Daily Archive 06.10.2019

Atherosclerosis obliterans 

Obliterating atherosclerosis of the aorta and major vessels of the lower extremities in frequency is in first place among other diseases of the peripheral arteries. It occurs mainly in men over 40 years old. The disease often causes severe limb ischemia, condemning patients to excruciating suffering and depriving them of working capacity. The process is localized mainly in large vessels (aorta, iliac arteries) or medium-sized arteries (femoral, popliteal). 

Etiology, pathogenesis of obliterating atherosclerosis

Atherosclerotic lesions of the arteries are a manifestation of general atherosclerosis. In its occurrence, the same etiological factors and pathogenetic mechanisms play a role that are responsible for the formation of atherosclerosis of any other localization. The main changes in atherosclerosis develop in the intima of the arteries. A young connective tissue appears around the foci of lipoidosis , the maturation of which leads to the formation of fibrous plaque. Platelets and fibrin clots settle on plaques. With abundant accumulation of lipids, there is a violation of blood circulation in plaques, the necrosis of which causes the appearance of atheromas, i.e. cavities filled with atheromatous masses and tissue detritus. Atheromatousmasses are rejected into the lumen of the vessel. Getting with a blood stream into the distal bloodstream, they become the cause of embolism. At the same time, calcium salts are deposited in the altered tissue of plaques, in areas of degenerating elastic fibers, which is the final stage in the development of atherosclerosis and leads to impaired patency of the vessel.

Clinic for obliterating atherosclerosis

During obliterating atherosclerosis, the same 4 stages are distinguished as with obliterating endarteritis. For several years obliteri – ruyuschy atherosclerosis may be asymptomatic, but after the first clinical manifestations progress rapidly. In some cases, due to the joined thrombosis, the clinical manifestations of the disease appear suddenly. A characteristic symptom of obliterating atherosclerosis is intermittent claudication, manifested by pain in the calf muscles, which appears when walking and disappears after a short rest. With atherosclerotic lesions of the terminal abdominal aorta and iliac arteries ( Leriche syndrome ), the pain is localized not only in the legs, but also in the gluteus, lumbar and thigh muscles. Intermittent claudication intensifies when climbing stairs or uphill. Chilliness , increased sensitivity of the lower extremities to cold, and a feeling of numbness in the feet are noted. Due to ischemia, the color of the skin of the lower extremities changes, which in the initial stages of the disease become pale, and in patients with Lerish’s syndrome have the color of ivory. In the later stages of the disease the skin of feet and toes becomes purplish-bluish okrasku.Razvitie trophic disorders leading to hair loss, breach of nail growth. One of the manifestations of occlusion of the aorto-iliac segment is impotence due to circulatory disorders in the system of internal iliac arteries. This symptom occurs in 50% of patients.

Diagnosis of obliterating atherosclerosis

When examined in patients with obliterating atherosclerosis, hypotrophy or atrophy of the muscles of the lower extremities is often noted. In obliterating atherosclerosis, the femoral- iliac segment is most often affected , therefore, starting from the place of discharge of the deep femoral artery, the pulsation in the vast majority of patients is not determined either on the popliteal artery or on the arteries of the feet. With the occlusion of the abdominal aorta and iliac arteries, it is not determined on the femoral arteries. Systolic murmur is usually heard over stenotic arteries. With stenosis of the abdominal aorta and iliac arteries, it can be determined not only above the anterior abdominal wall, but also on the femoral arteries under the inguinal ligament. Rheovasography with obliterating atherosclerosis records a decrease in the main blood flow in the lower extremities. In severe cases of lower limb ischemia, rheovasographic curves take the form of straight lines, additional teeth disappear on the catacrotis , the rheographic index decreases, the infrared radiation intensity recorded by the thermal imager decreases until the thermal pattern is completely darkened, thermal asymmetry increases. Ultrasound examination makes it possible to determine the level of atherosclerotic and the degree of blood supply to the distal parts of the affected limb. The main method of topical diagnosis in obliterating atherosclerosis is angiography. It allows you to determine the localization and extent of the pathological process, the degree of damage to the arteries (occlusion, stenosis), the nature of collateral circulation, the state of the distal bloodstream. By angio graphic signs of atherosclerosis include edge defects filling ize – degeneracy circuit portions of the arteries to the stenosis, the presence or segmental common occlusions with filling through distal collaterals network.

Differential diagnosis of obliterating atherosclerosis

Differential diagnosis should be made with obliterative endarte – Riitta and trombangiitom.Endarteriitom ill young people. Overcooling, frostbite, emotional stress contribute to its development. The arteries of the distal segments of the limbs are mainly affected, a long, undulating course of the disease is characteristic. In patients with atherosclerosis may occur symptoms of other vascular beds (heart, brain, kidneys, etc..), Giperholesterine – mia , diabetes that occurs very endarteriite redko.Differentsialnaya diagnosis of arteriosclerosis obliterans and thromboangiitis usually straightforward. The main difference lies in the fact that Trom – Bang occurs predominantly in young men and is characterized by a combination of symptoms of arterial insufficiency and migratory thrombophlebitis of superficial veins.