Atherosclerotic occlusion of the femoral and popliteal artery. Atherosclerosis occlusion of the lower extremities

Damage to the femoral arteries is the most common location of atherosclerotic arterial lesions lower extremities. When examining a population over 50 years of age, its frequency is 1%, and in patients with peripheral atherosclerosis it is 55%. .

Clinically, damage to this area is benign; about 78% of patients with intermittent claudication when only conservative therapy form a stable group for 6 years. Disabling intermittent claudication and critical ischemia are indications for surgical treatment– surgical (reconstructive vascular surgery or angioplasty) revascularization, while bypass surgery is still considered the operation of choice.

Percutaneous transluminal angioplasty (PTA) has been intensively introduced into the treatment of occlusive lesions of the femoral arteries for almost 40 years. The possibility of recanalization of long occlusions, good immediate results, simplicity of the procedure, and a very low percentage of complications are gradually expanding the indications for PTA and currently it is performed even in patients with severe and widespread lesions of the peripheral arteries.

Despite the improvement of methods and tools, widespread implementation stenting and the enthusiasm of researchers, the long-term results of angioplasty in the 90s did not correspond to the results of reconstructive operations.

Clinical series of studies have shown patency of the angioplasty site within 2 years ranging from 46 to 79% and 36 to 45% within 5 years. Such results did not allow us to widely recommend the implementation of PTA in the femoropopliteal segment.

These data differ significantly from the results of operations in the aortoiliac zone, in which the role of angioplasty is significantly higher and long-term results do not differ from the results of reconstructive surgery.

However, studies are ongoing with multivariate analysis of in which cases PTA is preferable to reconstructive surgery and what reasons influence long-term outcomes. In this paper, we analyze our experience in angioplasty of occluded (more than 10 cm in length) femoral arteries.

Materials and methods.

From 1993 to 2002, we performed 73 endovascular recanalizations of occluded superficial femoral arteries (SFA) in 58 patients (56 men and 2 women). The length of the lesion is more than 10 cm (from 11 to 26 cm, average length 15.5 cm). In 8 cases, 7 patients had completely occluded SFA from the mouth to the entrance to the Gunter canal.

History of the disease up to 10 years. Age ranged from 52 to 80 years ( average age was 61.5 ± 9.8 years). Smokers - 28 patients (48.3%), arterial hypertension noted in 30 (51.7%), hypercholesterolemia in 24 (41.4%) and diabetes in 13 (22.4%). 27 (46.6%) had cardiac ischemia. Indications for minimally invasive intervention were determined based on the results of noninvasive procedures and angiography.

Clinical symptoms. In 42 limbs, only intermittent claudication was detected (57.5%), in 10 - pain at rest (13.7%), ischemic ulcers and necrosis - in 18 cases (24.7%) and acute ischemia in 3 (4.1%).

In patients with intermittent claudication, the average brachial-ankle index (BAI) before surgery was 0.61 (± 0.11), and in patients with critical ischemia it was 0.39 (± 0.12).

It should be noted that combined interventions were performed relatively often: with angioplasty of the popliteal-tibial segment, which was performed in 9 patients (14.3%), and especially of the aorto-iliac segment - in 17 patients (25.4%). Thus, good functioning of the “inflow pathways” and “outflow pathways” was ensured, which, in particular, predetermined favorable long-term results of angioplasty.

Surgical technique.

Recanalization of the artery was performed using a hydrophilic guide "Road Runner" (COOK) and was successful in 73 (92.4%) cases out of 79. The approaches used were: antegrade femoral in 65 cases and retrograde popliteal in 8. In the presence of a stump of the SFA (proximal) - recanalization of the occluded segment was carried out antegradely, and in the absence of a stump - retrogradely, through the popliteal artery. It should be noted that it was the absence of the SFA stump and the presence of a powerful collateral extending at the site of occlusion that was the main reason for failures when attempting antegrade recanalization.

After conduction recanalization, balloon angioplasty was performed using “Opta” balloon catheters (Cordis), balloon diameter 5, 6 and 7 mm, length 100 mm.

195 stents were implanted, ZA stents from the company "COOK" were used (stenting index - 2.67), length 40, 60 and 80 mm, diameter 6 - 8 mm. Stenting was performed “pointwise” in areas of residual stenosis or occlusive dissection.

The largest number of stents implanted in one SFA is 4.
Anesthetic care. In all cases, local anesthesia was used.
Medication provision: symptomatic treatment+ Plavix 1 tablet once a day 3-4 days before the intervention, during surgery - heparin 100 IU per 1 kg of patient weight, after - heparin 1000 IU per hour with a dose reduction and a gradual transition on the third day (before discharge) for low molecular weight heparin - fraxiparin 0.6 once a day for 2 weeks + plavix for 6 months + aspirin cardio 100 mg constantly + symptomatic treatment.
The length of hospitalization averaged 2.56 days (from 2 to 4 days).

Results.

Immediate results: After successful conduction recanalization followed by balloon dilatation and stenting, good angiographic and clinical results were achieved in all cases. Complications were noted in 4 patients (6.0%). In 2 cases, distal arterial embolism occurred, in 2 others a false aneurysm of the femoral artery formed. Peripheral macroembolism with blockage of the blood flow of the popliteal artery or the main arteries of the leg is one of the main complications of recanalization of chronic occlusions. In one case, the embolus was aspirated through a catheter; in another case, the embolus was relegated to the anterior tibial artery and an open embolectomy was performed using a typical approach at the ankle level. False aneurysms were treated using ultrasound-guided pressure dressings.

Immediate and long-term results: The results were assessed by primary and secondary patency of the operated arteries

Control was carried out using a clinical examination using non-invasive research methods (measurement of PLI and ultrasound duplex scanning) at 3, 6, 12 months and then annually.

Clinical success was defined as the improvement of clinical symptoms and an increase in the brachial-ankle index by at least 0.15 or normalization of the peripheral pulse. The average PLI increased to 0.86 ± 0.22(p

In the long-term period (36 months or more), 31 patients were followed up, who had previously undergone 38 recanalizations. Restenosis of more than 50% was detected in 11 arteries (28.9%), reocclusion in 7 (18.4%). All patients underwent repeated angioplasty. In only one patient, due to the impossibility of repeated recanalization, a femoral-popliteal bypass was performed. 3 patients underwent repeated angioplasties during a follow-up period of up to 96 months, 3 times, and one - 4 times, with preservation of a patent SFA. It should be noted that in the presence of initial patency of the proximal portion of the popliteal artery, the best results were noted in both the immediate and long-term periods. Restenosis occurred more often in the distal portion of the SFA (in Gunter's canal) than in the proximal portions. In this case, the occurrence of reocclusion of the superficial femoral artery occurred without severe clinical symptoms characteristic of acute occlusion. Primary patency after angioplasty was 76% after 5 years, secondary patency 84.5%. Complications: in 1 patient with repeated punctures through the popliteal artery, an arteriovenous anastomosis occurred. The anastomosis was surgically separated. There were no fatal cases. No lower limb amputations were performed. Clinically, an improvement in blood circulation in the lower extremities and, accordingly, an increase in the patient’s quality of life was noted in all cases.

Cumulative patency was calculated using the Kaplan-Meier method and compared with the log-rank test (see Fig. 1)

Rice. 1.

As an example, we give the following clinical observation:
Patient G., 51 years old, with complaints of intermittent claudication on both sides after 150 m. The history of the disease was about 10 years, when he first noticed pain in calf muscles when walking. Upon admission, both lower extremities are warm, of normal color, movement and sensitivity are not reduced, the calf muscles are painless on palpation. Ripple is determined only at the level of the femoral arteries, absent distally, 2B degree of ischemia. PLI on both sides 0.56.
Angiography revealed: subtotal stenosis of the right common iliac artery (CIA) in distal section.(see Fig. 2)

Rice. 2.

The patient underwent balloon angioplasty and stenting of the right SAA and BOTH, recanalization of both SAA followed by balloon angioplasty and stenting through popliteal puncture approaches on both sides. Balloon angioplasty of the PCA and OBA was performed with balloons with a diameter of 10 and 7 mm, followed by stenting; the diameter and length of the stents were 10 mm and 60 mm in the PCA, 8 mm and 40 mm in the OPA, respectively. Recanalization of the SFA was performed on both sides with a hydrophilic “Road Runner” conductor, followed by balloon angioplasty with balloons with a diameter of 6 and 7 mm and stenting. ZA stents of the appropriate diameter and length from 40 to 80 mm were installed in all arteries. A total of 6 stents were installed: in the right PA, right BA, right SFA, 3 stents in the left SFA: 1 in the proximal part, starting from the mouth, 2 in the area of ​​Gunter’s canal. (see Fig. 3)

Rice. 3.

After the operation, a clear pulsation of the arteries of the lower extremities was noted at all levels, the patient was discharged on the 2nd day after angioplasty.
After 6 months, the patient noted the appearance of a feeling of numbness in the left foot when walking. A duplex scan of the arteries of the lower extremities was performed, which revealed stenosis of the left SFA 80% before entering the Gunter canal. PLI on the left is 0.7. Angiography revealed stenosis of the left SFA at the border of the middle and lower third immediately above the previously installed stents; there were no changes in other arteries and previously stented areas. Using a popliteal approach, balloon dilatation was performed with placement of another stent proximal to the previous one in the left SFA. The patient was discharged on the 2nd day, blood flow in the left lower limb was completely restored, PLI 0.86.
The patient returned to the clinic 1.5 years after the primary angioplasty and a year after the repeat angioplasty with intermittent claudication on the left after 400 m, the right claudication did not bother him. The patient also noticed moderate swelling of the left foot. The left ABI was 0.64. Angiography was performed again, this time using a transradial approach; restenosis was detected inside the stents at the mouth of the left SFA, restenosis in the middle portion of the left SFA, where stenting was not performed, and restenosis inside the proximal stent in the Gunter's canal. The right lower limb remained without hemodynamically significant changes. An arteriovenous discharge was detected in the left lower limb from the popliteal artery into the vein of the same name. (see Fig. 4a and 4b)

Using an approach in the popliteal region, the popliteal artery on the left was identified, the arteriovenous junction was ligated, the popliteal artery was punctured, and balloon angioplasty of stenoses of the left SFA was performed with a good immediate result, which did not require additional stenting. (see Fig. 5)

Rice. 5.

The patient was discharged on the 4th day with clinical recovery and an increase in PLI to 0.89.

This clinical observation is interesting because the patient underwent multi-level multiple angioplasty of occluded main arteries of the lower extremities. After repeated puncture of the popliteal artery, an arteriovenous anastomosis formed, requiring surgical elimination. A total of 7 stents were implanted. Despite repeated interventions, patency of all native main arteries of the lower extremities is maintained, hospitalizations are short, operations are gentle and minimally invasive. At the same time, in the future it remains possible to use any method for treatment.

Discussion.

There are a huge number of reports on the use of the PTA method in the treatment of occlusive lesions of the SFA, and the authors provide very different data, both on the clinical and angiographic indications for using the method, and on the long-term results of interventions. As for the surgical technique (methods and mechanism of recanalization, choice of access for intervention, choice of instruments and stents), it is, in principle, well developed. There are several factors affecting the long-term results of PTA, but the most important should be considered angiographic criteria, since they determine the patency of the artery in the long-term period. (,,,) The length of the lesion, its localization, the state of the “outflow tract” - these are the main criteria that ensure success or lead to an unsatisfactory result. Until now, it was believed that only with stenotic lesions of the SFA and short, less than 5 cm, occlusions with preserved distal arterial bed, PTA could be successfully used, and in other cases the patient was shown standard bypass surgery (for example, G. Agrifiglio et al., 1999) . In support of this fact, unsatisfactory results are described specifically with PTA of the femoral-popliteal area with long lesions (,). In addition, patency depends on the affected area: the more distal the intervention is, the worse its results.

The issue of stenting during PTA remains controversial. Residual stenoses after angioplasty (dissections, intimal detachments, elastic stenoses) are an indication for stenting in the femoropopliteal area. However, a study by Bergeron et al showed that stents cause neointimal hyperplasia as early as 4 months after implantation. Several other studies of long-term results of stenting in this area describe the occurrence of restenosis in 20 to 40% of cases over a period of 6 to 24 months, regardless of the stent model used. In these studies, the authors try to determine the reason for such a high rate of restenosis, considering stenting for occlusions to be one of them. Thus, when stenting a recanalized segment of an artery, restenosis occurs in 33-40%, while stenting stenosis occurs only in 9-18%; the second reason is the stenting area in the SFA. In the lower third of the thigh, restenosis occurs in 40% of cases, and in the upper third of the SFA only in 9%. The number of implanted stents, that is, the length of the artery section covered with stents, also affects the incidence of restenosis: 1 stent - 3.6% of restenoses within 6 months and 18% - within 4 years, and with 2 stents or more, respectively 7. 9% and 34% (25). Stenting, according to most researchers, does not improve long-term results in the femoropopliteal area, since it increases the frequency of restenosis. An attempt to use nitinol stents "Smart" (Cordis) coated with sirolimus for angioplasty of the SFA showed better results in terms of primary patency compared to the control group within 6 months. But then, within 12 months, the results were almost equal.

Conclusion.

Based on our experience, we believe that “point” (for residual stenosis and occlusive dissection) stenting is a method that allows one to obtain satisfactory results of angioplasty of an occluded SFA, preventing acute thrombosis and early reocclusion in the operated artery.

We believe that improvement in PTA results is only possible through aggressive reinterventions. Only reinterventions lead to improved long-term results and patency of the stented segment. Other researchers share the same opinion (, ,).

How much and how often is it possible to perform PTA to eliminate restenosis? Our experience shows that PTA can be performed an infinite number of times in a previously recanalized artery with or without placement of additional stents. Should we be afraid of restenosis and is this a reason for refusing to attempt PTA of long SFA occlusions? - No. What does a patient gain by choosing PTA over bypass surgery? Firstly, the minimum length of hospitalization, allowing you not to take a long break from everyday work, a minimum number of complications and quick rehabilitation in postoperative period due to minimal surgical trauma. The ability to perform multi-level, multi-vascular interventions to improve the “inflow pathways” and “outflow pathways”, allowing complete restoration of blood flow in the affected limb or even in both limbs during one hospitalization.

With the development of restenosis in stented artery There is always the possibility of performing repeated PTA, which leads to complete restoration of blood flow. Periodic examinations by the angiosurgeon and ultrasound monitoring of the stented artery are necessary, as well as constant anticoagulant and disaggregation therapy after the intervention. Yes, a recanalized and stented artery requires attention and care on the part of the patient and his attending physician, but is this so different from the management of patients after open reconstructive surgery? However, in the case of PTA, we preserve the native artery and always leave the patient the opportunity to undergo repeated interventions in the event of a “catastrophe” in the operated artery, which is extremely difficult, and in most cases impossible with open reconstructive operations. The only big disadvantage of PTA for recanalization of long occlusions (more than 10 cm) of the SFA is the high cost of the procedure, but this is compensated by the above-mentioned indisputable advantages.

High secondary patency during stenting is directly related to mandatory periodic non-invasive duplex examination of the angioplasty area for the earliest possible detection of neointimal hyperplasia and its control.

Analyzing the results of the study and literature data, we believe that PTA is the method of choice in the treatment of occlusions in the femoral area.

The choice of revascularization method for lesions of the SFA is based on an analysis of the patient’s general condition (taking into account age, concomitant pathology); data from instrumental research methods (the extent and extent of damage and the condition of the distal arterial bed), as well as the degree of ischemia, the presence of trophic disorders, and infection.

Elderly patients with severe concomitant pathology -

Damage to large vessels, which leads to narrowing and impaired circulation is obliterating atherosclerosis of the vessels of the lower extremities. Nowadays, this is one of the most common pathologies associated with an unhealthy lifestyle.

A person may not be aware of his illness, and attribute pain in the legs to fatigue. In order to prevent this disease, it is necessary to carry out timely prevention and begin treatment at an earlier stage.

We will tell you what you need to pay attention to and how to control arterial pressure, stick to proper diet and physical activity regimen, in other words, eliminate all risk factors for further development of the disease

Obliterating atherosclerosis of the vessels of the lower extremities - characteristics

Obliterating atherosclerosis is a disease that occurs when the walls of arterial vessels thicken due to deposits of lipids and cholesterol, which form atherosclerotic plaques, causing a gradual narrowing of the lumen of the artery and leading to its complete closure.

Atherosclerotic damage to the arteries in each individual case manifests itself in the form of narrowing (stenosis) or complete blockage (occlusion) in a specific section of the artery, which prevents the normal flow of blood to the tissues. As a result, tissues do not receive the nutrients and oxygen necessary for their normal functioning.

First, a condition called ischemia develops. It signals that the tissues are suffering from a lack of nutrition, and if this condition is not corrected, tissue death will occur (necrosis or gangrene of the legs).

A feature of atherosclerosis is that this disease can simultaneously affect the vessels of several pools. When the vessels of the extremities are damaged, gangrene occurs, damage to the vessels of the brain leads to a stroke, and damage to the vessels of the heart is fraught with a heart attack.

Atherosclerotic changes in the vessels of the lower extremities and aorta are present in most people of the middle age group, however, at the first stage, the disease does not manifest itself in any way.

Symptoms indicating arterial insufficiency are pain in the legs when walking. Gradually, the intensity of the symptoms increases and leads to irreversible changes in the form of gangrene of the leg. The disease occurs 8 times more often among men than among women.

Additional risk factors leading to an earlier and more severe course of the disease: diabetes mellitus, smoking, excessive consumption of fatty foods. Vascular atherosclerosis is characterized by constant progression, leading to gangrene of the lower limb, which entails amputation of the leg, which is necessary to save the patient’s life.

The development of gangrene can only be prevented by timely treatment and timely measures taken to normalize blood flow. Source: “2gkb.by” What kind of disease is this, and how is it dangerous? Obliterating atherosclerosis of the arteries of the lower extremities is a chronic disease characterized by narrowing of the artery (stenosis) and even its complete blockage (occlusion) as a result of sclerotic processes.

In this case, blood circulation is disrupted and the tissues do not receive proper nutrition, which ultimately leads to their death. Today, this disease affects mainly the male half of the population.

This is due to factors that provoke such disorders, for example, poor nutrition, bad habits. At the same time, you need to understand that most often the development of such a blockage does not occur quickly. Usually the process lasts for decades. That is why people over 40 and older suffer from it.

There are certain stages of obliterating atherosclerosis of the vessels of the lower extremities:

• Preclinical period. There is a violation of lipid metabolism. Fatty sediment begins to accumulate inside the vessel. Deposits may appear as spots and streaks.
• The first manifestations of blood flow disorders.
• Symptoms of the disease begin to appear more clearly. Characterized by a significant change in the inner wall.
• During the examination, an atheromatous ulcer, aneurysms and detached migrating particles are revealed. As a result, slight or complete closure of the lumen occurs.

There are several types of leg lesions.

• With the 1st, segmental occlusions (blockages) are observed.
• In case of the 2nd, the process spreads over the entire upper part of the femoral artery.
• With the 3rd, the popliteal and superficial femoral part is clogged.
• Type 4 - the obleteric process involves the popliteal and femoral arteries, but patency in the deep veins is preserved.
• With the development of type 5, a complete blockage of the deep femoral artery occurs.

Surgeries for obliterating atherosclerosis can be recommended already at the 2nd stage of the disease. Source: “stopvarikoze.ru”

This disease is a pathology that develops when the walls of blood vessels harden due to the deposition of cholesterol and fats in them, which subsequently form atherosclerotic plaques that narrow the lumen of the artery, causing its complete blockage.

Atherosclerotic vascular damage in each case is manifested by a narrowing of the diameter of the vessel or its complete closure in a specific place, preventing healthy blood flow. Accordingly, the tissues do not receive nutrients and oxygen for proper functioning.

Initially, a person is struck by ischemia, which indicates that the tissues have already suffered from a lack of nutrients entering them. If the disease is not stopped in time, tissue necrosis and gangrene of the legs will begin.

Atherosclerotic vascular diseases are distinguished by the fact that they can damage vessels simultaneously in several pools. With vascular pathologies in the legs, gangrene develops, with vascular pathologies in the brain, there is a risk of stroke, and if the vessels of the heart are damaged, it can provoke a heart attack.

Obliterating atherosclerosis of the lower extremities develops in most middle-aged people, but initially the disease does not manifest itself in any way. Signs of a pathological condition in the first stages of arterial insufficiency are pain in the legs while walking.

Over time, the symptoms become more and more intense, which causes irreversible damage, manifested by gangrene of the lower extremities. The disease affects males eight times more often than women. Source: “lechenie-sosudov.ru”

Based on the distance that a person walks without pain (pain-free walking distance), 4 stages of obliterating atherosclerosis of the arteries of the lower extremities are distinguished.

• Stage 1 - pain-free walking distance of more than 1000 m.
• Stage 2a - pain-free walking distance of 250-1000 m.
• Stage 2b - pain-free walking distance of 50-250 m.
• Stage 3 - pain-free walking distance of less than 50 m, pain at rest, pain at night.
• Stage 4 - trophic disorders.

In stage 4, areas of blackened skin (necrosis) appear on the fingers or heel areas. In the future, this can lead to gangrene and amputation of the damaged part of the leg. As the disease progresses and there is no timely treatment, gangrene of the limb may develop, which can lead to the loss of a leg.

Timely contact with a specialist, high-quality consultative, medicinal, and, if necessary, surgical care can significantly alleviate suffering and improve the patient’s quality of life, save a limb and improve the prognosis for this severe pathology.

In order to prevent the development of obliterating atherosclerosis of the vessels of the lower extremities, it is necessary to carry out prevention and treatment of atherosclerosis at earlier stages of the development of the disease.

It is important to remember that clinical manifestations of the disease appear when the lumen of the vessel narrows by 70% or more. In the early stages, the disease can only be detected with additional examination in medical institution! Timely contact with specialists will allow you to maintain your health! Source: "meddiagnostica.com.ua"

Treatment methods for obliterating atherosclerosis of the lower extremities will depend on the degree of arterial damage, the severity of symptoms and the speed of development. It was these factors that scientists took into account when classifying pathology.

The first classification principle is based on a very simple indicator that does not require any research. This is the distance that a person can cover before he feels discomfort in his legs.

In this regard there is:

• initial stage – pain and fatigue are felt after covering a kilometer distance;
• Stage 1 (middle) – not only pain and fatigue appear, but also intermittent claudication. The distance covered varies from ¼ to 1 kilometer. Residents of large cities may not feel these symptoms for a long time due to the absence of such stress. But rural residents and residents of small towns without public transport are aware of the problem already at this stage;
• Stage 2 (high) – characterized by the inability to cover distances of more than 50 m without severe pain. Patients at this stage of the pathology are forced to mostly sit or lie so as not to provoke discomfort;
• Stage 3 (critical). There is a significant narrowing of the lumen of the arteries and the development of ischemia. The patient can only move short distances, but even such loads bring severe pain. Night sleep is disturbed due to pain and cramps. A person loses his ability to work, becomes disabled;
• Stage 4 (complicated) – it is characterized by the appearance of ulcers and foci of tissue necrosis due to disruption of their trophism. This condition is fraught with the development of gangrene and requires immediate surgical treatment.

According to the degree of spread of pathological processes and the involvement of large vessels in them, they are distinguished:

• 1st degree – limited damage to one artery (usually the femoral or tibial);
• 2nd degree – the entire femoral artery is affected;
• 3rd degree – the popliteal artery begins to be involved in the process;
• Grade 4 – the femoral and popliteal arteries are significantly affected;
• Grade 5 – complete damage to all major vessels of the leg.

Based on the presence and severity of symptoms, pathology is divided into four stages:

1. Mild – lipid metabolism processes are disrupted. Is revealed only by carrying out laboratory research blood, since there are no uncomfortable symptoms yet.
2. Medium – the first symptoms of pathology begin to appear, which are often mistaken for fatigue ( slight pain after exercise, slight swelling, numbness, increased reaction to cold, “goosebumps”).
3. Severe – there is a gradual increase in symptoms that cause significant discomfort.
4. Progressive - the beginning of the development of gangrene, the appearance in the first stages of small ulcers that develop into trophic ones.

And now the most important classification, which has a decisive influence on the question of how to treat OASNK, is the ways of developing the pathology:

• rapid - the disease develops quickly, symptoms appear one after another, pathological process spreads to all arteries and gangrene begins. In such cases, immediate hospitalization, intensive care, and often amputation are necessary;
• subacute – periods of exacerbation are periodically replaced by periods of attenuation of the process (reduction of symptoms). Treatment in the acute stage is carried out only in a hospital setting, often conservative, aimed at slowing down the process;
• chronic - develops over a long time, primary symptoms are absent at all, then begin to appear in varying degrees of severity, which depends on the load. Treatment is medicinal if it does not develop into another stage. Source: "boleznikrovi.com"

Causes

As mentioned above, this pathology represents the spread of a general atherosclerotic process to the arteries of the lower extremities - the terminal aorta, iliac, femoral, popliteal arteries and arteries of the foot.

The leading cause of the disease is an imbalance of blood lipids, and the risk factors that are important in this case are:

• gender – male;
• bad habits, especially smoking;
• unhealthy diet – eating large amounts of fatty foods;
• hypertonic disease;
• carbohydrate metabolism disorder (diabetes mellitus).

The main morphological changes in OA of the leg vessels occur in the intima (inner lining) of the arteries. Cholesterol and droplets of fat are deposited on its surface - yellowish spots form. Around these areas after some time appears connective tissue– a sclerotic plaque is formed.

It accumulates lipids, platelets, fibrin and calcium salts in and on itself, as a result of which blood circulation in it is sooner or later disrupted. The plaque gradually dies off - cavities appear in it, called atheromas, which are filled with decaying masses. The wall of this plaque becomes very fragile and crumbles at the slightest impact.

Crumbs of the disintegrated plaque enter the lumen of the vessel and spread through the bloodstream into the underlying vessels - those with a smaller lumen diameter. This leads to embolism (blockage) of the lumen, resulting in critical ischemia of the limb in the form of gangrene.

In addition, a large plaque partially blocks the lumen of the vessel, as a result of which blood flow is disrupted in the part of the body that lies distal to the location of the plaque. The tissues experience a chronic lack of oxygen, the patient experiences muscle pain, a feeling of coldness in the affected limb, and later trophic ulcers are formed - difficult-to-heal skin defects.

These changes cause the patient excruciating suffering - sometimes his condition worsens so much that he himself begs the doctor to amputate the affected part of the limb. Source: "physiatrics.ru"

Atherosclerotic damage to the vessels of the lower extremities is a manifestation of systemic atherosclerosis, which most often develops under the following conditions:

• obesity
• hypertension;
• kidney and liver diseases;
• vasculitis;
• systemic lupus erythematosus;
• persistent herpes infections;
• hypercholesterolemia (blood cholesterol levels exceed 5.5);
• diabetes mellitus;
• blood clotting disorders;
• hyperhomocysteinemia;
• dyslipidemia (LDL level above 2);
• aneurysm of the abdominal aorta;
• physical inactivity;
• hereditary predisposition;
• smoking;
• alcoholism;
• frostbite of the feet;
• injuries of the lower extremities;
• excessive physical activity. Source: “doctor-cardiologist.ru”

As a rule, atherosclerosis begins its journey from the iliac and femoral arteries, moving down to the vessels of the leg and foot. Most often, blood vessels are affected at branching points. It is these areas that experience the greatest load.

A plaque forms in a critical location. The wall of the blood vessel changes color to yellowish, becomes dense, deformed and lacks elasticity. Over time, arteries may lose patency and become completely blocked.

It is rare, but it happens that due to atherosclerosis, a blood clot forms in the blood vessels. Then the count goes on in hours and even minutes. When a person suddenly becomes ill, and a limb seems cold and too heavy to lift, urgent help from a vascular surgeon is needed.

Depending on the location of the plaques and the length of the affected area of ​​the arteries, several anatomical types of disease of the femoral-popliteal-tibial segment are distinguished. For the femoral and popliteal arteries there are 5:

1. segmental (limited areas);
2. the entire surface of the femoral artery;
3. widespread lesions (or occlusion) of both the femoral and popliteal arteries with patency of the bifurcation area of ​​the second of them;
4. damage to both major blood vessels together with the area of ​​the popliteal fork, possibly with a lack of blood flow in it, but the deep femoral artery remains patency;
5. The disease, in addition to widespread spread to the femoral-popliteal segment, also affected the deep artery of the femur.

For the popliteal and tibial arteries, there are 3 options for blockage of blood vessels:

1. in the lower and middle parts of the leg, the patency of 1-3 arteries is preserved with damage to the branching of the popliteal artery and the initial parts of the tibial arteries;
2. the disease affects 1-2 blood vessels of the leg, with patency of the lower part of the popliteal and 1-2 tibial arteries noted;
3. the popliteal and tibial arteries are damaged, but some of their sections on the lower leg and foot remain patent. Source: "damex.ru"

Leriche syndrome is a disease of the aorta and iliac arteries

Atherosclerotic plaques narrow or block the lumen of large vessels, and reduced blood circulation occurs through small lateral vessels (collaterals).

Clinically, Leriche syndrome is manifested by the following symptoms:

1. High intermittent claudication. Pain in the thighs, buttocks and calf muscles when walking, forcing you to stop after a certain distance, and in the later stages constant pain at rest. This is due to insufficient blood flow in the pelvis and thighs.
2. Impotence. Erectile dysfunction is associated with cessation of blood flow through the internal iliac arteries, which are responsible for blood supply to the cavernous bodies.
3. Pale skin of the feet, brittle nails and baldness of the legs in men. The reason is a sharp violation of skin nutrition.
4. The appearance of trophic ulcers on the tips of the fingers and feet and the development of gangrene are signs of complete decompensation of blood flow in the later stages of the development of atherosclerosis.

Leriche syndrome is a dangerous condition. Indications for amputation of one leg occur in 5% of cases per year. 10 years after diagnosis, 40% of patients have had both limbs amputated.

Treatment of obliterating atherosclerosis of the iliac arteries (Leriche syndrome) is only surgical. In the majority of patients in our clinic, it is possible to perform endovascular or hybrid surgery - angioplasty and stenting of the iliac arteries.

Stent patency is 88% at 5 years and 76% at 10 years. When using special endoprostheses, results improve up to 96% within 5 years. In difficult cases, with complete blockage of the iliac arteries, it is necessary to perform aorto-femoral bypass, and in weakened patients, cross-femoral or axillary-femoral bypass.

Surgical treatment for atherosclerosis of the iliac arteries avoids amputation in 95% of cases. Source: "gangrena.info"

Damage to the arteries of the leg and foot

Atherosclerosis of the arteries of the leg and foot can be isolated, but is more often combined with obliterating atherosclerosis of the iliac and femoropopliteal segment, significantly complicating the course of the disease and the possibility of restoring blood flow.

With this type of atherosclerotic lesion, gangrene develops more often and faster. The development of critical ischemia against the background of lesions of the arteries of the leg and foot requires immediate surgical intervention.

The most effective is the use of microsurgical bypass with an autologous vein, which allows in 85% of cases to save the leg from amputation. Endovascular methods are less effective but can be repeated. Amputations should be carried out only after all methods of saving the limb have been exhausted. Source: "gangrena.info"

Disease of the femoropopliteal segment

Occlusion of the femoral and popliteal artery is the most common manifestation of atherosclerosis of the legs. The prevalence of these lesions reaches 20% among patients in the older age group. Most often, the main clinical manifestation of this disease is pain in the calves when walking a certain distance (intermittent claudication).

Critical ischemia does not always develop in this localization of vascular atherosclerosis. Often the trigger is a wound, abrasion or abrasion of the foot. Then a trophic ulcer appears, which causes pain and forces the leg to drop. Edema forms, which further impairs microcirculation and leads to the development of gangrene.

Treatment of femoral-popliteal-tibial atherosclerosis can initially be conservative. Drug therapy, sanatorium-resort treatment, and physiotherapy are provided. A very important treatment method is therapeutic walking and smoking cessation.

The use of these methods can prevent critical ischemia. Surgical treatment is suggested for cases of rest pain and gangrene.

Most effective method Surgical correction in these cases is microsurgical femorotibial or popliteal vascular bypass. Angioplasty is also used in some cases, but its effect is less long-lasting. Shunting allows 90% of patients with incipient gangrene to save the leg. Source: "angioclinic.ru"

Symptoms

Manifestations of obliterating atherosclerosis of the lower extremities develop gradually. A person may not feel any changes for a long time. As the process progresses and the lumen of arterial vessels decreases by more than 30-40% of the original diameter, such characteristic symptoms:

• Pain and feeling of fatigue in the leg muscles after physical activity (walking).
• Intermittent claudication is pain that is significantly worse when walking, causing the person to limp. After a short rest (restoration of oxygen and nutrients to the tissues of the legs), the pain decreases.
• Development pain at rest - an indicator of severe obliterating atherosclerosis, which indicates the possible development of complications.
• The feeling of numbness, which is initially present in the foot, then rises higher - the result of a deterioration in the nutrition of the nerves and a disruption in the passage of impulses along the sensory fibers.
• Feeling of cold in the leg.
• Decreased pulsation in the arteries of the legs - usually manifests itself as a noticeable asymmetry when checking the pulse in the same arteries of both legs.
• Darkening of the skin on the leg with arteries affected by atherosclerosis is a harbinger of incipient gangrene.
• Prolonged healing of the skin in the wound area, which is often accompanied by infection.

Such characteristic symptoms make it possible to determine the presence of obliterating atherosclerosis at the stage of significant changes in the tissues of the legs. Source: "prof-med.info"

The research algorithm consists of 3 main points: anamnesis, functional tests and ultrasound. Complaints, detailed medical history, examination of the patient. On the affected leg, the skin is thick, shiny, may be pale or red, there is no hair, the nails are thick, brittle, there are trophic disorders, ulcers, the muscles are quite often atrophied.

The sore leg is always colder, there is no pulse in the arteries. Having assessed these data, the doctor measures ABI - the ratio of systolic pressure at the ankles to the brachial pressure; normally it is more than 0.96; in patients with OASNK it is reduced to 0.5. When auscultating narrowed arteries, a systolic murmur is always detected; when an artery is occluded below its location, the pulse is weak or absent.

Then a complete blood biochemistry and ECG are prescribed, and systolic pressure is measured in the digital arteries and the lower part of the leg. Standard arteriography is performed to determine the patency of the main arteries.

CT angiography is considered the most accurate method of the disease, MR angiography, Dopplerography determine the speed of blood flow, the degree of saturation of muscle tissue with oxygen and nutrients, duplex scanning of large vessels of the legs determines the degree of blood supply to the affected leg, the condition of the artery wall itself, and the presence of compression.

All of the above studies should reveal the presence of leg ischemia. Functional tests are carried out:

1. Burdenko test. If you bend the affected leg at the knee, a reddish-bluish pattern appears on the foot, which indicates impaired blood flow and outflow.
2. Shamov-Sitenko test. Apply and compress the thigh or shoulder with a cuff for 5 minutes; when the cuff is loosened, the limb turns pink after it for half a minute; in case of pathology, it takes more than 1.5 minutes.
3. Moshkovich test. sick in horizontal position raises straight legs for 2-3 minutes, while normally the feet turn pale due to drainage of blood, then the patient is asked to stand up. Normally, the foot turns pink within 8-10 seconds; with atherosclerosis, it remains pale for a minute or more.

Consultation with a vascular surgeon is mandatory. Source: “sosudoved.ru”

Vascular atherosclerosis requires the development of an individual treatment regimen in each specific case. Treatment tactics depend on the extent, degree and level of arterial damage, as well as on the presence of concomitant diseases in the patient.

For atherosclerosis of the vessels of the lower extremities, the following methods are most often used:

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

With atherosclerosis of the lower extremities at the initial stage (at the stage of intermittent claudication), treatment can be conservative. The conservative method is also used to treat weakened patients whose condition is complicated by concomitant pathology, which makes surgical intervention to restore blood flow in the legs impossible.

Conservative treatment consists of medication and physiotherapy, including dosed walking and physical therapy.

Drug treatment involves the use of drugs that relieve spasm from peripheral small arterial vessels, thin and reduce blood viscosity, help protect arterial walls from further damage, and have a stimulating effect on the development of collateral branches.

Well drug treatment needs to be done several times a year, some medications need to be taken constantly. It should be understood that, so far, there is no medication that could restore normal blood circulation through a blocked artery.

The above-mentioned drugs only have an effect on small vessels through which blood moves around the blocked section of the artery. This treatment is aimed at expanding these bypass pathways in order to compensate for the lack of blood circulation.

For segmental narrowing of an artery section, an endovascular treatment method is used. Through a puncture of the affected artery, a catheter with a balloon is inserted into its lumen, which is brought to the site of narrowing of the artery. The lumen of the narrowed segment is expanded by inflating the balloon, as a result of which blood flow is restored.

If required, a special device (stent) is installed in this segment of the artery to prevent narrowing of this section of the artery in the future.

This is called balloon dilatation with stenting. Arterial stenting, balloon dilatation, angioplasty are the endovascular treatment methods most common for atherosclerosis of the lower extremities. Such methods allow you to restore blood circulation through the vessel without surgical intervention. These procedures are performed in a cath lab equipped with special equipment.

For very long areas of blockage (occlusion), it is more often used surgical methods aimed at restoring blood flow in the legs. These are methods such as:

• Prosthetics of a section of a blocked artery with an artificial vessel (alloprosthesis).
• Bypass surgery is a method in which blood flow is restored by directing the movement of blood around the blocked section of the artery through an artificial vessel (shunt). A segment is sometimes used as a shunt saphenous vein sick.
• Thrombendarterectomy - removal of atherosclerotic plaque from the affected artery.

These surgical methods can be combined or supplemented with other types of operations - the choice depends on the degree, nature and extent of the lesion, and they are prescribed taking into account the individual characteristics of the patient, after a detailed examination by a vascular surgeon.

In cases of multilevel atherosclerosis of the vessels of the lower extremities, treatment is used that combines bypassing of the blocked section of the artery and expansion (dilatation) of the narrowed one.

When an operation to restore blood circulation is performed when necrosis or trophic ulcers have already appeared, another surgical intervention may be required, which is performed either simultaneously with this operation or some time after it.

Additional surgery is needed to remove gangrenous dead tissue and cover trophic ulcers with a skin flap. The appearance of ulcers or gangrene is a sign of extensive arterial occlusions, multi-level vascular atherosclerosis with weak collateral circulation.

The possibilities of surgery in this case are reduced. In case of gangrene and multiple tissue necrosis of the lower limb, and it is impossible to perform surgery to restore blood flow, amputation of the leg is performed. If gangrene covers large areas of the limb and soft tissues irreversible changes have occurred, then amputation is the only way to save the patient’s life.

Arterial occlusion is the blockage of the lumen with the development of tissue ischemia. Vessel obstruction may be associated with thromboembolism or spasm. If blood flow has not resumed, then signs of necrosis increase in the area supplied by the femoral artery. If gangrene threatens, amputation is performed.

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Causes of femoral artery occlusion

The main factors that can lead to obstruction of blood flow through the femoral artery include intersection of the vessel during injury or surgery, as well as prolonged spasm.

Surgery is performed on the femoral artery if there is a threat to life due to a blood clot, embolus, or plaque. The profundoplasty procedure can be performed different ways. After the intervention, the person remains in the hospital.

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Occlusion of the arteries of the lower extremities is a fairly common disease. This pathology affects the blood vessels of the legs, but poses a danger to the entire human body.

Causes

There are reasons that cause vascular occlusion of the lower extremities:

• Embolism is the blocking of the lumen of the veins by blood clots that have reached the site of blockage through the bloodstream. An embolism forms in the branching zone of small-thick vessels.
• Thrombosis. If the pathology is caused by thrombosis, then it develops gradually. The thrombus is located on the vascular wall and gradually increases, closing the gap between the walls of the vessels.
• Aneurysm. The vessels dilate and lengthen, blood flow is disrupted and occlusion develops.
• Trauma causes disruption of the vessel, blocking its lumen or compression, which causes embolism or thrombosis, and subsequently occlusion.

Types and signs of the disease

Occlusion of the lower extremities can occur in any area of ​​the legs, and the lumen of large and small vessels is blocked.

There are such types of disease:

• Obstruction of large arteries, which interferes with blood flow in the femoral areas.
• Blockage of the small arteries that supply blood to the feet and legs.
• Mixed blockage of both small and large vessels.

Depending on what factors caused the development of the disease, the following types are distinguished:

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• Arterial. A thrombus appears in large arteries or on the valves of the heart, and is then carried by the movement of blood to the lower systems of the body.
• Air. The lumen of the vessel closes the air, which can occur as a result of lung injury.
• Fat. After a bone fracture, a piece of fat blocks the vessel.

Arterial obstruction occurs acute form and chronic:

• Acute occlusion develops when a vessel is blocked by a thrombus and has a rapid course.
• Chronic occlusion develops slowly, its symptoms depend on the formation of cholesterol plaques on the walls of the arteries and the gradual decrease in the lumen of the vessel.

The initial symptom of the pathology is lameness. Walking quickly causes pain, so the patient, sparing his leg, begins to limp. After rest the pain goes away. But gradually the disease progresses, pain occurs more and more often.

The patient develops the following symptoms:

• Constant pain that gets worse with light exertion.
• The skin on the affected area turns pale and cold, then turns bluish.
• There is no pulsation of the arteries at the site of blockage.
• Sensitivity decreases and numbness occurs in the legs.
• Leg paralysis develops.

After blockage of a vessel, tissue necrosis occurs in a few hours at the site of occlusion, and gangrene may appear. This is an irreversible process that can lead to amputation of the limb. Therefore, if a person has symptoms of occlusion, he should urgently consult a doctor.

Diagnostics

Diagnosis at the initial stage of the disease will help prescribe treatment in a timely manner, it will be simple. If a person feels tired when walking or has diseases that put the person at risk, he needs to see a doctor for examination. The doctor does an examination and finds out whether the blood supply to the lower extremities has worsened.

Important information: How to treat hemophilia in children and what clinical symptoms incoagulability of newborn blood

The examination includes:

• visual inspection;
• search for vessel pulsation;
• tomography;
• an oscillogram that will allow you to determine the presence of a disease.

The doctor may also prescribe arteriography to the patient, which will determine the picture of the disease and the exact location of the vascular lesion. In this case, a contrast agent is injected into the vessels. Timely diagnosis allows you to avoid progression of the disease and prevent complications.

Treatment methods

Vascular obstruction is treated with medications. The first stage of the disease is treated conservatively with medications.

The second stage of the disease and subsequent ones are treated with surgery.

conservative

Before treating blockages in the legs, the patient is examined and the diagnosis is confirmed. Then treatment is prescribed. At the onset of the disease, therapy is conservative and can be done at home. The patient is prescribed various groups of medications:

• Anticoagulants that reduce blood viscosity:
  • Aspirin;
  • Cardiomagnyl.
• Antispasmodics:
  • Spasmol;
  • No-Shpa.
• Fibrinolytics, which destroy and eliminate blood clots:
  • Actylase;
  • Prourokinase.
• Painkillers:
  • Ketanol;
  • Baralgin.
• Cardiac glycosides:
  • Digoxin;
  • Korglykon.

They use drugs that improve heart contractions, such as Novocainamide. For local therapy, Heparin ointment is used. Patients are recommended vitamin complexes and physiotherapeutic treatment. Electrophoresis promotes rapid penetration medicinal substances to the affected area. Patients are prescribed magnetic therapy, which relieves pain, normalizes blood circulation, and improves oxygen supply to the blood.

Operation

Patients at the second stage of the disease are prescribed surgery:

• stenting;
• bypass;
• thrombus excision;
• prosthetics.

The operation is intended to restore blood circulation. During bypass surgery, a shunt is placed to the affected area of ​​the vessel and blood flow is restored. Thrombectomy is used to remove a blood clot from an artery. At stage 3 of the disease, patients are prescribed necrectomy, that is, amputation of necrotic tissue, as well as fasciotamia, when the pressure on the muscle is reduced by cutting the fascia. Important information: How to treat moderate myocardial hypoxia (oxygen starvation of the heart) and what are its symptoms

For internal use You can use this recipe: take 1 tbsp of hawthorn and rosehip. l., add 1 tsp. crushed lingonberry and immortelle leaves. Pour the mixture into a thermos and pour boiling water over it. Insist 3 hours. Drink throughout the day. Tea cleanses blood vessels from cholesterol plaques.

Patients are prescribed a decoction of valerian root internally and as compresses. You can prepare a collection from the fruits of hawthorn, strawberries, and rowan. 2 tablespoons of berries are poured into 400 g of boiling water. Brew for half an hour. Drink during the day in 4 doses.

You can prepare an infusion of chestnut, fennel, adonis and lemon balm flowers. 1 st. l. the mixture of herbs is brewed with a glass of boiling water. The medicine is drunk per day. The course of treatment is a week, after which they take a break and repeat the course again.

Walnuts, nettle leaves and garlic are used for treatment:

• A bath of nettle leaves will improve blood circulation. 4 tbsp. l. nettles pour 1 liter of boiling water. Add the infusion to the bath. The procedure takes 20 minutes.
• Take garlic infusion. You need to chop 50 g of garlic, pour a glass of vodka, leave for 2 weeks in a dark place. 10 drops of infusion are diluted in 100 g of boiled water, drunk 3 times a day.
• For the tincture, place 1 kg of peeled walnuts in a 3-liter bottle. Pour liquid honey and cover with cellophane. Fermentation occurs. The jar is closed with an iron lid and placed in the cold for 3 months. Then drain the liquid and add 30 g of bee pollen. For a month you should consume 1 tsp daily. this remedy. Then they take a break for 2 weeks and repeat the course.

Prevention

To prevent the development of occlusion of the lower extremities, you need to follow rules that prevent the development of vascular obstruction and have a positive effect on the entire body. Necessary:

• give up alcoholic drinks and smoking;
• get rid of excess weight;
• follow a diet;
• fulfill physical exercise;
• do morning jogging;
• normalize blood pressure.

Patients over 45 years of age should be healthy lifestyle life, timely diagnosis and treatment of atherosclerosis, regular treatment in a sanatorium is useful.

Vascular occlusion is an acute blockage and cessation of blood flow associated with blocking the lumen of a vessel.

The causes of direct blockage of blood flow are:

• rupture of cholesterol plaque;
• movement of a blood clot;
• embolism at the level of the heart, thoracic or abdominal aorta.

Most common cause embolism is the formation of blood clots. The risk of clot formation increases with arrhythmia and tachycardia, left ventricular aneurysm, after surgery and heart valve replacement, against the background of endocarditis.

The thrombus, leaving the heart cavity through the aorta, travels all the way to the femoral artery and blocks it at the site of bifurcation (branching).

The tendency to clogged arteries increases with age due to cholesterol plaques. There is one version about where “fatty” deposits on the walls of blood vessels come from.

Arteries have muscle layer, as well as elastin in order to regulate blood pressure by compression and relaxation. Endothelial cells have a negative charge, like blood, so blood flow occurs without obstruction. During stress, arterial walls contract, responding to adrenaline in the same way as other muscle cells.

With prolonged voltage, the charge of the vascular walls becomes positive, which leads to “sticking” of blood cells. Likewise, prolonged contraction leads to endothelial damage and changes in wall polarity.

Cholesterol, which is part of the myelin sheaths of nerves, is a dielectric. It works as an insulating material.

In a damaged artery, cholesterol accumulates at the site of damage to “patch” the wall and allow blood to flow. To stop cholesterol deposition, you need to relax the blood vessels.

The causes of damage to arterial walls are usually inflammatory in nature:

• smoking;
• diabetes;
• obesity;
• sedentary lifestyle.

Causes of occlusion

The provoking factor is atherosclerosis. An atherosclerotic plaque is located inside a vessel on the wall and consists of cholesterol, fats and blood cells (platelets).

Over time, it changes in size, disrupting the passage of blood and nutrients to the brain. As a result, the plaque grows even more and completely blocks the artery.

Development depends entirely on the individual characteristics of the patient’s body and can last from 3 to 6 months.

Sometimes cupping occurs quickly within 2-4 weeks. This means that the atherosclerotic plaque was inside the vessel for a long time, but was in suspended animation.

The reasons why the passage of blood through the arteries of the lower extremities may be impaired include:

• pathological changes in the internal walls of blood vessels;
• entry into the vascular lumen of a thrombus, embolus or foreign body;
• vascular injuries.

Pathological changes in blood vessels

One of the main causes of vascular occlusion of the lower extremities is atherosclerosis. Atherosclerotic plaques that form on the inner walls of arteries and veins initially narrow their lumen, and over time can cause complete blockage. Factors that aggravate the risk of developing obliterating atherosclerosis are:

• chronic hypertension;
• obesity;
• hereditary predisposition;
• smoking;
• excess fat in the diet;
• diabetes.

Thrombosis

As a result of a violation of the blood clotting process, platelet clots are formed in the vascular bed, interfering with normal blood flow.

A thrombus can cause thromboembolism - complete blockage of the lumen of a vessel, accompanied by extensive ischemia of organs and tissues.

Embolism

Injuries and other causes

The causes of impaired blood flow in the vessels are:

1. Embolism is a blockage of the lumen of a vessel with the formation of a dense consistency. The cause of embolism is often attributed to several factors:

There are several main reasons for the appearance of this anomaly.

An obstacle forms in the vessel in the form of some foreign formation at the site of bifurcations.

Classification

Depending on the degree of blockage of the artery lumen, two types of occlusion are distinguished:

• gradual narrowing;
• sudden blockage.

When the artery narrows, the muscles do not receive enough blood, and ischemia develops, which can be partial or complete. When a vessel is blocked, tissue necrosis occurs.

Atherosclerosis leads to slow narrowing, in which cholesterol and atheromas are deposited on the arterial walls. Atherosclerotic plaques gradually narrow the lumen of the vessel. Calcification, which occurs due to age-related metabolic disorders, accelerates the narrowing of the lumen.

Less commonly, the cause of narrowing is an abnormal growth of the muscle layer - fibromuscular dysplasia, vasculitis (inflammatory processes), compression by tumors or cysts.

Pathology is divided into two categories: complete blockage of blood vessels and partial. When blood vessels are partially blocked, a narrowing of the vessel cavity is observed. Blood circulation continues to be produced, but the necessary nutrients are not enough for the brain to function properly. In medical terminology, this phenomenon is called “carotid artery stenosis.”

Depending on whether the lumen of the vessel is completely or partially blocked, two types of occlusions are distinguished:

• segmental (partial);
• complete (if the lumen is completely blocked).

Depending on the affected area, occlusions are distinguished:

• Small and medium vessels of the lower extremities: ischemia develops in the area of ​​the foot and ankle joint, for example, occlusion of the superficial femoral artery on the left or right causes disruption of the blood supply to the area from the knee and below.
• Large vessels: blood circulation throughout the limb and surrounding areas is disrupted. For example, occlusions of the left and right iliac arteries cause ischemia of both the lower extremities as a whole and the pelvic organs.
• Mixed, when both small and large vessels are affected.

Lower limbs

The most common type of pathology. More than 50% of identified cases of vascular obstruction occur in the popliteal and femoral arteries.

Take immediate action to therapeutic treatment necessary when at least one of 5 signs is detected:

• Widespread and persistent pain in the lower extremity. When moving the leg, the painful sensations intensify many times over.
• No pulse can be felt in the area where the arteries pass. This is a sign of occlusion formation.
• The affected area is characterized by bloodless and cold skin.
• Feelings of numbness in the legs, goosebumps, and slight tingling are signs of incipient vascular damage. After some time, numbness of the limb may occur.
• Paresis, inability to abduct or raise the leg.

If any of the above symptoms occur, you should immediately consult a specialist. With advanced occlusion processes, tissue necrosis may begin, and subsequently amputation of the limb.

CNS and brain

This type of pathology occupies three times the place in distribution. The lack of oxygen in the cells of the brain and central nervous system is caused by blockage of the carotid artery from the inside.

These factors cause:

• Dizziness;
• Memory losses;
• Fuzzy consciousness;
• Numbness of the limbs and paralysis of the facial muscles;
• Development of dementia;
• Stroke.

Subclavian and vertebral arteries

Leg occlusions vary according to the location of the problem in the bloodstream:

• Obstruction of small arteries. Affects the feet and legs.
• Defeat of large and medium-sized ones. The iliac and femoral arteries are affected.
• Mixed type, combining both of the previous ones (occlusion of the popliteal artery and lower leg).

Symptoms

In the first stages of the disease, signs of ischemia development are:

• painful sensations in the lower extremities, intensifying with movement and subsiding at rest;
• intermittent claudication;
• pallor, dryness, coldness of the skin;
• decreased sensitivity, numbness, burning or tingling sensations.

Symptoms tend to increase, and the longer the blood supply remains impaired, the more extensive the damage to the tissues of the lower extremities.

A number of signs indicate that the disease has manifested itself. Symptoms of occlusion depend on the location of the blockage of the vessel.

The disease has the following manifestations:

• lameness localized to the ankle;
• limb ischemia;
• pain of an unknown nature even at night;
• paresthesia;
• chills;
• convulsions.

Additional examination demonstrates a non-standard reaction of blood vessels to human movement (narrowing of the walls instead of expansion).

Diagnostic methods

The initial diagnosis is made after collecting anamnesis and examining the patient. To clarify the diagnosis and the affected area, instrumental and laboratory diagnostic methods are used:

• Blood test for coagulation with assessment of prothrombin index and fibrinogen content.
• Ultrasound with duplex scanning allows you to identify the area of ​​​​blood supply disturbances and assess the condition of the vessel walls.
• Angiography, MRI and CT are prescribed to obtain the most accurate picture of the pathology.

Most often, occlusion of the iliac or femoral artery occurs in the legs. A vascular surgeon will tell you what it is and what first aid is for the body.

Advanced occlusion of the vessels of the lower extremities has serious consequences for the body, including amputation of the legs, so any suspicion of the disease requires a thorough examination in a hospital:

1. The surgeon visually assesses the site of the suspected blockage, noting the presence of swelling, dryness and other skin lesions.
2. Vascular scanning helps to identify injured segments.
3. If the picture is unclear, an x-ray or angiography is ordered, in which contrast dye is injected into the artery.
4. The ankle-brachial index helps assess the condition of the circulatory system.

Methods for diagnosing occlusions of various arteries include examinations by medical specialists. It is necessary to clarify the neurological pathology and identify the focality of symptoms. Cardiologists examine the heart in more detail. To diagnose central retinal artery occlusion, a detailed examination of the fundus is necessary.

In the study of the vessels of the head and extremities, the following are of great importance:

• rheoencephalography;
• ultrasonography;
• Doppler color study of blood flow;
• angiography with the introduction of contrast agents.

To establish the connection between brain symptoms and damage to the adductor arteries and subsequent treatment, it is important to know:

• which extracerebral vessel is damaged (carotid, subclavian or vertebral arteries);
• how severe is the stenosis;
• the size of the embolus or atherosclerotic plaque.

To do this, the duplex study technique uses the calculated occlusion coefficient. It is determined by the ratio of the diameter at the site of narrowing to the undamaged area.

Occlusion is assessed in five degrees depending on the speed of blood flow relative to normal (less than 125 cm/sec.). Subocclusion is considered a pronounced narrowing of the lumen (more than 90%), this stage precedes complete obstruction.

Treatment

The examination of a patient complaining of pain in the calves should be complete. First, the surgeon palpates the pulsations from the abdominal aorta to the foot with auscultation of the abdominal and pelvic areas. If there are no palpable impulses, the patient is sent for Doppler ultrasound examination.

At mild symptoms and moderate severity, lifestyle changes help:

• to give up smoking;
• regular physical exercise;
• control of taking medications against hypertension, diabetes mellitus;
• dieting.

Drug support is prescribed only on the recommendation of a doctor:

• antiplatelet agents (aspirin, sodium heparin, clopidogrel, streptokinase and pentoxifylline)
• antilipemic drugs (for example, simvastatin).

To improve the condition of the arteries and to prevent embolism, you can seek help from an osteopath to relieve aortic spasm.

In severe cases, embolectomy (catheter or surgical), thrombolysis, or arterial bypass is performed. The decision to proceed is based on the severity of ischemia, the location of the thrombus, and general condition patient.

Thrombolytic agents administered by regional catheter infusion are most effective for acute arterial occlusion lasting up to two weeks. The most commonly used are tissue plasminogen activator and urokinase.

A catheter is inserted into the blocked area and the drug is delivered at a rate appropriate to the patient's body weight and stage of thrombosis. Treatment lasts 4-24 hours depending on the severity of ischemia. Improved blood flow is monitored using ultrasound examination.

Approximately 20 to 30 percent of patients with acute arterial occlusion require amputation within the first 30 days.

Blood clots in the arteries are treated exclusively with drug therapy. Doctors try not to resort to surgical intervention until the last moment, since this is a critical measure in situations that pose a direct threat to the patient’s life.

At the first stage, patients are prescribed blood thinners and anti-inflammatory medications. If there are concomitant diseases that are a provoking factor for stenosis or occlusion, then the treatment of these diseases is brought to the fore.

A lightweight form of occlusion does not require a spectrum medicines, the list is limited to anticoagulants and thrombolytics.

1. Anticoagulants are designed to reduce the chance of a blood clot. These drugs thin the blood and increase its flow to the brain. Patients are prescribed Heparin, Neodicoumarin, Phenilin.
2. Thrombolytics are aggressive drugs designed to destroy a formed blood clot. The course lasts several weeks, as a result of which the vessel opens and blood circulation is resumed. From this category, patients are prescribed Urokinase, Plasmin, Streptokinase.

Drug treatment is determined by the doctor depending on the condition of the vessels. After the blood clot is destroyed, the specialist prescribes medicines to exclude the chance of a new formation. Duration of use – up to several years.

Over time, it is necessary to consult and be observed by a doctor, to record changes in the carotid arteries.

It is possible to treat limb occlusion only after establishing an accurate diagnosis and stage of the disease.

Stage 1 – conservative treatment with the use of drugs: fibrinolytic, antispasmodic and thrombolytic drugs.

Physical procedures are also prescribed (magnetic therapy, barotherapy), which entail positive dynamics.

Stage 2 is based on surgery. The patient undergoes thromboembolism and bypass surgery to restore proper blood flow in the venous arteries.

Stage 3 – immediate surgery: excision of a thrombus with bypass, prosthetics of a part of the affected vessel, sometimes partial amputation.

Stage 4 - beginning tissue death requires immediate amputation of the limb, since sparing surgery can provoke the death of the patient.

After operations, subsequent therapy plays an important role in the positive effect, preventing re-embolism.

It is important to begin treatment in the first hours of development of occlusion, otherwise the process of gangrene development will begin, which will lead to further disability with loss of a limb.

Treatment and prognosis for occlusive vascular lesions is determined by the form of the disease and stage. Central retinal artery occlusion is treated with laser.

Conservative methods can be used in the first 6 hours of fibrinolytic therapy to dissolve the blood clot.

The main method is surgical methods. All operations are aimed at restoring the patency of the affected vessel and eliminating the consequences of ischemia of organs and tissues.

For this use:

• blood clot removal;
• creation of a bypass anastomosis or shunt;
• resection of the damaged artery;
• replacement of the affected area with an artificial prosthesis;
• balloon dilatation of the artery with stent installation.

Each operation has its own indications and contraindications.

Occlusion can be prevented using available measures to prevent atherosclerosis, hypertension, and diabetes. Compliance with the requirements for a balanced diet and taking medications significantly reduces the likelihood of dangerous consequences.

Preventive measures

Based on medical statistics, partial occlusion, not accompanied by acute symptoms, is accompanied in approximately 70% of cases by the possibility of developing a stroke. It is extremely difficult to determine the exact period of development, but it is necessary to expect the onset of the disease within 5-7 years.

A set of measures to prevent circulatory disorders of the lower extremities includes:

• dosed physical activity;
• body weight control;
• adherence to the principles of healthy and rational nutrition;
• quitting smoking and other bad habits;
• drinking enough fluids daily;
• if necessary and according to the doctor’s indications, take anticoagulants to prevent the development of thrombosis.

A number of measures are used to prevent blockage of blood vessels:

• Proper nutrition, enriched with vitamins and plant fiber with the exception of fatty and fried foods;
• Weight loss;
• Constant blood pressure monitoring;
• Treatment of arterial hypertension;
• Avoiding stress;
• Minimum consumption of alcohol and tobacco;
• Light physical activity.

Timely initiation of therapy for the development of any type of occlusion is the key to recovery. In almost 90% of cases, earlier treatment and surgery restores proper blood flow in the arteries.

Late initiation of treatment risks limb amputation or sudden death. The death of a person can be caused by the onset of sepsis or renal failure.

Advanced occlusion of the lower extremities most often requires surgical intervention and mechanical cleaning of the arteries. The vascular surgeon removes blood clots or cuts out entire sections, establishing normal blood flow. Cases of arterial bypass are common.

At the necrotic stage of the disease with the rapid development of gangrene, the doctor may decide on partial or complete amputation of the limb to prevent death due to:

• sepsis;
• renal failure;
• multiple organ failure.

Only timely application for medical care and intensive therapy in the early stages will help avoid a tragic outcome.

Antiplatelet agents help resolve blood clots.

Today defeats of cardio-vascular system occur quite often. Often these conditions are caused by a narrowing of the lumen between the walls of blood vessels or even their complete blockage.

Occlusion of the lower extremities has the same origin. The disease is difficult to treat, so doctors strongly recommend prevention. Understanding the causes of the condition, its symptoms, and knowledge of risk groups allows you to promptly contact a specialist and begin treatment.

Causes of pathology

The occurrence of occlusion in the lower extremities is associated with significant disturbances in blood flow. Obstruction is most often observed in the femoral artery. Factors accumulate over a fairly long period of time.

Most often, experts associate them with the following complications:

1. Thromboembolism - 90% of cases of blocking blood flow are caused by blood clots.
2. Atherosclerosis or blockage of blood vessels by cholesterol plaques.
3. Embolism - diagnosed when a vessel is blocked by gases or particles. For example, this condition may be caused by errors when placing an IV or administering intravenous medications.
4. Mechanical damage to blood vessels. The body most often closes the resulting “holes” with fat accumulations, which, when growing, can completely block the gap between the walls. This condition is especially dangerous when the popliteal artery is blocked, as it can lead to limitation of motor activity.
5. Aneurysm as a result of excessive stretching of the walls of blood vessels resulting from deformation and thinning.
6. Inflammation as a result of infection entering the body.
7. Injuries resulting from electric shock.
8. Complications after surgery.
9. Frostbite of the lower extremities.
10. Violation of blood pressure indicators.

Classification by cause and vessel size

Depending on the cause that caused the development of the disease, experts distinguish the following types of occlusion:

The pathology can affect the vessels of different parts of the leg. Based on this, experts identify another classification of occlusion of the lower extremities:

• obstruction of patency in medium- and large-sized arteries, due to which there is insufficient blood supply to the thigh and nearby areas;
• blockage of small arteries - the foot and ankle suffer;
• mixed occlusion, that is, a combination of the two above options.

As you can see, this is an extremely diverse disease. However, the symptoms of all types are similar.

Clinical picture of the condition

Symptoms manifest themselves in a wide range of signs. Based on the intensity of manifestations, experts distinguish four stages of the clinical picture:

1. First stage. Feelings similar to normal fatigue due to long walk, whitening of the skin after physical exertion. This symptom becomes a reason to visit a doctor if it recurs with some regularity.
2. Second stage. Pain syndrome occurs even if the patient does not put much strain on his legs, and is accompanied by third-party sensations that can cause the development of lameness.
3. Third stage. The pain becomes more acute and does not stop, even if the person is at rest.
4. Fourth stage. The skin on the legs becomes covered with small ulcers, and in some advanced cases of occlusion, gangrene develops.

The condition also has visual manifestations - blue discoloration of the skin, dark-colored blood vessels. Tactilely, the areas where vascular blockage occurs are colder compared to healthy ones.

Diagnosis of the disease

If a patient has been experiencing discomfort in the lower extremities for a long period of time, changes are visible on the skin, or there is any pathology of the cardiovascular system in the anamnesis, he should consult a doctor. Only in this case can you refute or, on the contrary, confirm the diagnosis and prescribe the correct treatment program.

• Conducting a visual examination of the legs, palpating the skin;
• scanning the arteries of the lower extremities to determine the exact location of blockage or narrowing of the lumen between the walls;
• calculation of the ankle-brachial index, which allows one to draw conclusions about the speed of blood flow and judge the intensity of the disease;
• MSCT angiography allows you to obtain a holistic picture of the condition of the vessels and their deviations from the norm.

Number of appointments diagnostic methods depends on how long ago the clinical picture arose in the patient, and whether there are any other diseases that can complicate the course of the disease.

Treatment tactics

The disease is treated by a vascular surgeon. The features of the procedures prescribed by the specialist are determined by the stage of the inflammatory process established during the examination:

1. Treatment of the disease at the first stage of development is limited to conservative methods. The patient is prescribed special medications that lead to the destruction of formed blood clots and help to establish blood supply at natural rates. To enhance the effect of medications, physiotherapeutic procedures are often prescribed. This promotes the regeneration of blood vessel walls. An example of the most effective procedure is plasmapheresis.
2. The second stage requires surgical intervention as soon as possible. As a rule, the doctor removes large blood clots that are not dissolved by medications and performs prosthetics on severely damaged areas of blood vessels.
3. With the onset of the third and fourth stages, the effectiveness of the drugs decreases even more. Surgery is indicated. In addition to bypass surgery, which is often prescribed at the second stage, dead tissue is removed. Another recommended operation is to cut the muscle fascia, which reduces tension in it. When the percentage of dead tissue is large enough, amputation of the damaged limb is performed.

In general, tissue death against the background of constantly progressive blockage of blood flow is the main danger of the disease.

Preventive measures

Medical practice has long proven that preventive measures help avoid the development of many serious diseases. The same applies to occlusion of veins and arteries of the legs. Prevention has a positive effect on all organs and systems in general.

What is useful to do to eliminate the likelihood of developing leg occlusion? The recommendations are quite simple:

1. Provide regular therapeutic load on the bloodstream, stabilize blood pressure. Saturate blood, tissues and internal organs Moderate physical activity and walking allow you to get the necessary amount of oxygen.
2. Avoiding excessive consumption of alcohol and smoking - bad habits negatively affect the condition of the walls of blood vessels.
3. Strict adherence to the rest and work schedule, organization of quality sleep.
4. Minimizing the amount of stress.

Prevention also includes timely examination by specialized doctors if there are diseases in the anamnesis that can act as provoking factors.

Pathologies of the circulatory system lead in the entire structure of diseases, among the main causes of disability and mortality. This is facilitated by the prevalence and persistence of risk factors. Diseases do not always affect the heart and blood vessels at the same time; some of them develop in the veins and arteries. There are quite a lot of them, but occlusion of the arteries of the lower extremities is the most dangerous.

The concept of occlusion (blockage) of blood vessels in the legs

Blockage of the arteries of the lower extremities leads to a cessation of oxygen and nutrients to the organs and tissues they supply. More often affected popliteal and femoral arteries. The disease develops abruptly and unexpectedly.

The lumen of the vessel may be blocked blood clots or emboli of various origins. The diameter of the artery, which becomes impassable, depends on their size.

Wherein tissue necrosis develops rapidly in the area below the blocked artery.

The severity of the signs of pathology depends on the location of the occlusion and the functioning of the lateral - collateral blood flow through healthy vessels running parallel to the affected ones. They deliver nutrients and oxygen to ischemic tissues.

Arterial blockage is often complicated gangrene, stroke, heart attack that lead the patient to disability or death.

It is impossible to understand what leg vascular occlusion is, to understand the severity of this disease, without knowing its etiology, clinical manifestations, treatment methods. We must also take into account the importance of preventing this pathology.

More 90 % of cases of blockage of the leg arteries have two main causes:

1. Thromboembolism - blood clots form in the main vessels, are delivered by the blood flow to the arteries of the lower extremities and block them.
2. Thrombosis - a blood clot as a result of atherosclerosis appears in the artery, grows and closes its lumen.

Etiology

The etiology of the remaining cases is as follows:

Risk factors

Vascular occlusion is a disease for the development of which the presence of risk factors. Minimizing them reduces the possibility of obstruction. They are:

• alcoholism, drug addiction, smoking;
• heredity;
• surgery on the blood vessels of the legs;
• unbalanced diet;
• pregnancy, childbirth;
• excess weight;
• sedentary lifestyle;
• gender - men are more often affected, age - more than 50 years.

Impact of underlying causes and risk factors more often accumulates for a long time.

Important! Experts note the spread of leg vascular occlusion among young people, many of whom sit in front of computers and gadget monitors. Therefore, when the first signs of occlusion occur, regardless of age category, you should immediately consult a doctor.

Types and signs of the disease

Blockage of the arteries can occur in any part of the lower limb; various diameters of the vessels overlap. In accordance with this, they distinguish varieties occlusions:

1. Obstruction large and medium arteries. The blood supply to the femoral and adjacent areas is disrupted.
2. blockage small vessels, supplying blood to the legs and feet.
3. mixed obstruction of large and small arteries simultaneously.

By etiological factors, which provoked the appearance and development of the disease, occlusions are divided into the following types:

• air - blockage of the vessel with air bubbles;
• arterial - obstruction is caused by blood clots;
• fatty - blockage of an artery with particles of fat.

Obstruction of the blood vessels of the legs occurs in two forms:

Acute occlusion occurs when an artery is blocked by a blood clot. Develops suddenly and quickly. Chronic illness proceeds slowly, manifestations depend on the accumulation of cholesterol plaques on the vessel wall and a decrease in its lumen.

Symptoms

The first sign of obstruction of the leg arteries is symptom of intermittent claudication. Intense walking begins to cause pain in the limb, the person, sparing the leg, limps. After a short rest, the pain disappears. But as the pathology develops, pain appears from minor loads on the limb, lameness intensifies, and long rest is necessary.

Over time they appear 5 main symptoms:

1. Constant pain, aggravated by even a slight increase in loads on the leg.
2. Pale and cold to the touch skin on the affected area, which eventually develops a bluish tint.
3. The pulsation of blood vessels at the site of blockage cannot be felt.
4. Decreased sensitivity in the leg, a feeling of goosebumps, which gradually disappears, leaving numbness.
5. The onset of limb paralysis.

Important know that a few hours after the appearance characteristic features blockage, tissue necrosis begins at the site of vessel occlusion, and gangrene may develop.

These processes are irreversible, therefore, untimely treatment will lead to amputation of the limb and disability of the patient.

If signs of intermittent claudication or at least one main occlusive symptom appear, this is a reason to urgently consult a doctor.

Treatment methods

The phlebologist conducts the necessary studies to confirm the diagnosis. After this, he prescribes treatment. On initial stages development of the disease, it is conservative and carried out at home. Drug therapy used:

• anticoagulants that thin the blood and reduce its viscosity (Cardiomagnyl, Plavix, Aspirin Cardio);
• antispasmodics, relieving vascular spasms (No-Shpa, Spazmol, Papaverine);
• thrombolytics (fibrinolytics) that destroy blood clots (Prourokinase, Actylase);
• painkillers, relieving attacks of pain (Ketanol, Baralgin, Ketalgin);
• cardiac glycosides that improve heart function (Corglicon, Digoxin, Strophanthin);
• antiarrhythmic drugs, normalizing heart rhythms (Novocainamide, Procainamide).

Anticoagulant effect of Heparin ointment is used for local treatment occlusion. Vitamin complexes are prescribed. Physiotherapy is used.

electrophoresis accelerates and ensures maximum penetration of drugs to the site of arterial damage.

Magnetotherapy relieves pain, improves blood circulation, and increases blood saturation with oxygen.

In case of severe development of occlusion and ineffective drug therapy, surgical treatment is used:

1. Thrombectomy- removal of blood clots from the lumen of the vessel.
2. Stenting- by introducing a special balloon, the lumen of the artery is opened and a stent is installed to prevent its narrowing.
3. Bypass surgery- creation of a bypass artery to replace the affected area. An implant or a healthy limb vessel can be used for this.

When gangrene develops, partial or complete amputation of the limb is performed.

Prevention

Performing simple prevention rules significantly reduce the risk of developing the disease:

1. Lead an active lifestyle, use moderate physical activity.
2. Visit skating rinks, swimming pools, gyms.
3. Quit smoking and alcohol or reduce the consumption of strong drinks to a minimum.
4. Eat the right foods that contain enough vitamins and microelements. Avoid foods that increase blood cholesterol, blood viscosity, blood pressure, and those containing large amounts of fat.
5. Avoid significant weight gain and maintain normal weight.
6. Avoid stress, learn to get rid of it.
7. Monitor the course and treatment chronic diseases, which can cause obstruction of the blood vessels in the legs.

Conclusion

Blockage of the arteries of the lower extremities in most cases develops over a long period of time, so early symptoms appear in the initial stages of the disease. They signal problems with blood vessels. You must not miss this moment and visit a specialist. This is the only way to correctly determine the cause of vascular occlusion, eliminate it, stop the development of pathology, and have a favorable prognosis for recovery.