Obliterating Atherosclerosis Of The Arteries Of The Lower Extremities - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Obliterating atherosclerosis of the arteries of the lower extremities

Content:

• What is lower limb atherosclerosis?
• Disease symptoms
• The reasons for the development of the disease
• Diagnostics
• Treatment of atherosclerosis of the lower extremities
• Diet
• Conclusion

What is lower limb atherosclerosis?

Atherosclerosis of the lower extremities is a group of pathological processes affecting the main blood vessels of the lower extremities, and representing a progressive violation of the blood supply to tissues due to narrowing (stenosis) or blockage (occlusion) of the arteries. The term "obliterating" in relation to this disease means a gradual, but sure narrowing of the lumen of blood vessels.

Arteries are large blood vessels. In the normal state, the lumen of the arteries is free and the blood circulates freely through the bloodstream. However, in some cases, the lumen of the vessels narrows, and the surrounding tissues do not receive enough nutrients and oxygen necessary to maintain stable functioning, as a result ischemia and subsequent necrosis develops.

In short, the mechanism of formation of the disease is based on blockage of blood vessels or their narrowing. Narrowing is a common cause, for example, in the body of a heavy smoker. Blockage can occur if a fat-like substance - cholesterol (LDL-lipoprotein complex) is deposited on the walls of the arteries of the lower extremities. However, the process of the development of pathology is not so simple and requires a more detailed explanation.

The mechanism of development of the disease

Most often, atherosclerosis of the vessels of the lower extremities manifests itself in old age and is caused by disorders of lipoprotein metabolism in the body. The development mechanism goes through the following stages.

1. The cholesterol and triglycerides that enter the body (which are absorbed into the intestinal walls) are captured by special transport proteins-proteins - chylomicrons and are carried into the bloodstream.
2. The liver processes the resulting substances and synthesizes special fatty complexes - VLDL (very low density cholesterol).
3. In the blood, VLDL molecules are affected by the enzyme lipoprotein lipase. At the first stage of the chemical reaction, VLDL is converted into intermediate density lipoproteins (or IDLs), and then at the second stage of the reaction, LDLP is transformed into LDLD (low density cholesterol). LDL is the so-called "bad" cholesterol and it is he who is more atherogenic (ie, capable of provoking atherosclerosis).

4. Fatty fractions enter the liver for further processing. Here, high-density cholesterol (HDL) is formed from lipoproteins (LDL and HDL), which has the opposite effect and is able to cleanse the walls of blood vessels from cholesterol layers. This is the so-called "good" cholesterol. Some of the fatty alcohol is converted into digestive bile acids, which are necessary for the normal processing of food and are sent to the intestines.

5. At this stage, the liver cells can fail (due to genetics or explained by old age), as a result of which, instead of HDL at the exit, low-density fat fractions remain unchanged and enter the bloodstream.

   No less, and possibly more atherogenic, are mutated or otherwise altered lipoproteins. For example, oxidized under the influence of H2O2 (hydrogen peroxide).

6. Low-density fatty fractions (LDL) are deposited on the walls of the arteries of the lower extremities. Long-term presence of foreign substances in the lumen of blood vessels contributes to inflammation. However, neither macrophages nor leukocytes can cope with cholesterol fractions. If the process is delayed, layers of fatty alcohol are formed - plaques. These deposits are very dense and impede normal blood flow.

7. Deposits of "bad" cholesterol are encapsulated, and blood clots form when the capsule breaks or is damaged. Blood clots have an additional occlusive effect and even more clog arteries.
8. Gradually, the cholesterol fractions in conjunction with blood clots take on a rigid structure, due to the deposition of calcium-containing salts. The walls of the arteries lose their normal extensibility and become fragile, which can lead to rupture. In addition to everything, persistent ischemia and necrosis of nearby tissues are formed due to hypoxia and lack of nutrients.

Atherosclerosis of the vessels of the lower extremities is an insidious pathology. In some cases, it may not manifest itself at all or manifest itself as nonspecific symptoms. For example, a patient can explain chilliness in the limbs or “goosebumps” by the fact that the limb “spent time” or “lay down”.

Symptoms of atherosclerosis of the lower extremities

Atherosclerosis of the lower extremities is easy enough to recognize even on your own, provided you are attentive to your own health and feelings. It manifests itself in a system of specific and general symptoms.

• Feeling of itching, "ripples" in the limbs, goose bumps, etc. Patients define these sensations differently, but often the feeling is similar to limb numbness as a result of prolonged uncomfortable position. In this case, the symptom is present for no apparent reason.
• Feeling of coldness in the lower limbs. Also in the absence of an apparent reason. It can also be observed in the warm season.
• Pallor of the skin of the legs.
• Thinning of the muscle and fat layer in the thighs, legs and feet. Narrowing or blockage of the arteries that supply oxygen and nutrients to the tissues leads to active tissue degeneration.
• Complete or partial loss of hair on the ankles and legs without subsequent hair growth. It is also associated with the development of tissue degeneration. The capillary system in the affected limbs grows unnaturally, but cannot compensate for the lack of blood supply.
• Pain in the leg area. Observed in a calm state, when walking and any physical activity, they increase. A specific symptom of atherosclerosis is lameness, caused by severe paroxysmal pain.
• In more "advanced" cases: darkening or redness of the feet and toes (tissues acquire an unnatural burgundy or dark red color), which indicates stagnation of blood and thrombus formation. The symptom is the precursor to such a formidable complication as necrosis.
• Formation of leg ulcers (so-called trophic ulcers).
• Tissue necrosis (gangrene). It manifests itself in the last stages of the process. Since the disease develops rapidly, the stage can come quickly.

Thus, with obliterating atherosclerosis of the lower extremities, a complex of formidable symptoms is observed. Their manifestation indicates the need for prompt medical attention. In most cases, delays and hesitation by doctors and patients will lead to amputation.

Causes of atherosclerosis of the lower extremities

Obliterating atherosclerosis of the lower extremities can develop for many reasons:

• Gender. Both men and women are equally ill. The age of persons suffering from atherosclerosis ranges from 45 for males and 50 years for women. Men, as a rule, acquire this pathology 1.5-3 times more often. The reasons for the difference in incidence are not fully understood, but it is assumed that estrogen (a female sex hormone) is able to somehow prevent clogged arteries.
• Age. As mentioned, the risk of getting sick increases proportionally with age. With the onset of menopause, the activity of the production of sex hormones in the female body decreases, therefore, after 50-55 years, the number of cases both among men and among women is approximately the same. In Russia, the statistics on atherosclerosis is truly horrifying: 75% of men and 25% of women under the age of 40 suffer from pathology. And at the age indicated above, the number approaches 90%.
• Elevated cholesterol and triglyceride levels. Both substances have the ability to clog blood vessels and cause ischemia. How to lower blood triglyceride levels?
• Hypertension. It represents an increased level of blood pressure. Normal values range from 120/80 to 130/85. Persistent or periodic excess of these figures indicates the presence of hypertension. Vessels in hypertension very quickly lose elasticity and become fragile. On the inside, “worn out” vessels lose their elastic smooth texture, becoming coarse. In this state, cholesterol plaques are formed much more actively.
• Genetic reasons. Atherosclerosis is a polyetiological disease. The hereditary factor plays an important role. The peculiarities of lipid metabolism in the body, the characteristics of the hormonal background, as well as the specificity of the immune system, with the help of which the development of atherosclerosis can proceed faster or slower, are inherited.
• Addictive habits. Nicotine, which is abundantly absorbed into the bloodstream, is extremely atherogenic. However, in heavy smokers, the mechanism of atherosclerosis formation is somewhat different. Without a doubt, nicotine is able to affect lipoprotein metabolism in the body, but most often the cause of acute insufficiency of blood supply to the tissues of the lower extremities is stenosis of the arterial walls, and not their blockage. Drugs have a similar, but even more destructive effect, and their use in the overwhelming majority of cases means certain death or severe disability. Alcohol in small therapeutic doses, on the other hand, can have a positive prophylactic effect.
• The presence of concomitant diseases and pathologies. Diabetes mellitus goes hand in hand with atherosclerosis. In diabetes mellitus, significant dysfunctions of lipid and lipoprotein metabolism are observed, and therefore, in 75-80% of diabetics, atherosclerosis develops during the first 4-5 years or even faster.
• Lack of thyroid hormones (thyroid hypothyroidism) also affects normal metabolism, increasing the risk of developing atherosclerosis of the lower extremities by 35-40%.
• Stress. Especially if they are permanent and protracted.
• Obesity. By itself, it often indicates the presence of metabolic disorders.

• Focuses of inflammation in large blood arteries

Diagnostics of the atherosclerosis of the lower extremities

Symptoms are not always pronounced, for this reason, it is quite difficult to diagnose atherosclerosis without proper medical training. Only an experienced doctor can correctly diagnose, and meanwhile, delays in the diagnosis and timely treatment can cost the patient the affected limbs.

Three main methods are of great importance in diagnostics:

• Samples.
• Taking anamnesis.
• Ultrasound examination of the vessels of the lower extremities.

Taking anamnesis

At the initial examination, the doctor who suspects the patient atherosclerosis should question the patient in more detail and take into account all the factors.

As a rule, in the history of patients there is a combination of the following elements:

• Smoking experience;
• Increased body weight;
• No allergic diseases;
• Over 40 years old;
• Outwardly, the patient looks older than the actual age;
• Complaints of pain and problems with both legs;
• Frequent to moderate attacks of intermittent claudication that affects many muscles in the legs, from the buttocks to the calves.
• The skin of the feet is pale;
• Pulse over large arteries is almost not felt. When listening to the affected areas, extraneous noise is detected.
• Present: hypertension, ischemic heart disease and / or diabetes mellitus.
• The manifestations are permanent. Does not depend on the time of year or day.
• There were people in the family with cardiovascular diseases. With a high degree of probability, the patient also has problems with cholesterol.

Functional tests and tests

At the end of the anamnesis collection, the doctor confirms his guess with special functional tests:

• Functional test Burdenko. Atherosclerosis is associated with stagnant processes in the vessels. When the leg is bent at the knee, the foot (sole) is covered with a marble vascular pattern. This indicates a poor outflow of blood from the limb.
• Shamov / Sitenko hyperemic test. Due to the same stagnant processes, the blood circulation of the tissues is impaired. To detect atherosclerotic disorders in the work of blood vessels, a special cuff is applied to the shoulder or thigh for 3-5 minutes. It compresses the surrounding tissue, preventing normal blood circulation. The normal blood supply (and, accordingly, the pink color) of the tissues returns to normal after 25-35 seconds. If the vessels are affected by atherosclerosis, it may take up to a minute and a half or more, depending on the degree of narrowing of the blood vessel channel.
• Functional test Moshkovich to assess the plantar symptom. The patient assumes a lying position. Then he raises his legs straight up, without bending them at the knee joints. In this position, the patient is asked to remain for two to three minutes. Then the patient takes a standing position. Normally, in a healthy person, the skin turns pale in the first position, since blood flows from the lower extremities, and as soon as it rises, the blood supply is restored, and the skin returns to its natural pinkish tint within 8-10 seconds or faster. This is not observed in patients with atherosclerosis. For 30 seconds or more, the skin is able to maintain a pale color, marbled vascular pattern, etc.

If violations have been identified, the doctor conducts a second, deeper test, aimed at establishing the degree of lack of blood circulation (plantar symptom). For this, the patient lies down again and stretches his legs up. But now he is asked to alternately or together bend and unbend his legs. Physical activity requires blood flow, and a lack of it will lead to rapid muscle fatigue. People with atherosclerosis experience rapid fatigue and pallor of the soles of the feet. Depending on the intensity and speed of the onset of these two factors, the degree of blood flow deficiency can be determined.

Ultrasonography

To establish the severity of circulatory disorders, they resort to vascular Doppler sonography. This study allows you to establish the speed of blood flow and the degree of saturation of tissues with essential nutrients and oxygen.

Other research methods

They are numerous and are prescribed to confirm the diagnosis:

• Laboratory research (analyzes). As a rule, in atherosclerosis, there is an increased concentration of triglycerides, LDL, and the most accurate and informative indicator is the so-called atherogenic index (coefficient), which is determined on the basis of the proportion between "good" and total cholesterol.
• Radioisotope studies can determine the level and quality of blood supply to tissues and establish the degree of anemia.
• Radiography makes it possible to establish the localization and size of vascular occlusions.

New diagnostic methods are actively being introduced, such as spectral scanning, through which you can study the contours of the affected vessels, determine the speed of blood flow through them and measure pressure, and others.

An inexperienced specialist often runs the risk of not seeing the disease. The reason lies in the high adaptability of the body to various adverse factors. The patient develops collateral blood supply. New blood structures are formed and grow, providing tissues with the necessary substances. Although this method is not able to replace the normal circulatory system in the affected area, partial compensation is still achieved. This blurs the picture, confusing the doctor.

Treatment of atherosclerosis of the lower extremities

Treatment of atherosclerosis of the lower extremities is a significant challenge, since the disease, as already mentioned, is polyetiological. Therefore, it can be caused by many reasons. Treatment consists of eliminating the root cause and getting rid of unpleasant and life-threatening consequences. The doctor must act competently and promptly. Atherosclerosis not only significantly reduces the quality of life, but also threatens the patient's health.

Conservative methods include:

• Drug therapy;
• Physiotherapy.

In extreme cases, they resort to surgical methods. Traditionally, highly invasive operations are widely used nowadays, however, great importance is attached to relatively low-traumatic endoscopic methods of intervention.

Drug therapy

Drug therapy is complex. Fractional courses of treatment are carried out for 1.5-2 months at intervals of up to 4 times a year, depending on the clinical picture. The drugs are aimed at combating vasospasm and vasoconstriction. Antispasmodics and drugs are used that expand the lumen of blood vessels (for example, no-shpa, compalamin, etc.).

Statins, fibrates, and fatty acid sequestrants are used to lower cholesterol. More modern ones include Ezetimib-SZ, Evolokumab and Alirokumab. Omega-3s are prescribed in addition to essential medicines.

An important role is played by drugs that increase the rheological qualities of blood and thereby improve its circulation (including the well-known aspirin (Thrombo ACC, Cardiomagnil, Cardiasc), or, in case of intolerance, more "calm" drugs: Curantil, Tiklid, Plavix, Brilinta, Trental.).

At the request of the patient, herbal preparations can be used in the complex, which have proven their effectiveness. These include: Inflaminat, Nattokinase, Revight Garlic Pearls, Ravisol - you can read more about them here.

Read more: Drugs for the treatment of atherosclerosis

Physiotherapy

It is used in conjunction with drug therapy. The following types are most effective:

• Exposure to the affected areas with combinations of direct and alternating current (interference therapy).
• Deep injection of drugs by means of electric current (electrophoresis).
• Magnetotherapy.
• UHF.

These therapeutic procedures contribute to the full or partial restoration of the damaged vessels.

In combination, these methods are highly effective at the early or later stages of the development of the disease. In 90% of cases, in combination with a hypocholesterol diet and giving up bad habits, conservative therapy gives the desired effect.

However, treatment does not always help. In addition, a situation may arise in which the process has gone too far and the vessels have finally lost their function without the possibility of its restoration. In this case, surgery is indispensable.

Surgery

Traditionally, vascular prosthetics remains the main method. The affected and lost its functions vessel is removed, a prosthesis is installed in its place. Modern vascular prostheses are not much different from natural tissues, therefore they fulfill their task with dignity and allow the patient to return to a normal and fulfilling life.

Fortunately for patients, time does not stand still, and an affected vessel that has not yet completely lost its functionality can be restored through angioplasty. This is a minimally invasive, but highly effective endoscopic method of eliminating occlusion or stenosis of a blood vessel.

Its essence lies in the fact that the endoscopist under the control of a video camera through a puncture in the femoral artery advances the catheter along the bloodstream to the affected area. Upon reaching the affected area of the artery, the doctor expands it, or eliminates foreign objects, due to which the function of the vessel returns. In contrast to the traumatic surgery to install a prosthesis, angioplasty is less traumatic. Another question - not always only she can do it.

Diet for atherosclerosis of the lower extremities

By itself, dietary changes are incapable of providing any therapeutic effect. It is effective either in combination with other therapeutic measures, or as a prophylaxis.

A diet for atherosclerosis of the lower extremities is not just a one-time action. To achieve the desired effect, it must be adhered to for a long time. The new way of eating should become, in a way, a way of life. This will provide treatment, as well as further prevention. However, in most cases, at the initial stages of the disease, it is rarely necessary to give up food for a long time.

The diet of a patient with atherosclerosis should include:

• Meat products. Lean meat, poultry (turkey is preferred).
• A fish. Fatty fish is also allowed, since its fat has a rather positive effect on blood vessels.
• Fresh fruits, vegetables and berries - unlimited.
• Fermented milk products, including fatty ones.
• Boiled and baked eggs (omelets). The lecithin contained in them, as well as a large amount of cholesterol, which, if properly prepared, will turn into a "good" form, will clear the vessels from layers.
• Vegetable oils (olive and sunflower oil).
• Cereals, wholemeal pasta. And also bran and bread.
• Green tea.
• Nuts (especially almonds and walnuts)
• Legumes and legumes (lentils, beans, peas).
• Dry red wine.
• Cheese (less than 30% fat).

It is necessary to limit the consumption of the following foods:

• Synthetic foods rich in trans fats. This is margarine, spread.
• Limit consumption of by-products (brain, kidney, liver) and products from them.
• Sausages.
• Mayonnaise, ketchup and other industrial sauces.
• Potatoes (fried) and fast food. Potatoes are acceptable in small quantities and only boiled (in their uniform) or baked.

Adhering to such a diet in conjunction with drug treatment and physiotherapy can alleviate the condition and get rid of the consequences of the disease.

Pay attention to the Mediterranean diet, which, according to studies, reduces the risk of recurrent heart disease by 50-70%.

Read more: Mediterranean diet: pros and cons

Conclusion

Thus, obliterating atherosclerosis of the arteries of the lower extremities may be directly related to the level of cholesterol in the blood, or may not have anything to do with it. One way or another, this is an extremely dangerous disease, which, in the absence of adequate treatment, leads to disastrous results. It is quite difficult to determine it (independently - and completely impossible). Only an experienced doctor can cope with the diagnosis and prescribe treatment.

Fortunately, modern medicine has a full range of diagnostic measures at its disposal. Treatment is usually conservative in the early stages. In addition to traditional medication and physiotherapy, general improvement of the body and the use of a special diet are recommended. However, in more severe cases, surgery is used.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.