Atherosclerosis of the lower extremities
The content of the article:
- Causes and risk factors
- Forms
- Stages
- Symptoms of atherosclerosis of the lower extremities
- Diagnostics
- Treatment of atherosclerosis of the lower extremities
- Possible complications and consequences
- Forecast
- Prevention
Atherosclerosis of the lower extremities is a chronic disease caused by impaired blood flow in the terminal parts of the abdominal aorta and its main branches as a result of the deposition of modified lipids in the vascular walls. Long-term hemodynamic disorder in the great vessels of the legs leads to ischemia and necrotization of adjacent tissues, threatening to result in such serious complications as trophic ulcers and gangrene.
Sclerotic vascular changes are one of the most common problems in the elderly. In men, the first signs of atherosclerosis of the lower extremities appear from the age of 45-50; for women an order of magnitude later - from 60–70 years. The incidence statistics in Russia makes a depressing impression: three-quarters of the male population under 40 suffers from atherosclerosis of the legs, and in older patients the incidence reaches 90%.
The formation of cholesterol plaques is the main cause of the development of atherosclerosis of the lower extremities
Causes and risk factors
The main prerequisite for the development of atherosclerosis is lipid metabolism disorders, as a result of which liver cells lose their ability to process low-density lipoproteins (fat-protein complexes) into high-density lipoproteins, which are easily utilized by the body. Low-density fatty complexes settle on the walls of the arteries, forming plaques that reduce the diameter of the vessels until they are completely blocked. Also, stenosis plays an important role in the pathogenesis of atherosclerosis - narrowing of the lumen of blood vessels due to a decrease in the elasticity of the muscular membranes of the arteries, which is typical for smokers and hypertensive patients.
Fat metabolism disorders and insufficient elasticity of the vascular walls can be a manifestation of aging or constitutional predisposition, however, in most cases, pathological changes in the arteries are caused by modifiable factors that the patient is able to influence. The relationship between morbidity and a sedentary lifestyle, overweight, smoking, prolonged stress and poor nutrition has been reliably established. Contrary to popular belief, a low-cholesterol diet does not at all interfere with the prevention of atherosclerosis, and in some cases even provokes its occurrence due to the creation of a deficiency in the diet of "good cholesterol", that is, high-density lipoproteins.
The main prerequisite for the development of atherosclerosis of the lower extremities is a violation of lipid metabolism
Certain chronic diseases and endocrine disorders contribute to the development of atherosclerosis. Here, the palm belongs to diabetes mellitus: it was noticed that in 75–80% of diabetics, atherosclerosis of the lower extremities develops within 4–5 years from the moment of manifestation of the disease. Uncontrolled hypertension, coronary artery disease, hypothyroidism, and chronic renal failure also increase the risk of atherosclerosis.
Forms
Depending on the leading mechanism of pathogenesis, there are two forms of atherosclerosis:
- obliterating;
- stenotic.
The most common obliterating atherosclerosis of the vessels of the lower extremities (OASNK) caused by deposits of low-density fatty fractions in the vascular walls up to complete blockage and arrest of blood circulation. In smokers, stenotic atherosclerosis of the legs is more common, which occurs against the background of persistent spasm of the arteries and a decrease in the elasticity of the muscular membranes of the vessels with a moderate amount of lipid deposits.
Stages
With a progressive course, atherosclerosis of the lower extremities goes through four successive stages of development. The current stage of the disease is determined by the intensity of pain in the legs, exercise tolerance and the severity of clinical manifestations of insufficient blood supply to tissues.
- Moderate manifestations of oxygen starvation of tissues: anemic skin. Pain in the feet and legs bothers the patient only with significant exertion - not earlier than after one kilometer.
- Low exercise tolerance. With the appearance of painful sensations in the legs at a distance of 200–900 meters, the stage of atherosclerosis of the lower extremities IIA is stated; if you feel discomfort less than 200 meters away - stage IIB.
- The pain in the legs does not subside at rest, which indicates a high degree of stenosis or obliteration of the vessels up to the complete closure of the lumen of the artery.
- Against the background of a constant deficiency of blood supply to the lower extremities, ulcerative-necrotic changes develop in the tissues adjacent to the affected vessels; possibly the appearance of gangrene.
Stages of development of atherosclerosis
Symptoms of atherosclerosis of the lower extremities
In the obliterating form of atherosclerosis, the clinical picture of persistent hemodynamic disturbances in the vessels of the lower extremities does not appear immediately. Up to a certain point, damage to the main arteries compensates for collateral circulation. In the early stages of the disease, pain in the legs is not observed in all patients; the first stage of atherosclerosis of the legs is often asymptomatic, and the only sign of a lack of blood supply is intermittent claudication, which is observed with obliteration of up to 80% of the lumen of the artery.
The increase in degenerative-dystrophic changes in the tissues with progressive atherosclerosis of the lower extremities is characterized by nonspecific manifestations:
- coldness and chilliness of the legs;
- pallor and cyanosis of the skin;
- slow hair growth and baldness of the legs;
- frequent feeling of "goose bumps" in the legs for no apparent reason;
- muscle and fat atrophy in the thighs, calves and feet;
- intermittent claudication.
In the early stages of atherosclerosis of the lower extremities, the only symptom is most often intermittent claudication
At the III – IV stage of atherosclerosis, stagnation occurs in the affected tissues, due to which the skin of the fingers and heels acquires a purple or purple hue; deformities of the nails are often observed. A change in the color of the skin gives reason to suspect the presence of a blood clot and warns of a high risk of developing trophic ulcers and necrosis.
Manifestation of atherosclerosis of the lower extremities of the late stage
Diagnostics
A preliminary diagnosis is made by a phlebologist on the basis of anamnesis and physical examination, taking into account the nature of the pulse of the large arteries. With a pronounced narrowing of the lumen of the vessels, the blows are almost not felt, and when listening to problem areas, extraneous noises are recorded.
Against the background of the general picture of obstructed blood flow in the lower extremities, functional tests are carried out according to Burdenko, Moshkovich and Shamov - Sitenko, which make it possible to assess the state of the peripheral circulation.
To clarify the diagnosis, additional instrumental and laboratory tests are prescribed:
- vascular Doppler ultrasound - accurately determines the blood flow rate in the large arteries of the legs, the oxygen and nutrient content in the adjacent tissues;
- biochemical blood test - reveals an increased content of triglycerides and low density lipoproteins. Calculation of the atherogenic index (the ratio of high-density fat fractions to total blood cholesterol) is of great diagnostic importance;
- radioisotope angiography - used to assess the level and quality of tissue trophism around the affected vessels;
- X-ray - prescribed for OSNK in order to clarify the volume and localization of lipid plaques;
- spectral scanning of arteries is the most informative innovative technique for the functional study of large vessels, which combines visualization of arterial contours, measurement of local pressure and determination of key hemodynamic parameters.
To assess the level of tissue trophism in atherosclerosis of the lower extremities, radioisotope angiography is performed
Treatment of atherosclerosis of the lower extremities
Conservative treatment of leg atherosclerosis is effective only at the initial stages of the pathological process. Standard therapeutic regimens include a course of antispasmodics, vasodilators, and blood rheological agents about four times a year. At the same time, treatment of concomitant diseases is carried out - the normalization of blood pressure in hypertensive patients, a decrease in blood sugar levels in diabetics, etc.
To restore local blood circulation and tissue trophism, physiotherapeutic procedures are additionally prescribed:
- electrophoresis;
- ultraphonophoresis;
- UHF;
- magnetotherapy;
- interference therapy; etc.
Complex therapy of atherosclerosis of the lower extremities involves the active involvement of the patient in the therapeutic process. It is necessary to quit smoking, bring body weight in line with the physiological norm and revise the menu. Therapeutic diet for atherosclerosis of the lower extremities (table number 10c) prescribes to limit the intake of saturated animal fats, trans fats and instant carbohydrates. If you are prone to obesity, you should reduce the calorie content of the diet by 10-15%. As a result, many familiar products are banned:
- fried foods and fast food;
- egg yolks;
- sausages and smoked meats;
- meat offal;
- sweet carbonated drinks;
- industrial sauces - mayonnaise, ketchup, etc.;
- chocolate and confectionery;
- margarines, spreads and other sources of trans fats.
Proper nutrition is important in the treatment of atherosclerosis of the lower extremities.
The diet must contain foods with a lipolytic effect, rich in fiber: fresh vegetables, fruits, berries and herbs, unrefined oils, sea fish and bicarbonate-sulfate table mineral waters. It is important to consume a sufficient amount of vitamins B 1, B 3, B 6, C, natural antioxidants, polyunsaturated fatty acids, macro- and microelements, in particular iodine and manganese.
Starting from stage II of the disease, surgical treatment of atherosclerosis of the lower extremities is indicated:
- femoral-popliteal or femoral-tibial shunting - direction of blood flow bypassing arterial occlusion through the shunt;
- removal of the affected artery followed by the installation of a prosthesis;
- stenting - expanding the lumen of the vessel by installing an internal frame - a stent;
- endarterectomy - open removal of sclerotic plaques;
- endovascular treatment - endoscopic removal of lipid plaques under video control.
With a large length of arterial occlusions and weak development of collaterals, the question of performing arterial reconstruction or amputation of a limb is considered.
Possible complications and consequences
A trophic ulcer of the foot or lower leg is one of the most common complications of leg atherosclerosis. In case of damage to the tendons, periosteum and bone tissue, there is a high probability of irreversible loss of limb function, and long-term non-healing ulcers are prone to malignancy.
With advanced atherosclerosis, the risk of necrotic complications and the rapid development of gangrene increases. In the most severe cases, a leg amputation may be required to save the patient's life.
Forecast
The outcome of atherosclerosis of the lower extremities depends on a number of factors - the severity of symptoms and dynamics of the process, heredity, age and general health of the patient, adherence to the doctor's recommendations and readiness to revise the usual way of life. Chances of a complete cure exist only if atherosclerosis is detected at the first stage against the background of an uncomplicated history, but you should not despair - with adequate treatment and active assistance of the patient in the therapeutic process, the disease can be taken under control and disability can be avoided, preventing the development of complications and preserving the functions of the limb.
Prevention
To prevent atherosclerosis and other vascular pathologies, it is important to maintain physical activity, quit smoking and control body weight in adulthood and old age. Hiking, swimming and light gymnastics boost your metabolism and burn off excess calories before they turn into plaques. With a tendency to diabetes mellitus and arterial hypertension, it is necessary to strictly follow the medication schedule and adhere to a diet.
A balanced diet increases the chances of avoiding atherosclerosis. For the normal course of reactions of lipid-carbohydrate metabolism in the daily menu of an elderly person, there must be a sufficient amount of vitamins, minerals, antioxidants, polyunsaturated fatty acids and plant fibers. For cooking, select only high-quality natural products that do not contain hydrogenated vegetable fats and industrial food additives. Do not get carried away with fatty foods, fast food and sweets: these foods dramatically increase the calorie content of the diet.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
