remedies is quite popular.

Traditional medicine offers great amount recipes to combat atherosclerosis. Here are some of them.

Herbal tincture

Ingredients: hops, horse chestnut, bighead root. The first recipe. Take the following ingredients:

20 grams of fruit horse chestnut;
35 grams of safflower root;
45 grams of common hops.

Pour boiling water over the herbal mixture (at the rate of 2 grams per 200 milliliters of water) and leave for several hours. Take the resulting decoction half a glass per day.

Herbal decoction

Ingredients: sage, St. John's wort, chamomile, mignonette, plantain. Second recipe. You need to take sage, St. John's wort, chamomile flowers, plantain and a string in equal proportions. Pour one measuring tablespoon herbal mixture one glass of boiling water.

Infuse the decoction longer (but not less than a day) in a dark room. Make applications using the resulting balm at least twice a day (for example, in the morning and before going to bed at night). After the procedure, you should always wash your feet thoroughly.

Oil rub

Ingredients: sea buckthorn oil, olive oil. The third recipe to help improve the condition of the skin on sore limbs. Take sea buckthorn and olive oils in equal proportions. Rub the oil mixture into your skin like a regular cream for three weeks.

Atherosclerosis of the vessels of the lower extremities involves treatment with folk remedies, changes in nutrition (adding useful microelements), and the use of various phytotherapeutic recipes. But this is not an alternative to traditional medicine.

Medicinal preparations based on herbs and herbal ingredients will help speedy recovery and improvement of all circulatory system body.

Bee glue, or propolis, is recommended for restoring protein and lipid metabolism. No more than 20 drops of 10% are needed alcohol tincture dissolve bee knot in 200 ml of purified water, take 3 times a day before meals.
Propolis and hawthorn tincture. The following will have an excellent vasodilating effect: folk recipe:
take equal parts of hawthorn tincture purchased at the pharmacy and mix with 10% alcoholic infusion of propolis.

Take 1 teaspoon 3-4 times a day after meals. Propolis is recommended for restoring protein and lipid metabolism.

Included in the following folk remedy includes:

hawthorn, rose hips - 10 parts each;
black elderberry, medicinal letter - 5 parts each;
immortelle and lingonberry leaves - 10 parts.

All medicinal components are mixed and 200 ml of purified filtered water is poured. The broth should be boiled for 5 minutes after boiling. After cooling and filtering the healing potion, you can begin treatment. It is recommended to use no more than 50 ml per session three times a day.

After two weeks of treatment, you need to take a break for 7 days and then continue. The course of treatment lasts 6 months, after which you need to see your doctor.

The undisputed leader in the treatment of vascular diseases of the lower extremities is natural Bee Honey. If a person is not allergic to this product, then daily use in the morning, a tablespoon of honey is a godsend for healing the arterial vessels of the legs.

In case of vascular atherosclerosis, mandatory adherence to a diet is necessary, it is key point in the treatment of this disease.

The goal of the diet is to reduce the amount of foods that contain a lot of cholesterol and animal fat. What you can eat:

lean chicken, veal, rabbit,
all types sea fish,
low-fat dairy and dairy products- eggs (no more than 1-2 per week),
fresh and frozen vegetables and fruits, vegetable soups),
nuts,
cereals and pasta,
wholemeal bread,
unhealthy cookies,
spices and low-fat seasonings,
tea, weak coffee, sugar-free juices, soft drinks.

What is better to limit:

vegetable oil,
beef, bacon, ham,
egg yolk,
hard and processed cheeses,
mayonnaise with reduced content fat,
soy sauce,
sweets,
alcohol.

butter, lard, margarine,
fatty meat, sausage, frankfurters, pate,
fatty meat broths,
offal,
whole and condensed milk, cream, sour cream, full-fat cottage cheese,
fatty cheeses,
ice cream,
fried potatoes, french fries, chips,
fatty mayonnaise,
sweet flour products.

Food should be prepared only using vegetable oil or boiled or stewed. From meat broths fat should be removed during cooking; when baking culinary products, it is better to replace the whole egg with only whites.

It’s better to season salads with a little, preferably olive, you can add vinegar or lemon juice. Salt should be limited or eliminated altogether.

Diet for atherosclerosis of the vessels of the lower extremities:

1st breakfast: Millet porridge with milk, vegetable salad with sunflower oil, weak coffee.
2nd breakfast: Cottage cheese with sugar, pears Lunch: Vegetable soup, boiled veal with buckwheat porridge, dried fruit compote.
Afternoon snack: Yogurt.
Dinner: seaweed salad with vegetable oil, sea boiled fish with baked potatoes, tea with lemon.
At night: kefir.

In any case, never forget to consult your doctors. Only a doctor can make the correct diagnosis and prescribe the most appropriate treatment for atherosclerosis of the lower extremity vessels.

Like any type of atherosclerosis, obliterating atherosclerosis of the lower extremities (ICD 10) is easiest to prevent if you regularly monitor your health and know the risk factors.

The diet should be adjusted so as not to contain excess cholesterol-causing foods. There are scientifically proven dietary recommendations, but they are remembered only when the disease has already appeared.

You can delay its appearance or eliminate it completely if you make a sufficient amount of physical activity, walks around fresh air, exclusion of alcoholic beverages and tobacco, reducing the share of sweet and flour products in nutrition, almost complete absence canned food, fatty, fried, spicy foods.

It is necessary to avoid hypothermia of the lower extremities, stagnation of blood in them due to uncomfortable shoes and high heels. Sitting in one place for a long time without changing posture also provokes problems with blood circulation. People with diabetes will help their skin on their legs, especially their feet, if they rub it with a small amount of insulin.

In case of OASNK, it is necessary to choose spacious, comfortable shoes to avoid calluses, bruises, avoid any injuries to the legs, and when sitting, do not cross your legs over each other, because At the same time, the vessels are pinched and the blood supply to the affected leg is disrupted.

It is necessary to take walks every day; it is very good for your legs. This also includes proper nutrition with the exception of animal fats, salt, smoked meats, fried, red meat, full-fat milk, and cream.

Quitting smoking is mandatory (this alone reduces the mortality rate from 54% to 18%). It is better to avoid alcohol in any dose. It is necessary to promptly treat any chronic diseases, control blood sugar levels, avoid stress, regularly visit a doctor for examinations, and systematically conduct courses of conservative treatment.

The prognosis is determined by the presence in the vicinity of other forms of atherosclerosis: cerebral, coronary - which, of course, do not improve health. Back in the 19th century, Louis Pasteur, a famous French microbiologist, came to the conclusion that infections are mainly to blame for the death of people (if we do not take into account accidents).

Therefore, you need to avoid vascular spasms that occur due to hypothermia of the legs. Since ancient times, people have said in such cases: “Keep your feet warm, your head cold, and your belly hungry!” and no infection will become a problem.

IN Lately A lot of fashionable sports shoes have appeared on sale, which are preferred not only by young people, but also by older people. Using sports shoes in winter is dangerous because they do not provide the necessary comfortable conditions for the feet.

Shoes must be worn not only according to the season, but also in size, and the feet in them should neither swell nor sweat. I have already described on the site how poorly nature has taken care of man’s means of transportation.

Nothing should interfere with the blood supply to the feet, since the arteries cannot exist normally without oxygen. The foot in cold and tight shoes always lacks oxygen.

And if to this is added sedentary sitting at a computer or at an office desk with documentation, then this is already a real threat due to atherosclerosis and its terrible consequences such as gangrene.

When we have to sit or even stand most of our working time, we need to perform leg exercises well known to many of us as often as possible:

for example, an exercise such as rising on your toes with your heel lifted to a height of 1 centimeter and sharply lowering it in order to forcibly create an impulse for blood movement will take very little time. It will be enough to spend 1 minute to speed up the movement of blood;
It will be useful for the patient to rotate the feet both clockwise and counterclockwise;
Dr. Bubnovsky, a well-known popularizer of a non-drug method of healing, ardently speaks out for the benefits of squats. The benefits of squats in the prevention of arterial atherosclerosis are simply enormous and therefore this exercise is mandatory;
and, of course, everyone can always find a place to do the “bicycle” exercise, but it will be even more beneficial to ride a bicycle or pedal an exercise bike.

It will be enough to spend at least 10 minutes a day on these exercises to create all the conditions for maintaining healthy legs for life.