Lameness develops. What is intermittent claudication

Intermittent claudication syndrome (angina cruris, Charcot's syndrome, claudication) is a fairly common pathology, the main symptom of which is a violation of the circulatory process in the vessels of the lower extremities. The anomaly leads to the appearance of pronounced pain in the legs, both when walking and at rest, due to which the person begins to limp.

Approximately one and a half million inhabitants of Russia suffer from the PH syndrome, among which about one hundred thousand are diagnosed with coronary artery disease of the legs. The number of limb amputations annually exceeds 40,000.

Among the main causes of the development of the disease are: atherosclerosis of the vessels of the lower extremities, infectious diseases, transferred recently, intoxication, severe injuries. HRP develops against the background of ischemia in the lower arterial pool, which spreads to the thoracic, lumbar and sacral regions of the spinal cord. The syndrome requires timely medical treatment, otherwise dangerous complications appear, and the risk of disability or death increases.

Most often, the anomaly develops in adults, mainly the elderly. Men are especially susceptible to the disease, as they are more prone to atherosclerosis. And the presence of addictions, irregular daily routine and rare visits to medical specialists only increase the risk of PC formation.

The main causes of the syndrome include the following pathologies:

Atherosclerosis. In about nine out of ten cases, the anomaly is the result of atherosclerotic vascular lesions. Damage to the aorta, iliac and femoral arteries leads to a decrease in the amount of oxygen that is carried in the blood. Ischemia occurs.
. Diabetes mellitus leads to the deposition of fatty plaques in the arteries, so the risk of developing the syndrome increases many times already during the first stage of the course of the disease.
Vasospasm. Due to a violation of the nervous regulation of the tone of the arteries of the legs, their lumen narrows, and the volume of blood flowing to the limbs is insufficient. One of the representatives of vasospastic diseases is Raynaud's syndrome.
Obliterating vascular diseases. and obliterating endarteritis are the result of an inflammatory process in the vessel wall, which reduces its lumen. These pathologies are characterized by the symmetry of the lesion of the limbs.
occlusive thrombosis. In its advanced form, the anomaly causes a violation of vascular obstruction due to the almost complete closure of their lumen in a certain area.

Among other factors that provoke the syndrome of venous intermittent claudication, there are:

severe intoxication;
long-term infections;
frequent;
hereditary predisposition;
trauma;
regular hypothermia;
obesity;
hypodynamia;
bad habits.

Classification

In medicine, there is a classification of forms of pathology, among which are the following:

Caudogenic (neurogenic). It develops with transient ischemia of the cauda equina roots, usually with narrowing of the spinal canal at the level of the lumbar spine. Lameness can be both congenital and acquired. In the second case, the caudal syndrome occurs against the background of an exacerbation of osteochondrosis or spondylopathy.
Vascular (vascular). This form is characterized by damage to the walls of blood vessels and a violation of their structure. As a result, tissues receive less oxygen, which provokes pathological changes.
Myelogenous. Appears due to impaired spinal circulation after long-term walking or increased physical activity.

Scientists distinguish 4 stages of the development of the disease, which help determine the further tactics of therapy:

1 stage. The patient has already identified various abnormalities in the functioning of the circulatory system, but he still does not experience pain while walking. The main sign of PX here is the discomfort that occurs in the legs after a long walk on foot or when climbing stairs. Quite often, the stage goes unnoticed, so the disease is actively progressing. It can be observed only on one leg - left or right, and maybe on both.
2 stage. It is divided into: 2A degree, when the patient can walk from 200 to 1000 meters without pain, and 2B, when the patient cannot walk even 200 meters. This stage still assumes a conservative impact.
3 stage. Is critical. Discomfort in the lower extremities does not disappear even at rest, while the skin becomes bluish, signs of blood stasis develop. Urgent surgery is needed to save the limb.
4 stage. Leads to tissue necrosis of the affected area and gangrene. It is impossible to do without surgical intervention, since the risk of death of the patient due to septic complications increases.

Characteristic symptoms

The main sign of the development of the syndrome is severe pain in the lower extremities when walking. In addition to the occurrence of discomfort, a decrease in skin sensitivity and slight weakness are considered a typical symptom, which is often confused with ordinary overwork. We recommend that you watch the video on the topic:

Over time, the lack of arterial blood increases and leads to discomfort, heaviness in the legs. The pain may be burning or throbbing, dull or aching. The localization of pain in this case can tell which diseases provoked P.Kh.

Pain in the foot and lower leg (low intermittent claudication) is observed with thromboangiitis obliterans.
If the pain is localized in the calf muscles and thigh muscles, this indicates obliterating atherosclerosis.
Pain in the gluteal muscles and in the muscles of the lumbar region (high intermittent claudication), which means there is an occlusion of the abdominal aorta.

A person with HP cannot walk for long periods of time, limps and often stops to rest. The patient's gait changes. In advanced cases, neither rest nor special painkillers help to get rid of pain. Most often, the anomaly is unilateral, but can affect two legs at the same time.

As the disorder progresses, other symptoms of the disease also progress. The patient is concerned about:

blanching of the skin;
decrease in temperature stop;
the appearance of trophic ulcers on the legs;
lack of pulse in the arteries of the lower extremities.

Intermittent claudication in advanced form can lead to the development of necrosis, to death. Therefore, do not delay the treatment of the disease.

How to diagnose?

To make a correct diagnosis and determine further treatment tactics, it is necessary to contact a vascular surgeon. The doctor must examine the patient and examine his medical history, as well as prescribe a number of instrumental studies, a study of blood and urine tests.

To confirm their own assumptions, the patient's pulse is felt and the limbs are palpated, paying attention to the piriformis muscle area.

Then the following types of examinations are carried out:

ultrasound and laser dopplerography, which allows you to assess the speed of blood movement in the vessels and determine the causes of blood flow disorders;
transcutaneous oximetry, aimed at counting the amount of oxygen in the capillaries of the skin and arterial vessels;
(pictured), which involves assessing the rate of restoration of normal blood flow in the limbs after walking 200 meters;
angiography - a contrast study of blood vessels, which determines the affected area and assesses the condition of the vascular walls;
functional tests of Opel, Palchenkov and Burdenko.

Differential diagnosis of PH is carried out with pseudo-intermittent claudication. About 90% of all cases of the syndrome are caused by obliterating endarteritis of the canal.

How to treat the disease?

Treatment of patients with CP in terms of modern ideas about the pathogenesis of HOZANK is carried out through medication or surgical intervention. Treatment in a hospital is indicated for patients with severe pain in the legs, as well as for advanced forms of the disease.

Conservative therapy

Drug treatment is indicated for each patient, regardless of the stage of development of the anomaly. So, even if a sick person has undergone an operation aimed at correcting blood flow, conservative therapy should still continue.

Among the areas of drug exposure are:

Prevention of thrombosis and thromboembolism. You need to take Aspirin Cardio or Thrombo Ass tablets.
Taking drugs that dilate blood vessels. "Sulodexide" and "Pentoxifylline" - such drugs improve microcirculation in the arteries and reduce blood viscosity.
Increased metabolism in affected tissues. Means "Naftidrofuril" stimulates metabolism, which helps to painlessly go long distances.
Stabilization of indicators and glycemia. This can be done by taking the drugs "Pravastatin" or "Simvastatin". Maintaining a normal level of glucose in the patient's blood is the main direction of therapy for the syndrome. Therefore, if a person has diabetes, it is worth resorting to treatment by administering insulin and taking lipid-lowering agents.
Correction of arterial pressure. For this, it is necessary to take Enalapril, Enalakor funds. Such drugs not only normalize blood pressure, but also prevent the risk of heart disease and hemorrhage.

If the patient needs surgery, but it is not yet possible, you should take a course of taking the drug "Iloprost". It not only reduces pain and accelerates the healing process of trophic ulcers, but also allows you to postpone the intervention for limb amputation.

Along with drug exposure, the following physiotherapeutic methods are also necessary:

hydrogen sulfide baths;
diathermy;
UHF therapy;
mud treatment;
hyperbaric oxygenation.

The patient should also avoid hypothermia, wear only comfortable shoes and clothes, follow the rules of foot hygiene. Patients with diabetes need to take care of the diet and strict control of sugar levels.

Special therapeutic walking is also recommended, as the movement stimulates blood circulation in the lower extremities. Hiking should continue until the pain in the legs occurs. After - you should rest and continue walking again. Walks in the fresh air must be carried out at least three times a week for 45 minutes.

Positive dynamics will be noticeable after a few weeks, but the minimum course of such an impact is 12 weeks. The complex of therapeutic measures includes exercises of physiotherapy exercises. They should vary from strength training to walking with sticks and exercises for the upper or lower extremities; It is also very useful to do a special massage and take a contrast shower in the morning.

Operation

Surgical intervention is the main method of therapy in the last stages of development. The most common operation is to amputate a limb.

Thrombectomy, angioplasty and endarterectomy are considered minimally invasive operations, which means they are performed without large incisions. The intervention may be aimed at removing part of the artery of the affected area or at increasing the lumen of the vessels. If it becomes impossible to carry out a full-fledged surgical intervention, bypass surgery is recommended to create a bypass for the movement of blood using one's own vessels or artificial prostheses.

To improve the blood supply to the lower extremities and reduce the number of trophic ulcers, lumbar sympathectomy can be performed. Surgery is necessary when vascular bypass is not possible. But the prognosis of the procedure is often unpredictable, so intervention is considered a fallback option for a limited number of patients.

Traditional medicine

As folk remedies for the treatment of the syndrome, there are:

mud lotions on the legs;
mustard baths;
applications from various types of clay;
bee therapy;
rubbing an ointment from natural sea buckthorn and olive oil into the skin of the feet;
heating with an infrared lamp;
compresses from burdock leaves.

But it is impossible to treat the syndrome with only one means of traditional medicine. Medical treatment is also required. Before you start using the advice of traditional medicine, be sure to consult with your doctor.

Preventive actions

To prevent the development of an anomaly, it is worth:

give up bad habits, especially smoking;
walk as often as possible;
engage in physical therapy under the guidance of an experienced trainer;
visit the pool;
wear only comfortable shoes and clothes made from natural materials;
give up fatty foods.

Intermittent claudication is a dangerous disorder that requires full treatment, which in its advanced form leads to limb amputation.

Atherosclerosis, complicated by serious pathologies of the heart and blood vessels, also has a number of concomitant diseases that are not so noticeable. One of them is intermittent claudication, which develops against the background of the underlying disease and often remains undeservedly overlooked.

Damage to the veins is an invariable accompaniment, and the veins of the lower extremities suffer the most. Unfortunately, pain in the legs when walking is not the kind of symptom that people go to the doctor for. Therefore, intermittent claudication has enough time for uninterrupted progression, capturing ever larger areas of exposure.

This neglect leads to the fact that patients can lose the affected limb already in the first six months after the diagnosis of critical ischemia of intermittent claudication. In addition, twice as often as in other patients diagnosed with atherosclerosis, they experience either various exacerbations of the pathological state of the vessels.

Causes

It is believed that the main cause of intermittent claudication is atherosclerotic vascular disease, however, there are other causes:

Traumatic effects on the legs;
Transferred ;
Deposition of toxins in the vessels of the legs;
Gout;
Frostbite.

The sources of HP disease mentioned above make up about ten percent of the provoking factors of the total number of visits to medical care.

Vascular atherosclerosis, like all diseases associated with a violation of the cardiovascular apparatus, preferably affects the male body. With the weakening of hormonal protection, that is, by the age of 65, the susceptibility to this pathology also increases in women, but the percentage of this statistic will still be approximately 70:30 in the ratio of a man to a woman.

The first thing that people pay attention to, although this is not the initial stage of the disease, is pain when walking of any intensity. Even before this main symptom of intermittent claudication, the attention of patients is attracted by minor symptoms of discomfort, such as fatigue of the legs, partial loss of sensitivity of the skin of the calves and ankles, "goosebumps".

But the real anxiety begins to cause the inability to walk without pain, even relatively short distances. This is due to the fact that the lack of arterial blood approaches a critical point and the vessels of the legs begin to starve.

The patient overcomes some distance quite tolerably, however, if a person does not take a break after the onset of fatigue, fatigue is quickly replaced by pain and uneven gait (limping). In this case, the patient needs to sit down, stretching out his legs (or one leg), otherwise the unpleasant sensations will be replaced by burning pains.

Over time, depending on how quickly the disease develops, the symptoms of intermittent claudication will be aggravated by the following signs:

Perhaps the appearance;
The temperature of the legs will become significantly lower relative to the general body temperature;
There will be an increasing pallor of the skin;
in the foot area ceases to be palpable.

Approximately at the level of damage to the legs, when trophic ulcers are detected by the patient, walking more than 150 meters will border on unbearable suffering for him. At this stage, frequent pauses and rest no longer play any role - the pain becomes unrelenting.

Diagnostics

Diagnosis of intermittent claudication does not take much time and rarely needs to be confirmed. Especially, this is clearly already at those stages when probing the pulse on the foot is almost impossible, and the appearance of the diseased limb is significantly different from the healthy one in appearance. All these features of intermittent claudication speak for themselves.

Sometimes, in order to draw up a general picture and to identify the stage at which the disease is located, a set of diagnostic measures is required, including:

in the areas of the ankle and shoulder (they should be of equal importance);
Antiographic study;

Treatment of intermittent claudication, with a complete confirmation of the diagnosis, is carried out mainly within the framework of medical support, although in special cases, an operation is prescribed.

Treatment

Even an operation to restore normal blood flow does not cancel subsequent therapeutic measures. Treatment of lameness, prescribed after rehabilitation, should accompany the patient throughout his life.

Physical activity therapy:

Most medical measures will lose their significance if they are not supported by constant, dosing physical exertion. The most accessible means of this is walking. You need to walk for at least half an hour every day, but if this time on your feet borders on severe pain, it is reduced to 10, to 15 minutes and then gradually increases.
Quitting smoking is very important during the treatment period.

Conservative treatment:

Medical treatment is designed to normalize lost functions, correct lipid metabolism, regulate blood pressure and accelerate metabolic processes in the body.
To normalize the work of the lipid spectrum, drugs are prescribed. They should be used in the treatment of intermittent claudication at any stage;
To control the level of sugar in the blood (if there is no history of diabetes), you need to monitor the readings of the glucometer and adhere to that excludes simple carbohydrates;
If the pressure is normal over 140/90 mm Hg. Art., in the absence of pronounced heart disease (diabetes,), then medication is prescribed, such as lisinopril and perindopril, which prevent the occurrence of strokes and heart attacks;
Responsible for sulodexide, recommended for intravenous administration

Operation

The technique of the surgical procedure may be;

Minimally invasive;
Amputation;

Amputation, as the most cardinal method, is carried out only in cases of extreme neglect of the condition. Minimally invasive methods include: thrombectomy, endarterectomy, and angioplasty. The latter is sometimes complicated by the introduction of a stent.

Bypass surgery is indicated when there is a possibility of saving the leg from amputation when other methods are inappropriate. At the same time, both the patient's own vessel and a flexible prosthesis are used as a shunt.

Surgical intervention is justified when intermittent claudication no longer responds to the drug effect, and the patient's quality of life decreases progressively.

- a fairly common and very dangerous pathology, and often it is not always given due attention by doctors. According to various data, the disease "intermittent claudication" affects about one and a half million Russians, about one hundred thousand are diagnosed with critical leg ischemia, and the number of amputations due to the disease reaches 40 thousand per year.

The predominant cause of intermittent claudication is atherosclerosis, which in most patients has another localization - the heart, kidneys. Sometimes paying close attention to these forms of atherosclerosis, doctors often do not concentrate on the diagnosis and treatment of intermittent claudication, which progresses, leading to severe disability and even death.

Causes of the syndrome of intermittent claudication.

Atherosclerosis - the main cause of the syndrome - intermittent claudication!

It is generally accepted that the main factors in the genesis of intermittent claudication are:

Atherosclerosis of the vessels of the legs.
Diabetic macro- and microangiopathy without concomitant atherosclerosis.
Autoimmune vascular disease (obliterating endarteritis).

As a rule, in nine out of ten patients, intermittent claudication is the result of atherosclerotic lesions of the arteries. And it is highly likely that there are other forms of atherosclerosis. Diabetic angiopathy is considered as the cause of the syndrome of intermittent claudication if it is isolated and not associated with atherosclerosis. Along with this, it increases the likelihood of lipid disorders and fatty deposits in the arteries.

Also, among other causes of the disease, endarteritis, trauma, infection and intoxication, hypothermia are indicated, although these conditions are much less common among the provoking factors of intermittent claudication. Pathologies are more susceptible to older people and mostly men. Since atherosclerosis of other localizations is also diagnosed in them more often than in women. In addition, men are more prone to violation of the regime, bad habits and rare visits to specialists.

Types of intermittent claudication.

Neurogenic (initially radiculoischemia, later degeneration of the nervous tissue joins).
Vascular (the most common cause is obliterating endarteritis, atherosclerosis). Distinctive features of neurogenic (caudogenic) intermittent claudication from claudication in vascular pathology are the presence of previously disturbing lower back pain, diagnosed intervertebral hernia, congenital, acquired stenosis of the spinal canal, pain in the legs is provoked by standing and walking, pain disappears in a position with a bent lower back (when tilted forward). Do not forget about the possible combination of different diseases.
Other causes: genetic diseases (McArdle disease), traumatological (trochanteric bursitis), neurological, psychogenic.

According to anatomical criteria, there are:

Central stenosis - a decrease in the distance from the posterior surface of the vertebral body to the arch at the base of the spinous process; up to 12 mm - relative stenosis, 10 mm - absolute stenosis.
Lateral stenosis - narrowing of the radicular canal and intervertebral foramen to 4 mm or less.
Combined stenosis.

Symptoms and diagnosis of intermittent claudication.

Distinguishing neurogenic intermittent claudication from intermittent claudication in vascular pathology allows the presence of pain not in one, but in both limbs, the presence of a history of lower back pain, verified, as well as the fact that the onset of symptoms is provoked by walking, the pain disappears when the torso is tilted forward, and pulsation was preserved on the vessels of the legs.

In most cases, the differential diagnosis between vascular and neurogenic intermittent claudication can be based on a critical evaluation of clinical symptoms and signs. If there is a pulse on the foot at rest and after exercise, vascular pathology is unlikely. Not so long ago, arteriography was used as a routine research method; Nowadays, non-invasive ultrasonic Doppler methods of examination are more often used.

Diagnostic difficulties usually arise in the presence of vascular occlusion in combination with spinal cord compression. In conjunction with clinical examination, other non-invasive techniques are used: electromyography and measurement of nerve conduction velocity, myelography, radiography of the lumbosacral region of the spine, computed tomography and arteriography.

Of no small clinical importance is the definition of the ankle-brachial index. These measurements should be taken after loading. Lumbosacral radiography is recommended to be performed in direct, oblique and lateral projections. A constant clinical symptom in all patients is pain in the lower back, lasting from several weeks to several years, radiating to one or both lower limbs. In patients with bilateral pain syndrome, the lesion of one limb may be more pronounced.

Burning, tingling, squeezing pain in the back or in the thigh area, which radiates to the posterolateral areas of the lower leg, ankle, and big toe, are also considered typical symptoms. The feeling of discomfort in the lower extremities sometimes appears only when walking, less often at rest, and when changing the position of the body. As a rule, the symptoms disappear when the movement stops, while resting while sitting or lying down. Urination disorders are not typical; there is a tendency to constipation.

Computed tomography reveals spinal canal narrowing, articular facet hypertrophy, and other soft tissue changes.

The neurogenic origin of the symptoms is confirmed by the effectiveness of the treatment without the use of vascular drugs. Conservative treatment - analgesics, muscle relaxation, wearing a corset - leads to an improvement in the condition of patients.

A more thorough assessment of symptoms should be aimed at finding a neurogenic genesis of the disease in most patients. The neurogenic origin of the disease is indicated primarily by the presence of pathological symptoms that disappear in a sitting or lying position. It is characteristic that the manifestation of the appearance of pain occurs when the patient walks. The gait changes, the patient limps, is forced to stop and rest. During the stop, the pain decreases somewhat, but often in severe stages, even rest no longer brings relief, the pain becomes constant. Usually the disease is unilateral, but both legs can be affected at once.

As vascular disorders worsen, other signs of intermittent claudication appear:

Lowering the temperature of the skin, blanching and cyanosis;
Trophic changes in the form of ulcers;
Loss of pulse in the arteries of the foot.

In the stage of critical ischemia of the lower extremities, the deficiency of arterial blood is so strong that patients begin to notice not only soreness, but also trophic changes - ulcers. Walking a distance of 150-200 meters becomes a real problem for them, because the pain is quite intense, and stopping and resting no longer help.

Depending on the cause of the syndrome - "intermittent claudication" - there are two forms of pathology:

Peripheral.
spinal.

Peripheral intermittent claudication is associated with atherosclerosis, endarteritis, and diabetes. It is accompanied by fatigue and discomfort in the legs, which are replaced by pain. The limb turns pale, becomes cold, the pulse on the arteries disappears. In the severe stage, trophic ulcers appear.

The spinal form develops when small vessels that supply blood to the gray matter of the spinal cord are affected. It is characteristic of some chronic diseases (myelitis, syphilis) and may be their early symptom.

Treatment of intermittent claudication.

It is important for the patient to refuse heavy physical exertion, taking medications as prescribed by the doctor.

Basically, conservative treatment is carried out for patients with mild and moderate intermittent claudication syndrome for 1-3 months. In case of ineffectiveness of conservative treatment, gross changes according to CT, MRI, with the consent of the patient, surgical treatment is performed.

Operative treatment.

The operation is performed under endotracheal anesthesia. The position of the patient on the operating table is determined by the planned operation. The type of operation is determined for each patient individually, depending on the cause of the pathology. The main goal of the operation is the decompression of neural structures, which is well defined by MRI examination.

Eg:

Posterior approach with removal of the arches at the affected levels and the adjacent yellow ligament, if necessary, supplemented by foraminotomy (partial resection of the superior articular process when it compresses the root), with transpedicular fixation (using rods, a transverse beam for structural strength, with and without distraction ) with or without spinal fusion, if indicated. Discectomy with cage implantation (both titanium metal and polymer), both anterior and posterior access, endoscopically, laminoplasty.

Both before and after surgery, the patient undergoes conservative treatment, the purpose of which is to correct concomitant pathology, relieve swelling of the spinal cord roots, and prevent infection. The normalization of blood pressure is also considered a rather important component of treatment. In the event that, in addition to the disease - intermittent claudication - there is no concomitant pathology, then the pressure should not exceed 140/90 mm Hg. Art. In case of presence, cardiac ischemia, chronic heart or kidney failure, the recommended maximum pressure is 130/80 mm Hg. Art.

For the correction of blood pressure, drugs from the angiotensin-converting enzyme group (lisinopril, perindopril) are indicated. It has been argued that these funds not only fight hypertension, but also significantly reduce the risk of vascular accidents and associated heart attacks and.

In order to improve the rheological parameters of the blood, antiplatelet agents are indicated. Particularly popular drugs based on acetylsalicylic acid (thrombo Ass, aspirin cardio). Anticoagulants for oral administration are not prescribed to patients with intermittent claudication, since there is a high risk of cardiovascular complications.

In order to correct metabolic disorders in tissues, pentoxifylline is used in a daily dose of 1200 mg. The drug improves microcirculation and blood rheology, dilates blood vessels, and the result is an increase in the distance that the patient can walk before the onset of pain.

Improves blood flow, reduces blood viscosity, normalizes the state of the endothelium, the drug sulodexide. Previously, it was prescribed only for critical tissue ischemia, but today it is also recommended for intermittent claudication. It is recognized that when taken orally and intravenously, the distance that the patient travels before the onset of pain is almost doubled.

Angiotensin-converting enzyme inhibitors (perindopril), beta-blockers (nebivolol), and angiotensin II receptor blockers (losartan) can improve endothelial function. Given the presence of hypertension and cardiac pathology in many patients, they are all the more appropriate and not contraindicated in the syndrome - intermittent claudication.

Folk remedies for intermittent claudication.

ginkgo- folk remedy

A lot of research has been devoted to the effect of ginkgo on intermittent claudication in the treatment. Some have achieved statistically significant and clinically significant increases in pain-free walking distance. Have your family member take standardized ginkgo extract tablets or capsules according to package directions.

Garlic for the treatment of intermittent claudication.

It's not clear why, but garlic seems to improve circulation to all parts of the body. The most convenient (and least smelly) form of this medicine is capsules. Let your patient with signs of intermittent claudication take two pieces two to three times a day for 2-6 months until the symptoms disappear.

Leg Cocktail for the treatment of intermittent claudication.

The amino acid arginine is needed to produce nitric oxide for the treatment of intermittent claudication. It's secreted by the endothelium (the inner lining of the arteries) and helps them relax and widen, meaning more blood flow, explains Decker Weiss, a naturopath at the Arizona Heart Institute in Phoenix. The standard treatment dose is 1 capsule with 500 mg arginine up to three times a day.

Prevention. It is necessary to exclude smoking, physical overwork, cooling, excessive mental stress.

Intermittent claudication syndrome (Charcot's syndrome) is a pathological condition that indicates the presence of certain pathologies in the human body. It occurs in many people of different ages and genders, but it is not always given due importance.

The presence of signs of intermittent claudication indicates the development of dangerous processes in the human body. Without proper treatment, this condition can lead not only to disability, but also to the death of the patient.

Features of the development of the syndrome of intermittent claudication

The main symptom of intermittent claudication (IC) is pain in the extremities, which manifests itself exclusively during walking. A sick person usually limps, his gait changes significantly. While walking, he is forced to constantly stop, periodically rest. When a person is standing or sitting, the pain subsides. If there is a rapid progression of intermittent claudication, discomfort in the limbs is present all the time.

The mechanism of development of this condition is the appearance of spasm in the vessels. Due to certain reasons, the arteries located on the lower extremities and feeding them can no longer fully perform their assigned functions.

There is a particularly strong lack of oxygen during walking, which causes all the discomfort. In this case, the limb tissues feel hypoxia, which irritates the nerve endings.

Symptoms of intermittent claudication

Intermittent claudication can sometimes be difficult to recognize. In the presence of this syndrome, the nature of discomfort may be different. Sometimes the person describes the pain as intense and burning, and other times as dull and aching.

Its localization may also be different. Most often, the pain manifests itself in the area of \u200b\u200bthe shins, thighs, calves, toes.

It also has an unstable character. Periods of remission are very often replaced by exacerbations. In this case, the duration of each stage may be different. In the event of a complete blockage of the artery, which leads to oxygen starvation, surgical intervention is necessary to restore blood circulation.

Despite the fact that the main symptom of this pathological condition is pain, it is also accompanied by other unpleasant phenomena:

the presence of a feeling of constant fatigue and weakness in the limbs;
the appearance of "creeping goosebumps";
decreased sensitivity of the skin on the legs;
local decrease in body temperature on the surface of the limb;
the skin on the legs becomes paler than on the whole body;
trophic changes in the skin appear, taking the form of ulcers;
in severe cases, no pulse is detected in the arteries of the foot.

Causes of intermittent claudication

The reasons for the development of such a dangerous condition as intermittent claudication include:

atherosclerosis. This disease is characterized by the formation of cholesterol plaques, which narrow the lumen of blood vessels. In especially severe cases, a complete blockage of the artery can occur, which leads to dire consequences. Atherosclerosis most often affects the vessels of the heart, kidneys, brain, but sometimes it also manifests itself in the lower extremities;
. This condition is the cause of intermittent claudication, if it is not provoked by atherosclerotic changes. Also very often diabetes mellitus leads to a violation of lipid metabolism in the body. This is what provokes the aggravation of atherosclerosis;
vascular damage due to the presence of autoimmune diseases;
other causes - hypothermia, gout, various injuries, past infections or intoxication of the body.

Also, the factors that contribute to the development of intermittent claudication include age. It has been established that older men are more susceptible to this pathology. In women, intermittent claudication is diagnosed much less frequently.

Classification of pathology

This pathological condition can occur in the following forms:

caudogenic intermittent claudication, which is also called neurogenic. This condition occurs due to narrowing of the spinal canal in the lumbar region. Neurogenic intermittent claudication can be either congenital or acquired. In the latter case, this pathological condition occurs against the background of osteochondrosis or spondylopathy. In the presence of these pathologies, normal transmission of nerve impulses is impossible, which leads to the development of intermittent claudication;
vascular PH. This pathological condition is considered true. It occurs due to atherosclerosis, which is accompanied by a decrease in the lumen of blood vessels due to the accumulation of cholesterol on their walls. As a result, tissues receive less oxygen, which provokes all negative changes. Myelogenous intermittent claudication develops against the background of impaired spinal circulation. This condition occurs after intense physical activity, long walking.

Severity of intermittent claudication

Intermittent claudication can present in a variety of ways. Depending on the severity of a person's condition, the following stages of this pathology are distinguished:

1 degree. It is characterized by the absence of external manifestations, but at the same time, blood circulation in the lower extremities is already impaired. In this case, PH can be suspected if, after a long walk (for a distance of more than 1 km) or after climbing stairs, a person feels discomfort in his legs. At this stage, intermittent claudication is rarely diagnosed, since the patient does not pay attention to the alarm signals of the body and does not go to the doctor;
2A degree. In this case, a sick person can cover a distance of 0.2 to 1 km without pain;
2B degree. Indicates that the disease has begun to progress and it can only be stopped by the right approach to treatment. In this case, the patient can overcome no more than 0.2 km, since he begins to be disturbed by severe pain in the limbs;

3 degree (critical ischemia). It is characterized by intense pain that does not disappear even after a long rest. At the 3rd degree of HRP, the patient's skin changes its color, blood stagnation occurs. In this case, only surgical intervention can prevent limb amputation;
4 degree. Its peculiarity is the development of irreversible consequences in tissues and blood vessels against the background of oxygen starvation. In this case, the appearance of trophic ulcers is observed,. The only way to save a person's life is by amputating the affected limb. Otherwise, the patient may die from.

Diagnostics

It is possible to establish the presence of intermittent claudication only by existing symptoms. Also, the following diagnostic procedures are used to identify circulatory disorders and their severity:

pressure is measured at the ankle and shoulder. Normally, the obtained indicators should not differ;
a general blood test is performed to identify the general condition of the body;
angiography is prescribed to determine the patency of the arteries;
Doppler ultrasound can detect any circulatory disorders;
in especially severe cases, CT or MRI is prescribed.

Medical treatment

In the presence of such a disease as intermittent claudication, treatment necessarily includes taking drugs to improve blood circulation. In especially severe cases, drug therapy should take place for life, because after stopping the drug, the person becomes worse, and more drastic measures may be needed.

Even after surgery, taking certain drugs is very necessary, which helps:

prevent stroke or other complications from the cardiovascular system;
normalize blood glucose levels;
balance blood pressure indicators;
normalize lipid metabolism;
prevent the formation of blood clots;
improve blood supply to tissues that are altered due to existing disorders.

Blood glucose levels

Most patients are prescribed a number of drugs with different effects. They help improve blood circulation, lower blood cholesterol levels, etc. For patients with diabetes, drugs are prescribed to normalize sugar levels. It is also very important to stick to a diet, lead a healthy lifestyle and do not neglect physical activity.

Surgery

In the initial stages of the disease, the operation helps to normalize blood circulation and prevent serious consequences for a person. In more severe cases, when trophic ulcers have formed, amputation of the limb (full or partial) is indispensable.

It looks like a trophic ulcer on the leg

In the early stages of the development of intermittent claudication, the following minimally invasive surgical interventions are practiced:

. It is carried out to remove a blood clot from the vessel, which prevents its complete blockage;
angioplasty. It implies the introduction of a special balloon into the narrowed vessel, which expands it to the desired size;
endarterectomy. In this case, a partial removal of the artery, which is most susceptible to atherosclerosis, is performed;
. It involves the installation of implants (artificial or from one's own tissues) instead of sections of vessels that do not fulfill their functions.

Prevention

To prevent the development of intermittent claudication, it is first necessary to abandon bad habits. It is also recommended not to neglect physical activity. Even in the initial stages of the disease, one should engage in physiotherapy exercises, walk, alternating all this with quality rest.

You should abandon uncomfortable shoes, which exacerbate all the negative processes in the body. It should fit in size, be made of quality materials, not rub. Also, in all cases, you must not forget about proper nutrition.

Intermittent claudication (IC, intermittent claudication) is a common and very dangerous pathology, which, however, is not always given due attention by doctors. According to various sources, PC suffers about one and a half million Russians, approximately one hundred thousand are diagnosed with critical, and the number of amputations due to the disease reaches 40 thousand per year.

The main cause of PX is considered, which in most patients has another localization - the heart, vessels of the brain, kidneys. Paying close attention to these forms of atherosclerosis, doctors often do not concentrate on the diagnosis and treatment of intermittent claudication, which progresses, leading to severe disability and even death.

Pain in the legs when walking worries many, but at best half of the patients come to the doctor with this symptom. Meanwhile, their risk of myocardial infarction increases to 60%, and the probability of death from heart disease is six times higher than that of other people who do not suffer from damage to the vessels of the legs.

Intermittent claudication syndrome requires active medical and surgical tactics. When diagnosing CP in the stage of critical ischemia in the first six months from the moment of its establishment, the limb can be saved only in 40% of patients, the same number of patients will undergo amputation, and the remaining fifth of the patients will die, therefore early detection of pathology is the primary task of practicing physicians.

Causes of PH syndrome

atherosclerosis: the main cause of PH syndrome

It is generally accepted that the main factors in the genesis of intermittent claudication are:

Diabetic macro- and without concomitant atherosclerosis.
Autoimmune vascular damage ().

In nine out of ten patients, intermittent claudication is the result of atherosclerotic lesions of the arteries. At the same time, the presence of other forms of atherosclerosis is very likely. Diabetic angiopathy considered as the cause of the syndrome of HRP if it is isolated and not associated with atherosclerosis. At the same time, diabetes mellitus increases the likelihood of lipid disorders and fatty deposits in the arteries.

Among other causes of the disease indicate endarteritis, trauma, infection and intoxication, hypothermia, gout, although these conditions are much less common among the "provocateurs" of HP.

Pathologies are more susceptible to older people, mostly men. Actually, atherosclerosis of other localizations is also diagnosed in them more often than in women. In addition, men are more prone to breaking the regime, bad habits and rare visits to specialists.

The main mechanism that provokes the PH syndrome is considered vascular spasm. The narrowed lumen of the already damaged arteries cannot deliver the required volume of blood to the limb, the tissues experience hypoxia, which is aggravated by increased stress (walking). Hypoxia acts negatively on the nerve endings, as a result of which the spasm intensifies even more.

Features of symptoms

The main symptom of intermittent claudication syndrome is pain in the legs when walking. Before it appears, problems with the vessels are indicated by weakness and rapid fatigue, a feeling of crawling and a decrease in skin sensitivity. Over time, arterial blood deficiency increases, and fatigue is replaced by pain.

Characterized by the appearance of pain when the patient walks. The gait changes, the patient limps, is forced to stop and rest. During the stop, the pain decreases somewhat, but in severe stages, even rest does not bring relief - the pain becomes constant. Usually the disease is unilateral, but both legs can be affected at once.

As vascular disorders worsen, other signs of intermittent claudication appear:

Lowering the temperature of the skin, blanching and cyanosis;
Loss of pulse in the arteries of the foot.

In stage critical ischemia of the lower extremities, arterial blood deficiency is so strong that patients begin to notice not only soreness, but also trophic changes - ulcers. Walking a distance of 150-200 meters is a real problem for them, because the pain is quite intense, and stopping and resting no longer helps.

Depending on the cause of the PH syndrome, two forms of pathology are distinguished:

Peripheral.
spinal.

Peripheral HRP associated with atherosclerosis, endarteritis, diabetes. It is accompanied by fatigue and discomfort in the legs, which are replaced by pain. The limb turns pale, becomes cold, the pulse on the arteries disappears. In the severe stage, trophic ulcers appear.

spinal form develops with damage to small vessels that supply blood to the gray matter of the spinal cord. It is characteristic of some chronic diseases (myelitis, syphilis) and may be their early symptom.

Video: lameness and its causes at different ages, the program “Live healthy”

Diagnosis and treatment

For the correct diagnosis of intermittent claudication, examination and conversation with the patient is usually sufficient. The characteristic signs of pathology immediately prompt the doctor to think about the obliteration of the arteries of the legs.

To confirm his assumptions, the specialist will conduct a pulse palpation and examination of the limbs, as well as a number of instrumental tests:

Determination of pressure on the ankle and shoulder (normally the same);
angiography;
CT, MRI;
Doppler ultrasound.

Treatment of intermittent claudication is carried out in two directions: medical support And surgical care. Conservative treatment is indicated for all patients without exception, regardless of the stage, prevalence of the disease, the degree of vascular damage, and it is prescribed for life.

If the patient underwent an operation to correct the blood flow, this does not mean that conservative treatment is no longer needed, it should continue. Isolated therapeutic care for intermittent claudication is acceptable only if the operation is impossible for some reason.

The goals of treatment for IC are recognized as improving the quality of life of patients and reducing the risk of developing severe cardiovascular complications, such as myocardial infarction, stroke. Conservative therapy includes not only the prescription of drugs, but the elimination of risk factors for the disease, primarily smoking.

In parallel with smoking cessation, all patients, without exception, are prescribed physical activity in the form of dosed walking. With seeming simplicity and accessibility, this method of treatment shows high efficiency even with severe degrees of arterial blood flow disorders in the legs.

Walking promotes muscle development, improves blood circulation and the condition of the vascular walls. It is prescribed at least three times a week with a duration of up to 45 minutes. The patient walks until the pain is tolerable, and only when the maximum pain is reached, it is stopped.

When prescribing a dosed walk, the patient should be patient and hope for improvement. The minimum duration of such treatment is 12 weeks, improvement occurs by the end of the first month of classes, and the maximum positive effect lasts for three or more months. It is important not only the attention of the doctor, but also the desire of the patient himself to fight the disease, observing all prescriptions and changing his lifestyle.

Conservative treatment

Directions of drug therapy:

Prevention of complications associated with and (heart attack, stroke);
Correction and blood glucose levels;
Normalization of blood pressure;
Improvement of trophism and metabolism in damaged tissues.

You can normalize the lipid spectrum with the help of drugs from the group (simvastatin, lovastatin, etc.). They are shown to all patients with PH, but it should be noted that the degree of arterial damage is not always proportional to lipid metabolism disorders.

Glycated hemoglobin, formed during atherosclerosis and other metabolic disorders, to a large extent contributes to damage to the vascular endothelium, so maintenance is an extremely important component of treatment. In the absence of diabetes, it is sufficient to control glucose levels, and in diabetes mellitus, therapy is necessary. hypolipidemic agents and insulin until normoglycemia is reached.

Since patients with carbohydrate metabolism pathology are very susceptible, they should carefully monitor the condition of the skin of the lower half of the legs, observing hygiene procedures and a motor regimen.

An equally important component of treatment is the normalization of blood pressure. If, in addition to HRP, there is no concomitant pathology, then the pressure should not exceed 140/90 mm Hg. Art. In case of hypertension, cardiac ischemia, diabetes, chronic heart or kidney failure, the recommended maximum pressure is 130/80 mm Hg. Art.

For the correction of blood pressure, drugs from the angiotensin-converting enzyme group (lisinopril, perindopril) are indicated. It has been proven that these drugs not only fight hypertension, but also significantly reduce the risk of vascular accidents and associated heart attacks and strokes.

To improve the rheological parameters of the blood are shown. The most popular are preparations based on acetylsalicylic acid (thrombo Ass, aspirin cardio). Anticoagulants for oral administration are not prescribed to patients with IC, as there is a high risk of cardiovascular complications.

In order to correct metabolic disorders in tissues, it is used pentoxifylline in a daily dose of 1200 mg. The drug improves microcirculation and blood rheology, dilates blood vessels, and the result is an increase in the distance that the patient can walk before the onset of pain.

Improves blood flow, reduces blood viscosity, normalizes the state of the endothelium sulodexide. Previously, it was prescribed only for critical tissue ischemia, but today it is also recommended for PH. It is shown that when taken orally and intravenously, the distance that the patient travels before the onset of pain almost doubles.

The use of gene therapy drugs and stimulation of the formation of nitric oxide with the help of its precursors are recognized as new and promising methods that are in the stage of clinical trials. The studies are bearing fruit: in Russia, the gene therapy drug neovasculgen has already been registered for use, the effectiveness and safety of which have already been proven. The use of neovasculgen leads to an increase in the distance of pain-free walking in a year and a half.

If surgical treatment is not possible, then the treatment regimen necessarily includes drugs based on prostaglandins (beraprost, iloprost) and prostacyclins, which help reduce pain, regenerate trophic ulcers, and even allow postponing leg amputation for some time.

Operation

Surgery- a radical method, but not abolishing the need for medication. The volume of the operation depends on the stage of the disease and the degree of blood flow disturbance. In severe cases, when ischemia reaches a critical level, ulcers and gangrene develop, amputation is performed.

Minimally invasive are considered with stenting,. Angioplasty consists of inserting a balloon into the vessel, which inflates and enlarges the lumen. Often the operation is supplemented by the installation of a stent. With endarterectomy, a part of the inner lining of the artery is removed in the place where the atherosclerotic process is most pronounced.

If it is impossible to carry out surgical treatment, but with the prospect of saving the limb, bypass surgery is indicated when a bypass path of blood flow is created using artificial prostheses or own vessels.

Intermittent claudication syndrome is an incurable pathology, but amenable to medication, which can slow the progression of vascular damage. Early diagnosis and the patient's compliance with all recommendations give a chance to save the limb, therefore, even if the doctor himself did not ask about pain when walking, it is necessary to inform him about this sign of a serious illness.