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Disease of peripheral arteries of the lower extremities
June 1, 2012
The illness which is called a disease of peripheral arteries arises as an effect of disturbance of a blood flow in arteries which supply the lower extremities of the person with blood. As a rule, it occurs owing to development in sick atherosclerosis owing to what not enough oxygen and useful nutrients gets to fabrics.
Features of a disease of peripheral arteries of the lower extremities
The main displays of a disease of peripheral arteries are a feeling of discomfort or emergence of an onychalgia when walking. At the same time development of pain can be shown in different parts of legs. The place of dislocation bolevyz feelings depends on what departments of arteries were damaged.
Depending on age of the person the risk degree of emergence of the first clinical signs of an illness increases. So, if to inspect group of people who already were seventy years old then in this case the disease of peripheral arteries will be revealed at one of three people. The risk degree of a course of a disease considerably raises at those who smoke or suffer from a diabetes mellitus.
Causes of illness of peripheral arteries of the lower extremities
The basic reason provoking development a disease of peripheral arteries is always atherosclerosis. The highest risk of development of this illness takes place at men who already were fifty years old. At women the probability of development of this illness is lower.
Specialists allocate a number of factors which promote development of a disease of peripheral arteries. In this case the defining value often has malicious smoking, existence at the person of a diabetes mellitus, continuous manifestation of high arterial pressure. General diseases lead to manifestation of disturbances in functioning of immune system that promotes education in an organism of antibodies, tropny to a vascular wall.
The probability of developing of this illness at people with the high level of cholesterol or triglycerides, high content in blood of a gomotsistenin is also higher. Also existence at the person of obesity has to guard: the risk increases if body weight exceeds norm more, than for 30%.
Higher chance of display of this disease takes place at people who already faced earlier problems with cardiovascular system. Besides, the risk to ache with this illness twice higher at black people.
Symptoms of diseases of peripheral arteries of the lower extremities
The most pronounced symptoms of diseases of peripheral arteries are shown by an onychalgia during walking. Similar pain arises in different parts of an extremity, depending on as far as and where arteries of legs are affected. Pain is often shown in buttocks, hips, knees, feet, shins.
The aorta is the largest vessel which is subdivided into two branches on which there is a blood supply of the lower extremities. At an aorta normality e a surface smooth inside. However over time in the course of progressing of atherosclerosis on a wall of an aorta lipidic plaques are postponed. As a result the wall is condensed, its integrity is broken, the internal gleam becomes narrower. All this leads to disturbance of a blood flow, and the first symptoms of a disease of peripheral vessels of the lower extremities as an effect of increase of insufficiency of blood supply of their vessels are shown. But it is important to consider also the fact that for rather long span this illness can not have an effect certain symptoms at all. But at the same time progressing of a disease will continue. Without timely carried out diagnosis and the correct therapy of an illness it as a result leads to loss of an extremity. At the same time very high risk of manifestation of disturbance of a blood-groove and in other bodies remains. The illness can affect heart, a brain that is fraught with development, respectively, an acute myocardial infarction and a stroke.
Most often as a symptom of atherosclerosis of the lower extremities the alternating lameness is shown. At such condition of the patient feels pain or discomfort when walking which disappear at a condition of rest. In certain cases pain is not shown, however there is a feeling of squeezing, a spasm or weakness at legs. Symptoms of the alternating lameness are shown most often when the person tries to climb up a height, to walk upstairs. At such physical efforts load of legs increases. After a while progressing of this state is observed: the alternating lameness begins to be shown already at lower exercise stresses. The similar state is characteristic approximately of a half of the people having diseases of arteries of the lower extremities. As other symptoms of this illness process of a hair loss standing is observed, skin standing becomes drier and turns pale, its sensitivity decreases. If too started cases take place, emergence yazvochek and blackenings on toes and about them is possible.
Severity of an illness is determined by that, displays of pain are how intensive whether there are trophic changes what distance the patient is capable to pass.
Gradually considerably intake of blood to fabrics worsens. In this case it is about critical ischemia of the lower extremities. At a similar situation morbidity can be too intensive and be shown even at rest. Pain at the same time is localized from a hip and to finger-tips, and at the most insignificant load of legs it considerably amplifies. If heavy ischemia of the lower extremities takes place, and at the same time there is no necessary treatment, then at the patient the necrosis of soft tissues can develop. It conducts to gangrene of the lower extremities.
Diagnosis of diseases of peripheral arteries of the lower extremities
In the course of diagnosis of a disease of peripheral arteries initially the specialist conducts detailed survey of the patient with the purpose to define features of his health, illness symptoms. Information on smoking, and also on the increased arterial pressure is very important in this case. After that inspection of the lower extremities is without fail performed and pulse is defined on them.
There are some tests allowing to define more precisely whether there is a damage of arteries of the lower extremities. This comparison of arterial pressure on hands and legs for definition of a lodyzhechno-humeral index, and also research of content of cholesterol in blood and a number of other biochemical markers of cardiovascular diseases.
Completely to confirm existence of this diagnosis and to define what nature of damages, it is necessary to conduct some tool researches. First of all, to the patient ultrasonic duplex ultrasonic scanning of arteries is appointed that allows to estimate parameters of a blood-groove and structure of vessels. Use of sensors with Dopler's effect and cuffs allows to determine pulse by the volume of blood which proceeds in different sites of legs.
Besides, to the patient appoint carrying out a magnetic and resonant angiography, computer tomography. To patients at whom very severe damages of peripheral arteries take place appoint carrying out a traditional angiography using x-ray emission.
Treatment of a disease of peripheral arteries of the lower extremities
First of all, the patient to whom such diagnosis was made has to consider that it is necessary to approach treatment of a disease of peripheral arteries surely in a complex. Very important point in therapy of a disease is cardinal change of way of life of the patient. It is important to treat it reasonably at detection of an illness at the earliest stage as change of habits will promote suspension of a course of a disease. In this case it is necessary to apply all measures which concern prevention of a disease of peripheral arteries of the lower extremities.
There is also effective medicamentous therapy. Medicines are appointed, first of all to exercise control over content in cholesterol blood, and also over the level of arterial pressure. Complex treatment of diseases of peripheral arteries includes administration of drugs, the thrombocytes reducing aggregation properties. Under their influence there is a blood fluidifying, emergence of blood clots is prevented. If at the patient severe pains are shown, use of the anesthetizing drugs is possible.
In the course of treatment it is important to watch the level of an exercise stress constantly. At the same time it is necessary not to reduce, and, on the contrary, to increase its level. Not less than three weekly it is necessary to go, at least, for thirty minutes. Such active lifestyle will help to reduce manifestation of symptoms of a disease.
All these recommendations are reasonable if the disease is shown in rather easy form. In case of a severe damage of arteries of the lower extremities conservative therapy is not always effective. Sometimes the specialist stops on need of carrying out surgical treatment. Operation is performed both by a traditional technique, and using modern technologies. How exactly to carry out surgical intervention, exclusively attending physician defines, being guided by specific features of a condition of the patient. In certain cases reasonablly combinations of several surgical methods.
The least invasive method of surgical treatment of a disease of peripheral arteries is the technique of angioplasty and stenting. It is applied if large arteries were injured. Angioplasty provides introduction to an arterial gleam of a flexible catheter through a femoral vein. After that enter the conductor delivering a special cylinder to the place where the vessel is narrowed. By inflating of a cylinder the normal gleam of a vessel is recovered.
In more serious cases carry out shunting of arteries. The additional vessel is for this purpose created. On it there passes the blood stream, bypassing an affected area of an artery. Apply both artificial prostheses, and the patient's veins to the shunt.
The method of endarterectomy assumes removal of an atherosclerotic plaque in the surgical way. For this purpose it is necessary to open an artery. However it is important to consider that such procedure can break the general blood stream up to an artery. Therefore, expediency of use of endarterectomy is defined with localization of defeat and extent of disturbance of a blood flow in a certain artery.
In the most hard cases when at the patient gangrene already developed, amputation of the affected extremity is carried out. This method of therapy is the most radical and is used at inefficiency of all other methods of treatment. At the same time about 90% of patients at whom the gangrenosis already began on condition of can avoid the carried-out treatment of amputation in time, or carry out it in the most minimum volume.
Prevention of a disease of peripheral arteries of the lower extremities
To provide high-quality and efficient prevention of this disease, it is important to approach a question of change of way of life responsibly. Without fail the special attention should be paid to existence of risk factors of emergence of this disease. To prevent their emergence, it is regularly necessary to carry out control of content of sugar to blood if at the patient the diabetes mellitus takes place. It is important not to exchange to take all measures to reduce cholesterol level in blood, and also arterial pressure. Both medicamentous drugs, and change of a food allowance are for this purpose applied. In particular, the diet should not include products with the high level of cholesterol, and also salty, smoked, hot dishes, products with the high content of calories and saturated fats. Gradually it is necessary to replace completely all animal fats vegetable. It is extremely important to get rid of smoking in this case completely. It is extremely important to the people having tendency to excess body weight not to allow developments of obesity. For this purpose it is necessary not only to balance food, but also to enter in the usual schedule regular trainings physical culture. Daily walking on foot will also help to keep shape and to suspend progressing of a disease of peripheral vessels of the lower extremities.
Section: Diseases of vessels