Conservative treatment of atherosclerosis. What is obliterating atherosclerosis of the vessels of the lower extremities - how to treat the pathology? Folk methods of treatment

Main symptoms:

• Paleness of the skin of the legs
• Pain in the calf area when walking
• Pain when walking
• burning skin
• Fever
• Increased susceptibility to cold
• Increased leg fatigue
• Blue toe tips
• Hair loss in the thigh area
• Loss of hair in the shin area
• The appearance of ulcers
• Splitting of toenails
• Dark red toes
• Skin hardening
• Lameness

Obliterating atherosclerosis of vessels lower extremities- a chronic disorder that affects large arteries, leading to varying degrees of circulatory failure. The main symptoms of the expression of the disease are - rapid fatigue of the legs while walking, lameness and numbness of the feet often occur.

The cause of such an ailment is considered to be a violation of blood circulation in the lower extremities, which occurs against the background of narrowing or blockage of the arteries. In the International Classification of Diseases (ICD-10), this disease has its own index I70. The course of the disease is characterized by damage, first of all, to the vessels and arteries of the thigh, after which the pathology spreads to the vessels of the feet and lower legs.

The duration of development is more than ten years. This means that a person may not be aware of the disease, and fatigue while walking can be attributed to age.

This type of atherosclerosis mainly develops in middle-aged and elderly people over forty years of age. Men are slightly more affected than females. Diagnosis of the disease consists in angiography and ultrasound of the arteries. Treatment consists of taking medications to reduce the symptoms of the disease, and surgical intervention, the degree of which depends on the damage to the arteries (includes prosthetics, angioplasty and bypass).

Etiology

Obliterating atherosclerosis is a manifestation of systemic atherosclerosis, which is why the causes of its occurrence are similar to the causes of the progression of this disease in any other localization. Predisposing factors for the manifestation of the disease are:

• genetic predisposition;
• long-term addiction to alcohol and nicotine;
• high blood cholesterol;
• sedentary lifestyle or working conditions;
• prolonged exposure to stressful situations;
• offensive in women;
• excessively high body weight;
• arterial hypertension;
• hypothermia of the body;
• wide range injuries of the lower extremities;
• age category - the disease is most often diagnosed in older people;
• disruption of normal operation thyroid gland due to its complete or partial removal.

Almost all patients with this disease have similar problems with the vessels of the heart and brain.

Varieties

Obliterating atherosclerosis of the arteries of the lower extremities is classified into several stages, which depend on how far a person can walk before pain or fatigue in the legs occurs:

• initial - painless walking is performed over a distance exceeding one kilometer. Discomfort begins to be expressed when performing heavy physical exercises. loads;
• medium - soreness occurs in the interval from fifty to a thousand meters;
• critical stage - fatigue begins to bother a person in less than fifty meters of walking. In addition, pain is expressed in a calm state or during sleep;
• complicated - characterized by the appearance of necrotic areas in the heel and fingertips that can cause. When obliterating atherosclerosis occurs at this stage, a person cannot take a single step without pain.

Depending on the degree of spread of the disease, there are several types of lesions:

• the first is limited;
• the second - the pathology extends to the femoral artery;
• the third - involvement in the process of the popliteal artery;
• fourth - complete defeat of the femoral and popliteal arteries;
• fifth - a deep lesion of all the above arteries.

According to the severity of symptoms, the disease proceeds in three stages:

• mild - expressed by lipid metabolism disorders. Atherosclerosis itself does not show any signs;
• moderate - the first characteristic features of the disease appear: numbness, increased susceptibility to cold, a feeling of "goosebumps" on the skin;
• severe - the symptoms intensify and bring significant discomfort to the person;
• progressive - this stage is characterized by the appearance on the lower extremities of fluid-producing ulcers and gangrene.

The development of the disease can be carried out in several ways:

• rapidly - acute manifestation signs, the rapid spread of the disease, gangrene. In such cases, the patient needs prompt hospitalization and amputation;
• subacute - attacks of exacerbation are replaced by periods of retreat of symptoms. The therapy is carried out in a hospital and is aimed at slowing down the process;
• chronically - there are no signs of the disease for a long time, the treatment is medication.

Symptoms

Since obliterating atherosclerosis of the lower extremities can develop over several years, it is quite for a long time it proceeds without expressing any symptoms. Often, this arterial lesion develops gradually, and the degree of its manifestation directly depends on the stage of the disorder - the more pronounced the signs, the more serious the level of the disease. In addition to the main symptom - pain and fatigue while walking even for short distances, the symptoms of the disease are:

• foot numbness;
• increased susceptibility to cold;
• persistent burning of the skin;
• pain in the calf area while walking long distances;
• the appearance of lameness;
• an increase in body temperature, up to a fever;
• the appearance of cracks on the heels;
• change in the color of the skin of the lower extremities - they acquire a pale shade on early stages, and in the later ones, the fingertips become dark red or cyanotic;
• - with the prevalence of the disease on the arteries of the thighs in males;
• hair loss in the thighs and lower legs;
• layered toenails;
• skin thickening;
• the occurrence of ulcers that can lead to gangrene even with the slightest bruise or cut;
• the occurrence of seizures during sleep.

Diagnostics

Diagnosis of obliterating atherosclerosis is complex and consists in the implementation of the following measures:

• collection of a complete list of all diseases of the patient and his close relatives. It is carried out to determine the cause of the disease, including hereditary;
• measurement of the pulsation of the lower extremities - with this disease, it is weak or completely absent;
• definition blood pressure;
• UZDG - scanning of the arteries of the affected limb;
• vascular radiography;
• computed angiography with the use of a contrast agent - using this procedure, it is possible to detect injuries and blood clots in the arteries;
• MRI of the vessels of the lower extremities - helps the specialist to assess the structure of the veins;
• additional consultation with a vascular surgeon.

In addition, the main task of a specialist during diagnosis is to distinguish obliterating atherosclerosis from other diseases with similar symptoms. After receiving all the test results, the doctor prescribes the most effective method therapy.

Treatment

Treatment of obliterating atherosclerosis is carried out in several ways:

• with the prescription of drugs;
• with the help of physiotherapy;
• surgical operations.

Drug treatment consists in the use of substances that are aimed at lowering cholesterol levels and helping to prevent blood thickening. In addition, antithrombotic drugs and antispasmodics can be prescribed. For elimination pain analgesics are used. If blood clots occur, injections of heparin and thrombolytics are performed.

Physiotherapy includes:

• well therapeutic massage;
• electrophoresis;
• electric or magnetic field therapy;
• current treatment;
• therapeutic baths with the addition of special mud, needles, radon, hydrogen sulfide.

Surgery is used in the event of ulcers that secrete fluid, pronounced gangrene and blue toe tips, as well as in severe stages of arterial disease. Surgical methods include:

• puncture of the artery for the introduction of a catheter with a balloon, which is brought to the site of narrowing and expand the artery. In some cases, they resort to installing a stent - they do this to prevent the recurrence of the disease;
• prosthetics of the affected artery;
• elimination of an atherosclerotic formation from the affected artery (it is detected using angiography);
• shunting - restoration of blood flow by changing the flow of blood, bypassing the affected area through an artificial vessel;
• amputation - only in cases of gangrene development, to avoid blood poisoning. Often carried out in the diagnosis of the fourth stage of the disease.

In some cases, the doctor decides to combine surgical operations.

An important factor in the effectiveness of therapy is the patient's refusal to smoke. If the patient does not do this, the result of the treatment will be rather low or will be completely absent.

Prevention

In order for a person not to have such a problem as obliterating atherosclerosis of the lower extremities, it is necessary to follow a few simple rules:

• lead healthy lifestyle life, completely abandon nicotine, limit the intake of alcoholic beverages;
• perform moderate exercise daily, especially with a sedentary lifestyle;
• monitor normal body weight;
• avoid hypothermia of the lower extremities;
• undergo preventive examinations and take blood tests several times a year.

Obliterating atherosclerosis of the vessels of the lower extremities (OASLE)- a long-term disease, characterized by a decrease in blood supply to the muscles of the legs with the development of intermittent claudication syndrome. This is one of the most common vascular pathologies. The development of the disease can lead to the appearance of trophic ulcers.

The cause of the disease (in more than 80% of cases) is atherosclerotic lesions of the vessels supplying the lower extremities, with the formation of plaques in the walls of the arteries, narrowing (stenosis) or completely blocking (occlusion) the lumen in the walls of the arteries. In advanced cases, trophic ulcers and even gangrene occur.

Atherosclerosis is a systemic disease. In many patients with damage to the arteries of the legs, lesions of other vascular pools are also detected, in particular, the coronary bed and cerebral vessels, and trophic ulcers occur.

Risk factors for the development of obliterating diseases of the vessels of the legs: smoking, high blood pressure, hypercholesterolemia, overweight, diabetes, physical inactivity, hypothyroidism, kidney disease, adverse environmental factors (hypothermia).

The subjective sensations of a patient suffering from OASNK with the occurrence of trophic ulcers can vary from a debilitating feeling of discomfort at rest to severe pain and nocturnal cramps. In this case, the pain is aggravated in the supine position and with prolonged walking. With an increase in the degree of tissue hypoxia, signs of trophic disorders appear (changes in skin color and impaired sensitivity), up to long-term non-healing wounds, the development of trophic ulcers and tissue gangrene.

Trophic ulcers usually occur in the lower leg, being a confirmation of a deep pathology of the blood supply. Treatment of trophic ulcers should be carried out in a timely manner, at the earliest possible stage of the development of the disease. Trophic ulcers easily become a medium for the spread of fungal and other diseases. Currently used for trophic ulcers combined treatment several methods at once. After the diagnosis of a trophic ulcer, treatment begins immediately and is currently successful, with low rate relapses. The peculiarity of trophic ulcers lies in their unpleasant appearance as they appear on the skin. Treatment of trophic ulcers is based on improving blood flow. In the treatment of trophic ulcers, special attention is paid to the causes of their occurrence, because the type of therapy used depends on it. Trophic ulcers can be caused venous insufficiency, arterial disease, diabetes. Accordingly, normal treatment of a trophic ulcer is impossible without combating the disease that caused it.

Diagnosis of a trophic ulcer

The main objective method for detecting circulatory disorders in the lower extremities and determining its degree is Doppler ultrasound.

Treatment of a trophic ulcer

Surgical treatment (vascular surgery) is indicated for severe disorders of the blood supply to the lower extremities, such as a trophic ulcer. If surgery cannot be performed, conservative therapy is performed.

Conservative therapy of OASNK in the department of purulent surgery of the National Healthcare Institution “Road Clinical Hospital named after I.I. ON THE. Semashko at st. Lublino JSC "Russian Railways" includes drugs: dilating blood vessels (verapamil), improving blood flow and preventing the formation of blood clots and trophic ulcers (pentoxifylline, sulodexide, low molecular weight dextrans, aspirin), prostanoids (vazaprostan, alprostadil).

If you have vascular disease of the lower extremities, such as a trophic ulcer, you need to start treatment as soon as possible. Only an integrated approach will solve problems with blood vessels.

Obliterating atherosclerosis of the vessels of the lower extremities - causes, symptoms and treatment

Obliterating atherosclerosis of the vessels of the lower extremities there is a local manifestation of general atherosclerosis. Atherosclerosis of the arteries is expressed in the thickening of the intima of the vessels and segmental occlusion of the arteries by atheromatous plaques, on which blood clots are attached. Often distal to the occlusion, the artery is patent for blood flow. This feature of obliterating atherosclerosis promotes the formation of collateral circulation and makes it possible to promptly correct impaired circulation.

Atherosclerosis obliterans is a disease of the elderly, although it can also occur at a younger age.

Contributing factors are obesity, hypertonic disease and chronic intoxication (smoking, etc.). Men get sick 9-10 times more often than women, so the endocrine factor in the development of obliterating atherosclerosis is not rejected.

Clinical picture. The clinic is due to the place of occlusion of the main artery. A favorite place for the formation of blood clots are the popliteal, femoral and iliac arteries and, finally, the aortic bifurcation. There are other localizations, but much less frequently.

Depending on the stage of circulatory disorders (see above), certain signs of limb ischemia appear. Patients look older than their years. The course of the disease is slow and progressive. The diseased limb is pale, trophic disorders are poorly expressed. Decreased early or complete absence pulsations in the main arteries. You can often hear systolic murmur over large vessels and the aorta, which is caused by irregularities of the inner wall due to atheromatous plaques. In the gangrenous stage, the zone of necrosis is extensive. Necrotic ulcers often occur in unusual places: on the heel, lower leg, etc.

Treatment of obliterating atherosclerosis always difficult. Patients are usually burdened with concomitant cardiovascular pathology.. In stages I and II held conservative treatment aimed at relieving arterial spasm and developing collateral circulation. In stage II. if there are no general contraindications, various operations are performed to restore the main blood flow. In stage III shows amputation of the limb, which is usually carried out above the knee joint.

Patients with any stage of the disease are subject to consultation with an angiosurgeon and subsequent dispensary observation.

Treatment of obliterating diseases of the vessels of the lower extremities

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If you have been diagnosed with atherosclerosis, treatment cannot be delayed - the sooner you start the therapeutic process, the faster the result will appear.

The Soyuz clinic employs vascular surgeons who have vast experience and are employees of the Institute. A. V. Vishnevsky.

They will accurately determine the cause of the disease and the stage of its development. Taking into account the somatic condition of the patient, his individual characteristics and the presence of concomitant diseases, our specialists will select the most optimal method of treatment.

We use both conservative and surgical treatments. All surgical methods are minimally invasive - vascular surgeons use the most modern technologies.

Thanks to the latest developments, all operations aimed at removing plaques and creating new pathways for blood flow are less traumatic. This innovative treatment guarantees a minimal risk of recurrence.

Atherosclerosis is a very common disease of the arteries. At healthy person arteries are very elastic, flexible, with a smooth surface. They clearly do their job, moving blood and supplying oxygen and nutrients to the entire body.

But sometimes, under the influence of various factors, the inner walls of the vessels begin to overgrow - become covered with plaques. With the further development of the disease, connective tissue begins to grow in the arteries, and calcium is deposited on the walls.

This leads to the fact that the vessels begin to deform, become clogged and can no longer actively supply the body with the necessary trace elements and oxygen. Due to lack of nutrition, atherosclerosis of the lower extremities can develop.

Treatment of the disease must begin as early as possible. The therapeutic process includes an integrated approach to the disease. Can be shown if needed. surgical treatment.

Symptoms

The disease is characterized by damage to the branching vessels of the legs, aorta and coronary vessels. The popliteal and femoral arteries also suffer. Atherosclerotic plaques form on the walls of blood vessels, which cause narrowing of the arteries.

Further development of the disease leads to the appearance of blood clots and the growth of scar tissue. Blockage of blood vessels leads to the fact that the muscles and tissues of the lower extremities do not receive the right amount of the necessary substances. Without timely treatment, with the development of this vascular disease, trophic ulcers can form.

The worst case scenario is gangrene.

The main symptom of the disease is intermittent claudication. When walking, there are pain in the leg, numbness, compression in the muscles. The pain usually goes away at rest, but returns with repeated exertion. Most often, it affects only one leg, but some patients may also have bilateral intermittent claudication.

With the further development of obliterating atherosclerosis, the pain begins to spread along the leg and goes to the muscles of the thigh and buttocks. Also, pain can be observed in the foot and toes.

The leg in which the disease develops is paler than normal, with manifestations of muscle atrophy, cyanosis (bluish coloration of the skin) of the fingers. Scratches, bruises, bruises - any damage heals for a very long time, and can lead to ulcers and inflammation.

In some cases, swelling of the legs and feet develops. A neurological symptom that can appear with atherosclerosis obliterans is chronic insomnia.

Treatment should be started as soon as the first symptoms appear. Timely therapy will stop the development of this serious disease and prevent its further development.

Causes of atherosclerosis of the vessels of the lower extremities

Atherosclerosis is a fairly common disease that begins to affect a person after 40 years. But after 65, the process of development of obliterating atherosclerosis is much faster. From the narrowing of the vessels of the legs, men are more affected - they are almost 80% of all cases.

Since atherosclerosis is a systemic disease, atherosclerosis obliterans is often only part of the problem. The vessels of the heart, brain, kidneys are also exposed to the destructive effects of this disease.

Factors influencing the development of the disease are:

• smoking
• stress
• excess weight
• sedentary lifestyle
• high cholesterol
• genetic predisposition

One of the main negative factors in the development of atherosclerosis of the lower extremities is smoking. Nicotine and tar increase the number of heartbeats, contribute to the development of plaques. Due to smoking, the vessels become coarser, lose their elasticity and become thinner.

Smoking also causes high blood pressure. Atherosclerosis of the vessels of the extremities in smokers occurs twice as often as in non-smokers.

Excess weight is also associated with the development of the disease - malnutrition and excess adipose tissue negatively affect blood vessels and the heart. In addition, excess weight, which leads to a serious load on the legs, increases the chances of developing atherosclerosis obliterans.

The sedentary lifestyle that many people lead also affects the process of vasoconstriction. Sedentary work and lack of adequate physical activity often lead to the development of the disease.

To avoid this, you need to exercise. This will not only improve blood circulation, but also keep yourself in shape.

Stressful situations, various unrest do not directly affect the occurrence of obliterating atherosclerosis, but are provoking factors.

Often with nervous breakdowns and stress people "jam" or "wash down" their problems. Alcohol, fatty foods, smoking - all this leads to the development of not only atherosclerosis, but also to a whole bunch of other equally serious diseases.

Hereditary diseases - hypertension, coronary heart disease, diabetes mellitus - are not the least important in the development of atherosclerosis. If your close relatives suffered from these diseases, and especially those aggravated by atherosclerosis, the likelihood of developing atherosclerosis increases dramatically.

The existing unfavorable heredity should keep you on your guard - you need to carefully monitor your health, lead a healthy lifestyle, eat right, play sports. By eliminating additional negative factors, you can avoid the development of atherosclerosis.

Symptoms of atherosclerosis of the aorta

Atherosclerosis of the aorta is one of the most common forms of the disease. Depending on which parts of the aorta are affected, the manifestation of symptoms also depends.

The largest arterial vessel - the aorta - starts from the heart and branches into many small vessels. The two main sections that run through the body are the thoracic aorta and the abdominal aorta. The thoracic aorta supplies blood upper part body - head, neck, hands, organs chest. Abdominal aorta, respectively, lower - organs abdominal cavity and small pelvis, legs.

Atherosclerosis can affect both the entire aorta as a whole and its individual sections.

The development of atherosclerosis of the thoracic aorta begins earlier than others and, as a rule, the defeat of the thoracic region occurs simultaneously with the development of atherosclerosis of the coronary arteries of the heart and cerebral vessels.

A person may not feel any symptoms for a long time, but the very first and most obvious sign of the disease is strong pain in the chest. Also, with atherosclerosis of the thoracic aorta, blood pressure rises, the head is often dizzy, there is difficulty in swallowing, burning in the chest. Some patients (males) develop increased hair growth in the ears.

If you notice the manifestation of at least part of these symptoms, you should consult with a specialist and conduct an examination.

Atherosclerosis of the abdominal region may also not bring any problems for some time. Only over time, the main symptoms begin to appear - digestion is disturbed, abdominal pain appears, appetite decreases, and weight loss occurs. The pain most often appears after eating and is in the nature of seizures.

This form of atherosclerosis can cause the development of abdominal coronary disease(a disease of the digestive system that occurs due to impaired blood flow).

Complications of atherosclerosis of the abdominal aorta are arterial hypertension, kidney failure and thrombosis of the visceral arteries.

Diagnostics

Diagnostic procedures are prescribed by your doctor during the first consultation. Depending on the stage of the disease, diagnostics with Doppler ultrasound can be used.

It will help determine the level of blood supply to the affected area and the degree of atherosclerotic occlusion (impaired patency). X-ray angiography allows you to find out the exact level of arterial damage and see the area of ​​pathological changes.

X-ray angiography has contraindications for use and, if necessary, can be replaced by magnetic resonance contrast angiography or computed tomography. These types of studies are absolutely safe.

Treatment of atherosclerosis

First of all, treatment involves the complete elimination of risk factors that provoke the development of the disease. This helps to reduce the risk of complications and stabilize the patient's condition.

The approach to the treatment of obliterating atherosclerosis of the vessels of the lower extremities should be complex, individual and include not only medical procedures, but also lifestyle correction. The most important condition for starting treatment is smoking cessation. Only with the consent of the patient to a change in lifestyle can the effect of treatment be guaranteed.

Must be abandoned bad habits(smoking, alcohol), exclude fatty and cholesterol-rich foods, adhere to a balanced diet, choose an adequate physical activity.

Human organism - one system, and obliterating atherosclerosis can be both a cause and a consequence of various disorders occurring in it.

Medical treatment

An important role in this disease is given to drug treatment. It not only reduces the level of cholesterol in the blood, but is also a preventive measure - it prevents the occurrence of complications.

Medicines should be taken only after consulting with your doctor. Usually, drug treatment based on four groups of drugs.

• Medications with nicotinic acid reduce the level of cholesterol and triglycerin in the blood.
• Medications with fibrates reduce the synthesis of fats in the body.
• Medications with sequestrants of bile acids remove their excess from the body. This leads to lower fat and cholesterol levels.
• Statin drugs stabilize the production of cholesterol by the body itself.

Surgery

Surgical treatment is prescribed when the patient has a certain degree of damage to the walls of blood vessels, leading to impaired blood supply and a decrease in the quality of life.

Sometimes these lesions can only be repaired with surgery. This method of treatment is the most suitable in this case.

Specialists of the Soyuz clinic will select the type of surgical intervention that is right for you, depending on the degree of development of the disease and the individual characteristics of the organism.

A very effective method of surgical intervention is the expansion of the lumen of the vessels with a balloon. Simultaneously with the expansion, plaque removal and shunting (creating a new path for blood flow) occurs.

In advanced cases, angioplasty or vascular stenosis is used. Sometimes a special metal frame (stent) is installed in the artery, the presence of which ensures the normal functioning of the blood flow.

Any type of treatment - both medical and surgical - requires a serious approach and the implementation of all doctor's recommendations.

It is important to understand that no one is immune from the occurrence of a relapse, but the strict implementation of all recommendations and careful attention to your health will help you avoid many problems and stay healthy for many years.

The condition of bradycardia is usually called by cardiologists a certain type of disorder of the normal sinus rhythm, physiologically controlled by the pacemaker of the first order. This violation of the normal functioning of the heart can be characterized by a significant decrease in the frequency of myocardial contractions, when the pulse rate drops to 50 or even 30 beats per minute.

As a rule, the development of bradycardia may be due to a decrease in the automatic function of the so-called first-order pacemaker or sinus node.

Such disorders in the work of the heart can occur against the background of: sclerotic changes in the myocardium, when exposed to cold, a sharp increase in intracranial pressure, poisoning, hypothyroidism. And this is not a complete list of factors included in the concept of the cause of bradycardia.

In addition, a decrease in heart rate is often observed in well-trained, young people who are professionally involved in sports - and in this case, bradyarrhythmia is not a pathology at all, but is considered a variant of the norm!

Taking into account all of the above, many will probably want to understand: how does this rhythm disorder manifest itself, how to treat bradycardia and should it be done? Let's try to answer these questions in today's post.

• What signs allow you to independently recognize the disease?
• How is it diagnosed in medical institutions?
• Why does this disorder occur?
• First aid at home with the development of pathology
• When is a doctor indispensable?
• Hospital or home treatment options

What signs allow you to independently recognize the disease?

First of all, I would like to note that bradycardia, the symptoms of which we will consider, is not at all a final diagnosis or a specific pathology, rather, it is a certain diagnostic conclusion confirming a decrease in heart rate in a particular patient.

In other words, the state of bradycardia is a symptom that may indicate some changes (physiologically normal or pathological) occurring in the human body!

At the same time, the state of bradycardia, the symptoms of which are quite simple and understandable, can be easily recognized on your own, because the main indicator of the heart rate is the pulse, which is easily felt at home.

But, in addition, in order to independently determine the problem, it is necessary to know the normal indicators of the frequency of heart contractions in adults and children, and then remember the indicators of deviations characteristic of the state of bradyarrhythmia.

So, taken as the norm, the indicators of the frequency of heart contractions should correspond to the following figures:

• for children over one year old and up to ten or even twelve years old - the boundaries of normal heart rates are 70 to 130 beats per minute;
• children over ten, twelve years old, for adults, the normal pulse is sixty or one hundred beats in one minute;
• for professional athletes border normal pulse can range from forty to sixty beats per minute.

If the heart rate drops significantly, the pulse rates are below the generally accepted norms (for these groups of patients), doctors fix an attack of bradyarrhythmia.

Moderate rhythm disturbances of this type often do not cause any subjective discomfort in patients - then doctors can record physiological bradyarrhythmia associated with fatigue, hypothermia that occurs during sleep.

But, sometimes an attack of slowing the pulse manifests itself too clearly (pulse indicators fall below forty beats per minute), supplemented by other pathological symptoms:

In such situations, doctors talk about the development of an attack of a pathological rhythm disorder, possibly associated with the most serious heart (or other) pathology in the body. In order to understand whether treatment for bradycardia is required and what it should be, it is important to be able to clearly diagnose the problem, which can only be done in a medical institution.

How is it diagnosed in medical institutions?

Pathological bradyarrhythmia is recognized taking into account the patient's complaints (outlining the symptoms described above), collecting an anamnesis, conducting a standard electrocardiogram. On electrocardiogram records, an attack of bradyarrhythmia manifests itself as follows:

• there is a clear reduction in the frequency of heart contractions, less than age norms, usually less than forty beats per minute;
• sinus rhythm is maintained, as evidenced by the presence of P waves in front of all QRS complexes;
• sinus rhythm remains correct, which is manifested by the preservation of RR intervals or their difference of less than ten percent;

In addition, sinus bradyarrhythmia of extracardiac etiology is characterized by a rapid increase in the frequency of heart contractions during elementary physical exertion or when a dose of atropine is administered. An attack of such a bradyarrhythmia can be considered a variant of sinus respiratory arrhythmia.

An attack of organic sinus bradyarrhythmia (in the intracardiac form) is in no way associated with respiratory arrhythmia - when using atropine, the reduced heart rate does not change, physical activity can very slightly increase the frequency of contractions of the heart muscle.

Why does this disorder occur?

The causal factors that cause a reduction in heart rate are incredibly varied. The problem can be caused by:

In addition, as we have already noted, a decrease in the heart rate is often observed in trained professional athletes, which, in the absence of other pathology, is considered a variant of the norm.

First aid at home with the development of pathology

When an attack of bradyarrhythmia occurs, when a person notes certain unpleasant symptoms described above, it is initially recommended to sit down and try to count the pulse.

If the heart rate indicators differ slightly from the norm (the average adult's pulse is at least 50 beats per minute), you can try to help cope with the attack as follows:

• drink a cup of warm sweet tea or coffee, you can add a few drops of ginseng or belladonna tincture to the drink;
• if possible, warm up, it is possible to make a warm foot bath;
• in a relatively normal state of health, do some physical exercises.

But, if an attack of bradyarrhythmia is accompanied by severe dizziness, fainting or impaired consciousness, the first aid to the patient should be somewhat different. In such a situation, it is important:

• lay the patient down and try to warm him;
• be sure to call an ambulance;
• with disorders of consciousness, give the patient a sniff of ammonia.

Attention important! An attack of bradyarrhythmia, in some cases, can be extremely dangerous, the development of heart failure or sudden stop hearts.

That is why self-treatment of bradycardia is categorically unacceptable! When providing first aid to a patient, it is unacceptable to use any medications, since this can lead to the most serious side effects, the development of exacerbations of the pathology that caused the decrease heart rate.

When is a doctor indispensable?

It is generally accepted that minor cardiac arrhythmias do not pose a direct danger to the patient's life. But, if attacks of a moderate decrease in the frequency of contractions of the heart muscle occur with a certain frequency, you should definitely seek advice from a cardiologist, in the near future. free time. Leaving such phenomena unacceptable is unacceptable.

At the same time, there are situations when, with the development of bradyarrhythmia, the help of doctors is urgently needed. So, urgently call an ambulance in the following situations:

It should be noted that in such situations, the patient needs the help of doctors urgently, we can say that these are situations when the time count (for which a person can be saved) is literally minutes!

Hospital or home treatment options

The choice of tactics for the treatment of bradycardia always depends on the type of pathology, the reasons for the development of a decrease in the rhythm. Sometimes given state, in principle, may not require treatment.

However, if the reduction in heart rate is associated with cardiac causes, it is extremely important to identify these causes and begin treatment of the underlying disease.

If the state of slowing the heart rate is associated with some hemodynamic disorders, doctors can prescribe belladonna preparations, tincture of ginseng root, sometimes eleutherococcus extract, ephedrine, caffeine and other restorative agents to the patient. The dosage is always selected strictly individually.

If bradyarrhythmia is accompanied by signs of a violation of the correct sinus rhythm, angina pectoris, changes in blood pressure, manifestations of heart failure, conservative treatment may include:

• the appointment of drugs of the group of antiarrhythmic drugs;
• taking medications from the group of beta-blockers or calcium channel blockers;
• the use of drugs that correct pressure indicators or other drugs.

It cannot be said that in complex conditions, the treatment of the pathology in question can be operational. For example, the development of the Morgagni-Adams-Stokes syndrome against the background of primary pathological bradyarrhythmia requires an urgent solution to issues related to the implantation of a pacemaker in a patient.

Sometimes the complex treatment of the disease in question can be supplemented by the use of folk recipes. Among the most popular folk recipes to help cope with bradycardia, doctors call the following:

It is important to say that any treatment for heart rhythm disorders should always be agreed with the doctor, and drug therapy, in principle, cannot be assigned independently!

Clinics in Moscow and St. Petersburg, which carry out a full-fledged complex therapy in the state of bradyarrhythmia, will be presented in the table below.

In conclusion, it should be noted that the state of bradycardia, unfortunately, can be completely unpredictable. Sometimes this problem goes unnoticed by the patient, without requiring specific treatment.

But, sometimes the problem can be complicated by the most serious and life-threatening conditions, up to cardiac arrest and death.

That is why most practicing doctors do not get tired of repeating - the detection of signs of bradyarrhythmia is a reason to visit a cardiologist. Self-reliance in the treatment of any heart rhythm disorders (including bradyarrhythmia) is categorically unacceptable!

• Do you often experience discomfort in the area of ​​the heart (pain, tingling, squeezing)?
• You may suddenly feel weak and tired...
• Feeling high pressure all the time...
• There is nothing to say about shortness of breath after the slightest physical exertion ...
• And you have been taking a bunch of medications for a long time, dieting and watching your weight ...

Atherosclerosis of the vessels of the legs: occurrence, treatment, prognosis

Atherosclerosis of the vessels of the lower extremities is one of the most serious and most dangerous diseases leg arteries. It is characterized by the fact that due to blockage of blood vessels by atherosclerotic plaques or blood clots, there is a partial or complete cessation of blood flow in the lower extremities.

With atherosclerosis, there is a narrowing (stenosis) or complete overlap (occlusion) of the lumen of the vessels that supply blood to the lower extremities, which prevents the normal flow of blood to the tissues. With arterial stenosis of more than 70%, the speed indicators and the nature of blood flow change significantly, there is insufficient blood supply to cells and tissues with oxygen and nutrients, and they cease to function normally.

Damage to the arteries leads to pain in the legs. In case of progression of the disease, as well as with insufficient or incorrect treatment, trophic ulcers or even necrosis of the limbs (gangrene) may appear. Fortunately, this rarely happens.

Obliterating atherosclerosis of the arteries of the lower extremities is a very common disease of the blood vessels of the legs. The largest number of cases is detected in the age group over 60 years - 5-7%, at the age of 50-60 years - 2-3%, 40-50 years - 1%. But atherosclerosis can also be diagnosed in younger people - in 0.3%, people aged 30–40 years get sick with it. It is noteworthy that men suffer from atherosclerosis 8 times more often than women.

Fact: Smoking men over 50 years of age are at the greatest risk of getting atherosclerosis obliterans.

The main causes of atherosclerosis

The main cause of atherosclerosis is smoking. The nicotine contained in tobacco causes the arteries to spasm, thereby preventing blood from moving through the vessels and increasing the risk of blood clots in them.

Additional factors that provoke atherosclerosis of the arteries of the lower extremities and lead to an earlier onset and severe course of the disease:

• elevated cholesterol levels with frequent consumption of foods rich in animal fats;
• high blood pressure;
• excess weight;
• hereditary predisposition;
• diabetes;
• lack of sufficient physical activity;
• frequent stress.

Symptoms of atherosclerosis of the vessels of the legs

The main symptom to look out for is leg pain. Most often, pain occurs when walking in the calf muscles and thigh muscles. When moving, the muscles of the lower extremities increase the need for arterial blood, which delivers oxygen to the tissues. Narrowed arteries during physical exertion cannot fully satisfy the need of tissues for arterial blood, which is why oxygen starvation begins in them, and it manifests itself in the form of intense pain. At the beginning of the disease, the pain disappears quickly enough when physical activity is stopped, but then returns again when moving. There is a so-called intermittent claudication syndrome, which is one of the main clinical signs of obliterating atherosclerosis of the arteries of the lower extremities. Pain in the muscles of the thighs is called high intermittent claudication pain, and pain in the calves of the legs is called low intermittent claudication pain.

In old age, such pains are easily confused with painful sensations in joints inherent in arthrosis and other joint diseases. Arthrosis is characterized not by muscle, but by joint pains, which are most intense at the beginning of the movement, and then somewhat weaken when the patient “paces around”.

In addition to pain in the muscles of the legs while walking, obliterating atherosclerosis of the arteries of the lower extremities can cause the following symptoms in patients (one of them or several at once):

1. Chilliness and numbness in the feet, aggravated by climbing stairs, walking, or other exertion.
2. Temperature differences between the lower extremities (a leg affected by atherosclerosis of the vessels is usually slightly cooler than a healthy one).
3. Pain in the leg in the absence of physical activity.
4. Non-healing wounds or sores appear in the area of ​​the foot or lower third of the leg.
5. Darkened areas form on the toes and feet.
6. Another symptom of atherosclerosis may be the disappearance of the pulse on the arteries of the lower extremities - behind the inner ankle, in the popliteal fossa, on the thigh.

Stages of the disease

According to the existing classification of arterial insufficiency of the vessels of the legs, the above symptoms can be divided into 4 stages of the development of the disease.

• Stage I - pain in the legs that appear only after a lot of physical activity, such as walking long distances.
• Stage IIa - pain when walking over relatively short distances (250-1000 m).
• Stage IIb - the distance of painless walking is reduced to 50–250 m.
• Stage III (critical ischemia) - pain in the legs appears when walking at a distance of less than 50 m. At this stage, pain in the muscles of the lower extremities can begin even if the patient is at rest, this is especially evident at night. To relieve pain, patients usually lower their legs from the bed.
• IV stage - at this stage, the occurrence of trophic ulcers. As a rule, areas of blackening of the skin (necrosis) appear on the fingers or heel areas. In the future, this can lead to gangrene.

In order not to bring obliterating atherosclerosis to an extreme stage, it is important to diagnose it in time and treat it in a medical institution.

Treatment of atherosclerosis of arteries of the lower extremities

This disease requires an individually designed treatment regimen for each individual patient. Treatment of atherosclerosis of the vessels of the lower extremities depends on the stage of the disease, its duration, the level of damage to the blood arteries. In addition, when diagnosing and compiling a clinical picture, the presence of concomitant diseases in the patient is also taken into account.

If obliterating atherosclerosis is detected at the initial stage, it may be sufficient to improve the condition by eliminating risk factors. In this case, help:

1. Compulsory cessation of smoking and other bad habits.
2. Compliance with a diet low in animal fats and lowering cholesterol levels in the blood.
3. With excessive fullness or obesity - weight correction.
4. Maintaining normal blood pressure at a level not exceeding 140/90 mm Hg. Art.
5. Regular physical activity (walking, swimming pool, exercise bike, etc.).
6. For patients with diabetes - control of blood sugar levels.

With vascular atherosclerosis, the use of the following products is strictly prohibited: butter, margarine, lard, margarine, fatty meat, sausages, pates, offal, high-fat dairy products, fried potatoes, ice cream, mayonnaise, flour buns.

Important: A sedentary lifestyle makes blood vessels less elastic and accelerates the progression of the disease.

At other stages, the following methods are used to treat atherosclerosis of the vessels of the lower extremities:

• Conservative;
• Endovascular (minimally invasive);
• Operational.

Conservative treatment

It can also be used at the initial stage of the disease, as well as in cases where the patient's condition does not allow the use of other methods (with complications due to concomitant pathology). Conservative treatment involves the use of medications, physiotherapy and includes pneumopressure therapy, dosed walking and exercise therapy.

Unfortunately, there are no medications that completely restore normal blood circulation in a clogged artery and cure atherosclerosis. Drug treatment can only give support and affect the small vessels through which blood flows around the blocked section of the artery. Drug treatment aims to widen these "detours" and compensate for poor blood circulation.

To relieve spasm from small arterial vessels, thin the blood and protect the walls of arteries from further damage, special medical preparations, some of which need to be drunk in courses, while others should be taken constantly.

In addition to medicines, patients are prescribed pneumopress therapy - massage of the soft tissues of the leg with the help of special equipment. By alternating between low and high blood pressure in the cuff worn on the limb, the peripheral arteries expand, the blood flow to the skin, muscles and subcutaneous tissue increases, and the vessels are stimulated.

Endovascular treatment

The most common methods of treatment for atherosclerosis of the vessels of the legs are endovascular methods - arterial stenting, balloon dilatation, angioplasty. They allow you to restore the normal circulation of blood through the vessel without surgical intervention.

Such procedures are carried out in the X-ray operating room, on special equipment. At the end, a pressure bandage is applied to the patient's leg, and he must remain in bed for 12-18 hours.

Surgery

If the clogged arteries in the legs are too long for endovascular methods, one of the following types of surgery is used to restore blood circulation in the legs:

1. Prosthetics of an artery section with an artificial vessel (alloprosthesis);
2. Shunting is the restoration of blood flow by redirecting the movement of blood through an artificial vessel (shunt). A segment of the saphenous vein of the patient himself can be used as a shunt;
3. Thrombendarterectomy is the removal of an atherosclerotic plaque from an affected artery.

Surgical methods can be combined or supplemented with other types of operations. If the operation is performed at the IV stage of the disease, when dead zones have already appeared, these areas are surgically removed and the trophic ulcers are closed with a skin flap.

If obliterating atherosclerosis has passed into the extreme stage, when the patient has developed gangrene of the lower extremities, and it is no longer possible to restore blood flow, amputation of the leg is performed. Sometimes this becomes the only way to save the patient's life.

How to avoid the disease?

Prevention of atherosclerosis includes primarily:

• To give up smoking.
• Proper nutrition, cholesterol-free diet.
• Physical exercise.

These are three whales that will reduce the risk of atherosclerosis of the vessels of the lower extremities. It is not necessary to exhaust yourself with physical exercises, you can just do it daily. hiking and do leg exercises. In addition, as a prophylactic, a special acupressure and traditional medicine recipes.

Read more about the comprehensive prevention of atherosclerosis here.

Video: atherosclerosis of the vessels of the legs, presentation

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Hello. Today we will talk about such a disease as obliterating atherosclerosis of the vessels of the lower extremities. It is also called atherosclerosis of the legs, blockage of blood vessels, obstruction of the vessels of the lower extremities, etc.

Why about him? But because my blog ended with a poll "What articles would you like to see on my blog?". The theme " Vascular diseases lower limbs." And since a large number of people suffer from obliterating atherosclerosis of the lower extremities, I chose this topic.

I will talk about atherosclerosis of the lower extremities only what I know myself, what patients say. Just pure practice and my experience.

We will discuss only issues related to the conservative treatment of obliterating atherosclerosis of the vessels of the lower extremities. Many people know what atherosclerosis is. There is a lot of information on this topic on the Internet. Anyone who is interested can find everything on this topic.

If atherosclerotic plaques form in the lumen of the vessels of the lower extremities and lead to impaired blood supply to the legs due to stenosis (narrowing), occlusion (blockage) of the arteries, then this disease is called atherosclerosis obliterans.

The process itself is localized most often in large vessels (aorta, iliac arteries) or medium-sized arteries (femoral, popliteal).

Men suffer from this disease most often, starting from the age of 40 (although I have also met younger patients). But the main contingent is people of pension and old age, aged 55 and over. As a rule, their atherosclerosis affects not only the vessels of the legs, but also the brain, heart, kidneys, etc.

In principle, the entire clinical picture of the disease depends on how much the atherosclerotic plaque narrows the lumen of the vessel and what trophic changes appear on the lower extremities as a result of this, how their function is impaired.

In some cases, the plaque completely blocks the lumen of the vessel and the blood does not flow through it.

How is it, you ask, if the blood does not flow to the legs, then gangrene should develop? Yes, some people develop it and others don't.

Why? But because the second person has a highly developed collateral circulation, while the first one does not. But we'll talk about this a little later.

For several years, obliterating atherosclerosis of the vessels of the lower extremities may be asymptomatic. But sometimes, with the appearance of the first symptoms, it begins to progress rapidly.

What complaints are most often made by a person with this pathology? This:

- increased chilliness, usually fingers and feet. People say that even in the heat or in a warm room they wear felt boots or woolen socks;

- there is a feeling of numbness in the feet;

- at rest, pain in the legs usually does not bother. Pain (often in the calf muscles) appears when walking and stops after a short rest. This is the so-called "intermittent claudication". Depending on the stage of the disease, pain when walking occurs after 10-20-50-100-300 meters or more. In advanced cases, the pain is constant.

What is it connected with? But with what: normally, a healthy artery has a certain diameter and the amount of blood passing through it is enough to nourish the tissues of the lower extremities. The artery affected by atherosclerosis has a smaller diameter and during exercise (walking) is not able to provide tissues with oxygen, which is manifested by pain in the muscles. A person at this moment has to get up and stand.

At this time, the “old”, oxygen-poor blood “leaves” and “fresh” blood “comes in” in its place - the pain disappears and the person moves on. But after a certain number of meters (everyone is different), the pain in the legs appears again, and this whole process begins again and again;

- with damage to the aorta and iliac arteries (the so-called Leriche's syndrome), pain occurs in the gluteal muscles, and thighs, and the lumbar region;

- the skin of the lower extremities becomes pale, dry, the hair on the legs falls out, the growth of nails is disturbed. In a severe form of the disease, on the contrary, you can see when a person sits with his legs down, the foot and fingers become red. But as soon as the legs are given a horizontal position, the skin becomes pale, almost white. Sometimes such people even sleep sitting up and it is clear why. Since in this position - legs below - more blood flows into the lower limbs than if the person was lying down;

- when examined in patients with obliterating atherosclerosis of the lower extremities, malnutrition, and even muscle atrophy (usually shins) is noted. A person notices that the leg began to lose weight, the amount of muscle tissue decreases. And the reason is still the same - insufficient blood supply (with nutrients and oxygen) to the tissues of the lower extremities;

— common symptom atherosclerosis in the aortoiliac segment is impotence, because the blood supply in the system of internal iliac arteries is disturbed. This symptom occurs in 50% of patients.

Obliteration (narrowing and occlusion) of the vessels of the lower extremities does not occur immediately, but gradually, and the body has time to partially adapt to new conditions. This is manifested by the development of collateral circulation, i.e. blood "looks" for workarounds. And she finds them in the form of small arterial trunks, which, as it were, “bypass” the affected area of ​​the artery, i.e. the body forms a kind of shunt.

So what causes gangrene?

According to my observations, this happens when:

- part of the atherosclerotic plaque is torn off and this plaque clogs the underlying vessels with blood flow,

- there are always thrombotic masses on the plaque itself, the separation of which also clogs the vessels, and all this happens suddenly and the person may need an emergency operation,

- and finally, the slower development of gangrene, this is when the collateral circulation is so weak that there is no effect from it, and trophic changes rapidly increase, turning into gangrene.

Young people. after the examination by a vascular surgeon, of course, it is desirable to carry out surgical treatment.

And there are many types of surgery. This is both laser removal of atherosclerotic plaques and balloon expansion. stenotic vessel, and prosthesis of the entire area of ​​the affected vessel (remove part of the artery and sew an artificial (or from the patient’s vein) vascular prosthesis in its place), and shunting (the place of obliteration is “bypassed” with a vascular prosthesis) (see figure).

The main problem is that a large number of patients are people 65-90 years old, with a bunch of concomitant diseases, for whom surgical treatment is simply contraindicated. Well, except perhaps only the amputation of the lower limb with gangrene for health reasons.

Why amputation is performed at the level of the thigh for the bulk of sick people with gangrene?

Previously, in our conditions, we performed up to 30-40 amputations per year. Some have been amputated at the level of the lower leg. This did not give any effect, and the leg continued to rot further, only on the lower leg. We amputated a little higher - the effect is the same - the gangrene did not stop and we amputated the limb at the level of the thigh. Only then did the process stop. Apparently, this happens because there is not enough good blood supply to the lower leg, the vascular network is not developed, there is no good collateral circulation.

Most patients should be treated conservatively twice a year.

What are the main principles of such treatment of patients with obliterating atherosclerosis of the vessels of the lower extremities?

1 Considering that atherosclerosis is plaques, and plaques are cholesterol, drugs that lower blood cholesterol levels are used:

- statins - block the formation of cholesterol in the liver. These include: simvastatin, lovastatin, pravastatin and others.

- fibrates - increase the amount of high-density lipoproteins and reduce total cholesterol. They should be taken with great caution after consulting a cardiologist. These are drugs such as bezafibrate, clofibrate, gemfibrozil, fenofibrate.

- derivatives of nicotinic acid - strongly expand blood vessels so use with caution. The drug enduracin is side effects practically does not have.

Other drugs such as colestipol, probucol, guarem, lipostabil, benzaflavin, and eikonol help lower cholesterol levels. They block the formation of atherosclerotic plaques.

2. Drugs that improve rheological properties blood: various heparins, warfarin, small doses of aspirin, clopidogrel, etc.

3. Medicines aimed at improving microcirculation and the development of collaterals. These are pentoxifylline, trental, chimes, etc.

4. Physiotherapy treatment:

– ozone therapy

- barotherapy for the lower extremities

- SMT on the lumbar region (ganglia)

- magnetotherapy.

And now I will briefly show the treatment regimens that I carry out for patients with atherosclerosis of the lower extremities on an outpatient and inpatient basis.

Ambulatory treatment:

- Trental or Pentoxifylline 400 mg 2 times a day for a month

- Cardiomagnyl 75 mg 1 time per day in the evening after dinner (permanent intake is possible)

- Wessel Due 1 t - 2 times a day

- Actovegin 0.2 - 2 times a day

– Nikoshpan 1t – 2 times a day

- Vitamin E - 2 capsules - 2 times a day.

With local erosions on the skin, Curiosin powder can be used. When cleansing the wound, Actovegin or Solcoseryl ointment can be applied to clean granulations.

In terms of examination, in addition to general clinical tests, it is imperative to take biochemical analysis blood lipids and their fractions.

Undergo an ultrasound scan of the vessels of the lower extremities to determine the stage, degree and level of arterial damage.

Hospital treatment includes:

- infusion intravenous therapy: alternate - Reopoliglyuki 400.0 + Novocain 0.25% -100.0 - 1 day, 2nd day - Trental (or Pntoxifylline) 5.0 + Phys. solution 0.9% -250.0; Potassium chloride 4% -20.0, Analgin 50% -2.0, Diphenhydramine 1% -1.0, Riboxin 10.0, Ascorbic acid 5% -2.0, Magnesium sulfate 25% -3.0. The course of infusion therapy is 20 days.

– Papaverine 2% -2.0 + A nicotinic acid 2.0 intramuscularly for 10 days.

- Actovegin 2.0 intramuscularly at night for 10 days.

- you can take (better with diabetic angiopathy) Sulodexide 250 LRU 2 times a day for 30-40 days between meals.

Courses conservative therapy should be carried out 2 times a year, preferably in spring and autumn.

Be sure to read my blog post HERE in addition to this.

To be honest, obliterating atherosclerosis of the vessels of the lower extremities is an incurable disease, but if you follow the above methods of conservative treatment, you can significantly improve your quality of life and avoid such a formidable complication of atherosclerosis of the lower extremities as gangrene.

Health to all. A. S. Podlipaev

Recommendations are given for reference purposes only and are preliminary-informative in nature. As a result of the recommendation received, please consult a doctor, including to identify possible contraindications! Acceptance of recommended medicines is possible ONLY IF THEIR IS GOOD TOLERABLE TO PATIENTS, TAKING INTO ACCOUNT THEIR SIDE EFFECTS AND CONTRAINDICATIONS!

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If atherosclerosis of the arteries of the lower extremities is suspected, the following studies are carried out: Non-invasive studies - do not cause discomfort to the patient during the study, and can be performed on an outpatient basis.

1. The study of the pulse is the primary assessment of blood circulation in the lower extremities, when determining normal pulsation by a vascular surgeon, the presence of significant atherosclerotic changes in the arteries of the lower extremities is unlikely.
2. Arterial blood pressure - after measuring blood pressure in the arms and legs using ultrasound Doppler (a device for determining blood flow), the obtained numbers are compared and a general conclusion is made about the presence of arterial blood flow disorders in the lower extremities
3. Duplex (triplex) scanning of the arteries - ultrasound vascular examination allows you to detect narrowing or blockage of the artery, to measure the diameter of the vessel. Gives information about the condition of the saphenous vein of the leg, to resolve the issue of using the saphenous vein as a bypass (shunt) to bypass the clogged section of the artery.
4. Computed angiography CT angiography is a study performed on a spiral computed tomograph with simultaneous injection of contrast into the saphenous vein of the arm, providing information on the presence and extent of narrowing, blockage, and dilation of the arteries. Invasive study - the study is carried out by injecting contrast into the arteries under x-ray control.
5. Angiography/Angiogram is the most valuable study in patients with atherosclerosis of the arteries of the lower extremities who, according to the preliminary examination and examination, are indicated and planned for surgical treatment. The contrast is injected into the artery and a special x-ray shows the exact location of the blockage or narrowing of the artery and the condition of the arteries above and below the affected area. Angiography is necessary when there is a question about endovascular intervention or surgical treatment of atherosclerosis of the arteries of the lower extremities.

Treatment of atherosclerosis of arteries of the lower extremities

The complex of treatment is aimed at stopping pain, lameness and other symptoms in the lower extremities caused by narrowing or blockage of the arteries of the lower extremities by an atherosclerotic plaque. Atherosclerosis today cannot be completely cured or prevented, but the progression of the disease can be halted by reducing the risk factors for the disease. This requires a change in the patient's lifestyle.

Smoking: It is necessary to give up any form of tobacco. Long-term cigarette smoking is the most unfavorable risk factor causing the progression of atherosclerosis of the arteries of the lower extremities. The nicotine in tobacco causes the arteries to constrict, preventing blood from reaching organs and tissues and increasing the risk of atherosclerosis. In addition, smoking reduces the amount of oxygen in the blood, and can cause blood to thicken and increase the risk of blood clots (clots) forming inside blood vessels.

High blood pressure: High and uncontrolled blood pressure (hypertension) forces the heart to work harder and puts extra stress on the arteries. Blood pressure should be measured regularly by the patient, as often hypertension occurs without obvious signs. If you have hypertension, you must follow the treatment prescribed by your doctor, even if you feel well.

Diet: The risk of atherosclerosis can be reduced by following a diet and carefully monitoring your blood cholesterol levels. Foods with high content cholesterol (fatty meats, cheese, egg yolk). Need to eat fat plant origin, vegetable oil. A salt-restricted diet is needed to reduce blood pressure and edema. If you are overweight, a total weight loss diet is essential. It is necessary to control the level of cholesterol in the blood serum. If cholesterol remains high while following the diet, then cholesterol-lowering treatment is prescribed. Training walking - is important in the treatment of patients with lameness. Often, patients, fearing pain when walking, restrict themselves in their movements and switch to a sedentary (sedentary) lifestyle. It has now been proven in international studies that training walking up to 45-60 minutes per day in patients with atherosclerosis of the arteries of the lower extremities leads to the development of roundabout (collateral) circulation and an increase in the distance without pain walking.

Diabetes: the presence of diabetes contributes to the early development of atherosclerosis and its rapid progression. It is important to control blood sugar and treat diabetes in patients with atherosclerosis of the arteries of the lower extremities. Foot care: if blood circulation in the lower extremities is disturbed, serious complications (infection, poor healing, trophic ulcers, gangrene) can occur with any minor injury (wound) of the leg. ). Feet should be checked daily. Seek medical attention immediately if you notice any lesions or sores on the skin of your foot.

Pharmacological therapy: In addition to your doctor's other advice, the following drugs may be prescribed:

• Antiplatelet agents - these drugs reduce the risk of heart attacks (angina pectoris, myocardial infarction) or strokes and transient brain disorders associated with atherosclerosis of the arteries. They can also increase pain-free walking distance (distance walked without stopping) by increasing blood flow to organs and tissues: Aspirin - One aspirin tablet at a dose of 75-325 mg daily. Clopidogrel (Plavix®) 75 mg, a more modern antiplatelet agent. International studies are currently underway to determine the effectiveness and benefits of this drug.
• Anticoagulants - these drugs prevent blood clotting and the formation of blood clots: Warfarin (Coumadin ®) - a drug in tablets, its administration requires monitoring of the blood INR analysis Clexane, fraxiparin, fragmin, heparin - anticoagulants in injections, as a rule, treatment with these drugs is carried out in conjunction with warfarin and ends when the therapeutic effect of warfarin is achieved Drugs that improve blood circulation in the arteries of the lower extremities: Pentoxifylline, Trental 400 1 tab x3 times a day (1200 mg per day), at least a month

Surgery

Surgical treatment for atherosclerosis of the arteries of the lower extremities is used in cases where the ongoing conservative treatment is not effective and (or) there are signs of disease progression that limit the patient's lifestyle.

The main task, before surgical treatment, is to determine the exact localization of the site of narrowing (stenosis), or blockage (occlusion) of the artery. For this, ultrasound duplex scanning and (or) computed angiography of the arteries of the lower extremities is used. Angiography (angiogram) is an obligatory study in patients who are planned for surgical treatment. The study is performed under local anesthesia. Through a puncture in the groin, a special catheter is inserted into the femoral artery. A contrast (dye) is injected through the catheter. During the injection of contrast, a special X-ray examination is performed. Angiography complements the information obtained earlier and allows you to see the extent of the narrowing or blockage of the artery, and assess the condition of the arteries above and below the affected area of ​​the vessel.

After determining the location and extent of the blockage or stenosis of the artery, two methods of treatment can be used: angioplasty (endovascular treatment) or surgery (open surgery).

Angioplasty- a procedure that can be performed during angiography. To perform angioplasty, a special balloon is used to expand the narrowed section of the artery. Through a puncture in the groin, the balloon is inserted into the lumen of the artery and is located at the level of the narrowing of the artery. The balloon is inflated, which causes the artery to expand at the site of narrowing. In order for the dilated vessel not to narrow again, a special device, a stent (framework), is brought and installed in the area of ​​the artery where angioplasty was performed. The stay of the patient in the clinic after angioplasty is usually within a day.

If the patient has a pronounced lesion of arteries by atherosclerosis, and it is not possible to perform angioplasty. open surgery is required. Bypass surgery is used to restore blood flow. During the operation, a suitable section of the artery is found above and below the site of blockage (occlusion). And between these two sections of the artery, a shunt is sewn (bypass). Bypass surgery uses the patient's own saphenous vein or a synthetic prosthesis as a bypass. The duration of the operation can take from 2 to 5 hours. The patient's stay in the clinic is 3-7 days after the operation. In 10% of cases during surgery, the patient needs a blood transfusion.

Angioplasty and open surgery- safe procedures good results. Factors that may reduce the success of each procedure include: - the number and severity of blockage and narrowing of the arteries, - the general health of the patient Strict monitoring of risk factors for atherosclerosis of the arteries of the lower extremities after the intervention is required. The most significant risk factor that affects early deterioration. result of smoking treatment. Therefore, a lifelong cessation of smoking is essential.

Conclusion

Atherosclerosis of the arteries of the lower extremities can be manifested by slight intermittent claudication. With the progression of the disease and the absence of the necessary treatment, the development of extensive gangrene and loss of the lower limb (amputation) is possible. The rate of disease progression depends on the number and severity of atherosclerosis risk factors (smoking, diabetes, hypertension, obesity, etc.) Timely treatment, quality medical care, smoking cessation, blood pressure control and correction, daily exercise, timely angioplasty or surgery can significantly reduce the symptoms of the disease, save the leg and improve the quality of life and prognosis in patients with atherosclerosis of the arteries of the lower extremities.

Treatment of atherosclerosis of the lower extremities

There are many diseases that lead to disability, and in the worst case, to death. One of the highest positions in this list is occupied by obliterating atherosclerosis of the lower extremities. Most often this disease occurs in the elderly and almost always in men.

This is a disease that affects large and medium-sized arteries in the legs. They can no longer properly supply the lower extremities with blood, as its circulation is hindered by vasoconstriction and blockage by plaques and blood clots. It appears due to cholesterol and fat on the walls of blood vessels. The viability of tissues is impaired, which leads to problems with movement, the appearance of ulcers and necrosis.

If you do not start treatment of atherosclerosis of the lower extremities at least at this stage, then there is a high chance of developing gangrene and then the leg will have to be amputated.

Causes of atherosclerosis of the lower extremities

Among the main causes of atherosclerosis is an unhealthy lifestyle. They lead to it:

• smoking;
• too fatty food;
• lack of physical activity;
• obesity.

It can also be called:

• diabetes;
• frostbite;
• heredity;
• metabolic disorders, including cholesterol;
• hypertension;
• infections affecting the kidneys.

All these reasons make obliterating atherosclerosis of the lower extremities truly the scourge of our century, which, along with varicose veins, affects our legs.

Symptoms of atherosclerosis of the vessels of the lower extremities

During the first months, the disease often proceeds without obvious signs and does not cause any special problems. However, as soon as it enters a more severe phase, numerous symptoms appear that progress rapidly. Among them:

• lameness;
• pain in the legs when walking, as well as their rapid fatigue;
• pain in the legs at rest;
• foot numbness;
• temperature changes - the legs are "chill", colder to the touch than healthy limbs;
• the appearance of wounds and sores that do not heal;
• darkening of the toes and skin of the feet (they become purple-bluish in color), the development of necrotic changes on them;
• hair loss in the area of ​​the affected arteries.

It is very important at the first signs of the disease to consult a doctor for diagnosis, because it is one of those that can be fully cured only in the early stages. In the complicated form, modern methods of treatment are much less effective and often only manage to stop the symptoms, which return again after a while.

Diagnosis of atherosclerosis of the lower extremities

In our clinic, the treatment of any disease, including obliterating atherosclerosis, begins with a comprehensive diagnosis. This approach allows us to find out all the nuances, put accurate diagnosis and not to miss the moments that can play a major role in the further healing of the patient.

In this case, our doctors can give an initial conclusion after examining the patient, especially when we are talking already about a rather acute stage with visible differences between the diseased and healthy limbs. Further diagnostics include:

• tomography;
• listening to noises and pulsations of the arteries;
• Vascular ultrasound;
• angiography - the diagnosis of blood vessels using a contrast agent.

And, if necessary, other studies.

With the help of this, we not only establish the presence or absence of signs of atherosclerosis of the lower extremities, but also find its causes, places of blockage, and determine the severity of the disease. That's the only way you can choose effective methods treatment.

Treatment of atherosclerosis of the vessels of the lower extremities

As well as diagnostics, we also approach the treatment of atherosclerosis of the lower extremities, that is, in a complex way. In our blade, we believe that dealing with symptoms is pointless unless the cause is addressed.

In the initial stages of the disease, it is enough to cure the source of the disease and take preventive measures- reduce weight, monitor sugar and pressure, give up bad habits, go on a diet. Also, doctors of our clinic can prescribe drugs that improve blood circulation and vascular patency, relieve spasms.

In our clinic clinical researches cell transplantation bone marrow for obliterating diseases of the lower extremities have been carried out since 2002. When using unfractionated MNCs, instrumental indicators (perfusion index, transcutaneous oxygen pressure) allow registering a decrease in ischemia to varying degrees in all patients. In 50-82% of cases, the growth of collateral vessels was noted according to angiography. Improvement of subjective symptoms was noted by more than 85% of patients. At the same time, transplantation of bone marrow MNCs made it possible to avoid limb amputation in 90% of patients with a critical degree of ischemia.

Legs are an opportunity to walk that none of us are ready to give up. Unfortunately, sometimes they do not want to cooperate with us, one of the reasons for which is obliterating atherosclerosis of the lower extremities. This is a serious disease, dangerous, but not invincible.

In our clinic, highly qualified doctors with extensive experience in diagnosing and treating vascular diseases will do everything to restore the functioning of your arteries as much as possible and slow down the further development of the disease. The sooner you come to us, the greater the chance that it will recede forever.

Chronic obliterating diseases of the lower extremities account for more than 20% of all types of cardiovascular pathology, which corresponds to 2-3% of the population. They are characterized by a steady progressive course, an increase in limb ischemia and a pronounced pain syndrome. Despite the use modern methods conservative and surgical treatment, critical degrees of ischemia with limb gangrene develop in 15-20% of patients.

In numerous experimental studies It has been shown that the implantation of bone marrow mononuclear cells (MNCs) into the ischemic area can cause the formation of new vessels (angio- and vasculogenesis) as well as an increase in blood flow through existing collaterals. At the same time, both hematopoietic stem cells and progenitor cells and stromal cells of the bone marrow have angiogenic properties. The ability of stem hematopoietic and mesenchymal cells of the bone marrow to transdifferentiate into endotheliocytes, myocytes, and pericytes, directly participating in the formation of new vessels, has been demonstrated. In addition, in the area of ​​ischemia, bone marrow MNCs produce a complex of cytokines necessary for the formation and growth of blood vessels from local tissues.

In experiments on rodents with ligation of the femoral artery, implantation of bone marrow MNCs into the gastrocnemius muscle resulted in an increase in the number of capillaries by 50 percent or more, increased blood flow, and increased exercise tolerance. In experiments on large animals, after the introduction of bone marrow MNCs, an increase in capillary density by 2.5-3 times was noted, as well as remodeling of collateral vessels with a 5-fold increase in blood flow velocity.

Clinical trials of MNC bone marrow transplantation for obliterating diseases of the lower extremities have been conducted since 2002. When using unfractionated MNCs, instrumental indicators (perfusion index, transcutaneous oxygen pressure) allow registering a decrease in ischemia to varying degrees in all patients. In 50-82% of cases, the growth of collateral vessels was noted according to angiography. Improvement of subjective symptoms was noted by more than 85% of patients. At the same time, transplantation of bone marrow MNCs made it possible to avoid limb amputation in 90% of patients with a critical degree of ischemia.

Purpose of the study

Evaluation of the effectiveness of intramuscular (into the gastrocnemius) administration of autologous bone marrow MNCs in the treatment of patients with obliterating diseases of the lower extremities, as well as possible complications.

Contingent of patients

Main Diagnosis

• Obliterating atherosclerosis of the arteries of the lower extremities.
• Obliterating endarteritis of the lower extremities

Inclusion Criteria

• Men and women aged 30 to 65 inclusive.
• The presence of obliterating atherosclerosis or obliterating endarteritis of the vessels of the lower extremities with limb ischemia of 3-4 degrees.
• Patients must be mobile enough to follow the rehabilitation program and visit schedule.
• Patients must be able to give informed consent, this consent must be obtained before starting treatment.
• With grade 4 ischemia, necrotic changes are limited to the toes and trophic ulcers, i.e. high limb amputation is not required.

Exclusion Criteria

• Simultaneous participation in another clinical trial.
• Failure to meet study criteria.
• The presence of autoimmune diseases.
• The presence of signs of inflammation according to the analysis.
• Any known malignant disease or history of one.
• The presence of an acute infectious disease.
• The presence of other diseases that disrupt the function of the limb.

Bone marrow sampling

Bone marrow sampling will be carried out under aseptic conditions (operating room of the surgical department of the Immunopathology Clinic. Local or general anesthesia (depending on the patient's psycho-emotional lability). Puncture site - wing ilium 2-3 cm posterior to the anterior-superior spine.

Isolation of the mononuclear fraction of the bone marrow

The isolation of the mononuclear fraction will be carried out in the laboratory of cellular biotechnologies of the Research Institute of Clinical Immunology.

Introduction of bone marrow MNCs

MNC bone marrow suspension (parts 1 and 2) will be injected locally into the gastrocnemius muscles at 40-45 points. At a high level of stenosis, it is also possible to inject a cell suspension into the thigh muscles. Cells will be injected under local anesthesia in a "fan-shaped" fashion, i.e. from one injection, cells can be injected into 7-10 points. Immediately after the injection, bed rest is required with isometric contractions of the muscles of the lower leg and thigh for 2 hours. Subsequently, specific mode restrictions are not required.

Other treatments

All patients during their stay in the hospital and during subsequent outpatient treatment will receive standard complex conservative treatment using antispasmodics (papaverine, drotaverine, etc.), antiplatelet agents (pentoxifylline, acetylsalicylic acid, etc.), metabolic drugs (solcoseryl, actovegin) , vasoprotectors (pyricarbate, etc.), anti-atherosclerotic agents (cholestyramine, ciprofibrate, simvastatin, etc.).

Efficacy and safety assessment

Follow-up examinations of patients after MNC bone marrow transplantation will be carried out after 1 week, 1 month, 3 months, 6 months and then with an interval of 1 year. If the condition of the patient associated with the disease under study worsens, an examination using the necessary additional methods will be performed immediately.

The safety of the intervention will be judged by the presence or absence of possible complications associated with the introduction of MNCs - allergic reactions, infectious complications at the injection site, significant progression of limb ischemia. The general somatic status will also be assessed (based on physical examination, general clinical tests) to exclude the adverse effect of transplantation on comorbidities. Particular attention will be paid to oncological pathology.

Obliterating atherosclerosis is a circulatory disorder in the peripheral arteries, provoked by narrowing of their lumen or complete overlap and threatening ischemia of the lower extremities. Obliterating atherosclerosis of the vessels of the lower extremities is coded 170.2 according to the classification of microbial 10.

Obliteration of the vessels of the lower extremities is the gradual destruction of their lumen with replacement by connective tissue, which stops the blood supply and leads to chronic oxygen starvation relevant fabrics. Obliterating atherosclerosis is caused by an excess of cholesterol on the walls of the arteries of the lower extremities.

The veins of the legs in this disease are just an area of ​​​​maximum damage by cholesterol plaques. Systemic atherosclerosis is provoked by a combination of several factors that affect the condition of the vessels:

• heredity;
• hypertension;
• increased blood clotting;
• kidney and liver diseases;
• hypercholesterolemia;
• dyslipidemia;
• diabetes;
• tuberculosis;
• rheumatism;
• smoking;
• irrational nutrition;
• alcoholism;
• obesity;
• hypodynamia;
• hypothermia and frostbite of the lower extremities;
• leg injuries.

The elderly and men are primarily at risk.

Symptoms and stages of pathology

Obliterating vascular diseases are characterized by symptoms caused by acute or chronic ischemia of various tissues and organs (skin, muscles, bones, joints, vascular wall) of the lower extremities, occurring both in motion and at rest.

• Muscular pain in the thighs and calves of the legs when moving, as in the working muscle tissue not getting enough blood. The patient walks with stops, waiting for attacks of pain. As OASLE progresses, the pain becomes chronic.
• Hot-cold foot syndrome. Since an insufficient amount of blood enters the limb with the affected vessels, it seems colder than healthy.
• Feeling of coldness, tingling and numbness in the feet as a result of impaired blood flow and damage to nerve sensitivity.
• Regarding the affected area of ​​the vessels, pain in the feet or legs, thighs and buttocks, inability to hold gases and problems with potency.
• The formation of non-healing ulcers, thickening or brittle nails, impaired hair growth, darkening of the skin.

There are 4 phases of OASNK. The first two phases are reversible with the proper level of therapy.

1. At the first pain in the lower extremities make themselves felt only after serious physical exertion. Painless walking distance of at least one kilometer. The disease is found only when laboratory research condition of the blood, indicating the excess of the permissible level of cholesterol.
2. At the second stage, the first physical symptoms of obliterating atherosclerosis become noticeable. Cold and numb feet, cramps occur. When walking for a distance of no more than 1000 meters, the legs begin to hurt. With the progress of OASNK, the pain-free distance is shortened to only 250 meters.
3. The third phase is characterized by pronounced clinical signs. The skin becomes thin and easily damaged. When lifting a sore leg, the skin turns pale, when lowered, it turns red. The blood flow deteriorates so much that pain in the legs occurs even after 50 meters. Also, pain is disturbing in an immovable state, especially at night. To alleviate the pain syndrome, patients take a forced prone position with a lowered leg.
4. Lameness and pain in the foot and fingers become permanent. The skin turns black, there are areas of necrosis of the skin, fiber and muscles. Muscular atrophy sets in. Mobility is sharply limited, and then the patient becomes completely unable to move independently. There is a risk of formation of trophic ulcers and gangrene of the fingers and heels, which threatens the need for amputation of the limb. Without a timely surgical operation possible death.

Diagnosis of obliterating atherosclerosis

To confirm the diagnosis of obliterating atherosclerosis and clarify the area of ​​vascular damage, a series of laboratory tests(coagulogram, detailed blood test for lipids, fibrinogen, glucose) and instrumental-hardware examination.

Initial inspection

The clinical picture of disorders is obvious, therefore, in the diagnosis, the direct examination of the patient by an angiologist and the study of pathognomonic signs come to the fore. Obliterating atherosclerosis is not an independent disease, therefore concomitant diseases and injuries of the lower extremities are carefully studied.

Measurements of blood pressure in the legs and arms are taken, pulsation in the arteries of the lower extremities is checked. With the development of the disease, the pulsation below the area of ​​occlusion is weakened or absent, a systolic murmur is heard above the narrowed vessels.

Duplex scanning of the vessels of the legs

Scanning provides an opportunity for the condition of the arteries, the degree of their elasticity and the level of blood circulation in OASLE. The method is based on determining the speed at which sound waves are reflected from moving blood elements, and allows you to identify the presence of obstacles to blood flow.

Duplex scanning does not require special preparation. Before the procedure, the patient must undress from the waist down. The sensor is moved from top to bottom - from the zone of the inguinal ligament, along inside hips and under the knee, and finish at the calves. During the procedure, the doctor may ask you to change the position of the body several times, as well as stand up and walk a little.

The study lasts approximately 45 minutes. Duplex scanning has no age restrictions. Pregnant women and children can also be examined. It is a non-invasive, harmless, painless and safe procedure.

Peripheral arteriography

Diagnosis of the condition of the arteries using an X-ray machine and the injection of a contrast agent containing an iodine compound.

Preparation includes giving up alcohol for two weeks and excluding food intake four hours before the procedure. To reduce sensitivity to contrast agents, antiallergic agents are prescribed. At the end of the examination, it is indicated to drink as much plain water as possible in order to speed up the removal of the contrast agent from the body.

Arteriography has a number of contraindications: allergy to a contrast agent, pregnancy, kidney failure, severe diabetes mellitus, some thyroid diseases, heart failure, multiple myeloma, weight over 130 kg. Therefore, an additional examination is required before the procedure.

The method makes it possible to detect aneurysms, blockage of blood vessels. As a rule, one study is performed to choose from: scanning or arteriography.

The study of the state of blood vessels using magnetic resonance imaging. The procedure is performed in cases where the diagnosis of obliterating atherosclerosis of the vessels of the lower extremities must be confirmed after angioscanning or arteriography, which turned out to be insufficient. As a rule, the disease can be accurately determined after one of these methods.

Contraindications: pregnancy, the presence of metal implants in the body (for example, pacemakers), claustrophobia.

It is forbidden to take alcohol for three days, smoke for a day, eat and drink 6-8 hours before the procedure. The duration of the examination is up to 1.5 hours.

MR angiography has several advantages over other methods. It displays the state of blood vessels in the most detailed way and detects even small pathologies in their structure and in blood circulation. The method makes it possible to avoid the effects of X-ray radiation on the patient's body and contrast agent in most cases. MR angiography can be performed with or without contrast agents.

Treatment of the disease

After confirming the diagnosis, a treatment program is developed taking into account the stage and other nuances of the development of the disease. Therapy also involves the treatment of comorbidities that contribute to the formation of obliterating atherosclerosis.

It is possible to completely cure obliterating atherosclerosis only with the help of arterial prosthetics. However, such a cardinal method of solving the problem is resorted to only in the last stages of the disease. In the first two phases, they are limited to the use of medications.

Medical treatment

Treatment medicines allows you to eliminate the pain characteristic of obliterating atherosclerosis, and stop the further formation of cholesterol plaques.

The patient may be prescribed:

• statins (fluvastatin, rosuvastatin), which regulate the amount of cholesterol in the blood;
  

  
  
  

• spasmolytics (No-shpa, Galidor, Papaverine) and ganglion blockers (Pentamine), which relieve vasospasm and improve blood circulation in small arteries;
  

  
  
  
  
  
  

• anticoagulants (Heparin, Warfarin) and antiplatelet agents (Aspirin), which help reduce blood clotting and prevent the formation of blood clots;
  

  
  

• painkillers (Novocaine) to relieve acute attacks of pain;
  
  
• antioxidants (ascorbic acid) to protect the arterial walls at the cellular level.
  
  

Medical therapy is also required after successful surgery. With systemic atherosclerosis, there is always the possibility of relapse. You will have to take pills for life.

Medicine has developed several gentle and radical methods of surgical intervention. Minimally invasive operations are safer, but they are used only in case of damage to the disease of a small section of the artery.

1. Balloon angioplasty is a minimally invasive intravascular operation that allows you to restore the normal patency of the vessel by inserting a special balloon into its cavity that expands the lumen.
2. Shunting is a procedure to restore blood flow by bypassing the site of narrowing with a shunt (part of a patient's healthy vein or its artificial counterpart).
3. Stenting is the installation of a frame into the lumen of the vessel to expand in diameter and support the walls of the area narrowed by the pathological process.
4. Autodermoplasty of the skin - reconstruction of the area of ​​the skin with extensive trophic lesions.
5. Vascular prosthetics - removal of an occluded vessel and its replacement with a graft.
6. Vessel endarterectomy - a cholesterol plaque is removed from the vessel along with the altered inner shell of the vessel wall.

With irreversible pathological processes limbs are amputated. This is a forced measure to stop gangrenous infection and avoid death. After surgery to remove a limb, continued vascular treatment is required.

Folk remedies

Traditional medicine is an effective addition to medical therapy, but cannot be its replacement, especially at stages 3–4 of atherosclerosis. Before using a folk recipe, you should consult your doctor for contraindications.

The plant helps lower cholesterol levels. Recipes:

• Mash 200 g of fresh ripe berries, pour a glass of alcohol. Insist 3 weeks, filter. Take one teaspoon half an hour before meals and at bedtime.
• One teaspoon of cranberries and one tablespoon of hawthorn and immortelle are poured with 1 liter of boiling water and infused for 3 hours in a thermos. Drink one glass a day.

Relieves inflammation, heals wounds, strengthens blood vessels and improves blood circulation. 20 grams of chopped peel or flowers are poured with 1 liter of water and boiled for 30 minutes in a water bath. After filtering, boiling water is added to compensate for the water evaporated in the bath. Dosage - 2 tablespoons per day.

Effective remedy for lowering cholesterol levels. 2 cups of fresh red clover flowers are poured with 1 liter of vodka and infused for 2 weeks, shaking occasionally. After straining, take 1 tablespoon before breakfast and dinner.

Helps relieve swelling. Damp pharmacy tincture gauze and apply to places of edema for several hours.

Lifestyle and diet

If you only take pills, but do not change the lifestyle that has led to the destruction of health, the treatment will not be effective. First of all, you need to give up bad habits.

Alcohol contributes to increased swelling, and nicotine - to vasoconstriction and poor blood circulation in the limbs, so you need to stop drinking and smoking.

To normalize metabolism and improve blood circulation, therapeutic exercises are indicated. Walking exercises are especially helpful. You can start with small distances and a slow pace, gradually increasing the load. Exercises should be regular, as their implementation prevents further damage by atherosclerosis of the vessels of the muscles involved in the exercises.

Overvoltage is also not recommended, so the degree of stress should be regulated by the doctor depending on the state of the body. Exercises of a general tonic nature must be alternated with breathing exercises that help saturate tissues with oxygen.

For the treatment of atherosclerosis, it is necessary to adjust the diet in order to reduce cholesterol levels and normalize weight. You should adhere to fractional nutrition (small portions 5-6 times a day), do fasting days. It is recommended to replace smoked meats and fried foods with boiled and stewed ones, limit the consumption of hot spices and salt. Preference should be given lenten dishes and avoid red meat altogether. You should also exclude strong tea and coffee, sugar, sweets, purchased mayonnaise and ketchup, flour products.

Forecast and prevention of obliterating atherosclerosis

The disease is easier to prevent than to treat. If a person falls into the risk zone, he needs to monitor his health and regularly undergo preventive examinations.

Basic preventive measures:

1. Rejection of bad habits. First of all, smoking.
2. Stick to the guidelines for diet food. Exclude canned, fatty foods, as well as sweet and flour products. Weight correction will reduce the load on the lower limbs and avoid many other diseases.
3. Do not overcool your feet. Avoid uncomfortable shoes and heels to avoid blood stasis.
4. A sedentary lifestyle and a long stay in one position also provokes problems with blood circulation. For supporting circulatory system in good shape, regular physical exercises are recommended: swimming, hiking, running, skiing. Aerobic exercise is the most useful, thanks to which the working muscles are saturated with oxygen as much as possible.

Timely application for medical care allows you to save the limb and improve the prognosis for this severe pathology.