Despite the fact that the angiopathy of lower limbs to treat vascular disease, it is almost never seen in vascular surgery.This is largely due to the peculiarities of its course and direct causes.
Characteristics and causes angiopathy
literal definition angiopathy is in a few words - vascular pathology, which leads to their functional impairment.Therefore, under this definition falls whole layer of vascular disorders.But traditionally under this definition refers to diabetic angiopathy of lower extremities.Sometimes they define Raynaud's disease and vascular disorders such.
mechanism of angiopathy is a gradual decrease in vascular function. Concurrently tissue disorganization are processes that receive blood flow through these vessels.Thus pathogenesis of angiopathy can be briefly described as follows.
- Violations of the vascular intima.Always precede the development of key processes.They give rise to aseptic inflammation that creates obstacles to laminar blood flow.For diabetes is very common on the background of the development of atherosclerosis disorders of lipid metabolism.The same is observed in Raynaud's disease.But if in the first case it affects the small blood vessels, "caliber" (capillaries, arterioles), for Raynaud's disease process begins with a large main arteries.
- transition from laminar to turbulent flow creates conditions for crossing the fibrinogen into its insoluble form - fibrin.Just a huge role to play mediators and various chemically active substances in large quantities released during inflammation.
- first two conditions favor the reduction of tissue perfusion rate.Since capillary blood flow slows down.Reduced
- perfusion leads to the development of ischemic tissue cells.
- Ischemia gradually develops into the development of necrotic changes.Further, these processes can be self-sustaining by lysis enzymes.Recent destroyed by cell death, and their contents of "spills" out.
angiopathia always slowly leads to the development of ischemia and tissue necrosis.These results do not depend on the causes of vascular disorders.However, some differences in the changes can be seen at the initial stages.
If the immediate cause is diabetes, the first symptoms of lower limb angiopathy almost always begin with violation of innervation of tissues.Because vascular changes here begin with the smallest capillaries.The patient experiences a different paresthesia, numbness of the extremities.And the farther from the cloth to be the main vessel, the earlier these changes occur.
In case of violation of the venous outflow with varicose veins of the lower extremities of the disease debut begins with a feeling of heaviness and "tired legs".Because this situation is the result of the progression of stagnation.
When disease and Raynaud's syndrome angiopathy generally appears after the start of the pathological process, is clearly visible when the underlying disease clinic.Symptoms of numbness of limbs appear after some time (sometimes years) after the first signs of the disease.Chief among these is the so-called symptom of intermittent claudication.Man while walking then begins to limp, but one, then the other leg.
angiopathy caused by autoimmune disease debuts with signs of inflammation of the skin and subcutaneous tissue.For example thrombocytopenic purpura or Shenlyayn-Henoch disease begins hemorrhagic rash on the skin.After that joins inflammation of the subcutaneous tissue.However, unlike the previous three reasons not further development of the disease involves necrosis of deeper tissues.Even during prolonged ischemia flowing muscles and bones are not observed.Therefore, the angiopathies in their conventional sense of the disease does not apply.
pathology depending on the immediate causes, signs of angiopathy of the lower extremities may start with relatively minor symptoms.Man worried heaviness in the legs, "tired legs", or all starts with numbness of the skin, feeling chill.
As the disease progresses the symptoms become more pronounced, and worried almost constantly. Finally, the stage is when symptoms of defeat begins to be always present.
further course of the disease leads to the appearance of signs of tissue necrosis.This is reflected in the development of Lipodermatosclerosis (in the case of varicose veins) or gangrene (diabetes).As one of the most extreme manifestations of vascular angiopathy in both cases are the so-called trophic ulcers.These deffekty skin and subcutaneous tissue are persistent course tends to deepen.
For diabetic angiopathy of lower extremities more than for any other pathologies characterized by the development of gangrene feet.This situation calls for early action, since the process involves the entire limb quickly and can lead to the death of a person due to the development of septic complications.
Principles of therapy angiopathy
All treatment angiopathy of lower extremities based on two main principles.This slow down the process and prevent various complications.
To slow the disease process used drugs and methods of the two groups.
- causal drugs and measures nemidakamentoznogo impact.They are aimed at the immediate cause which led to vascular pathology.And their choice is determined only by the disease.So the treatment of diabetic angiopathy of lower extremities is inconceivable without the correction of glycemia.
- Pathogenic Sanctions.There are already used means of improving the trophism of tissues and reduce the severity of vascular complications.
methods and drugs of the first group massage and contrast shower of the lower limbs, wearing preventive bandages venotoniki desagregants and (in extreme cases may anticoagulants), medicines and sahorosnizhayuschie specific diet,
more specific measures of the second group.Physical methods of exposure are shown as a supplement the basic therapy of trophic ulcers.
- In diabetes used Antiplatelet agents and anticoagulants, cardiovascular and metabolic drugs.Reparants (eg aktrvegin) are indicated for the prophylaxis and treatment of venous ulcers.In the case of gangrene, amputation is shown.Its volume depends on the size and extent of disease.
- with varicose veins are also used antiplatelet agents, anticoagulants.In addition to these appointed venotoniki and vascular metabolitiki.For amputation of the lower limb little recourse.One of the main surgical interventions is Troyanova surgery to remove the saphenous femoral vein.It promotes elimination of trombogemorragicheskih complications.