Angiopathy of the extremities

A number of diseases characterized by damage to the vascular wall are called angiopathies. Such pathologies can affect various parts of the body, as well as vessels of various calibers - from capillaries to large vessels. Today we will talk about what angiopathy of the extremities is, how serious this diagnosis is, and how to overcome the disease.

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Causes of angiopathy of the extremities

Most often, doctors encounter diabetic angiopathy, the development of which is preceded by diabetes mellitus. With such a diagnosis, not only the vessels of the extremities, but also the kidneys and the retina can be affected.

The second most common disease is hypertensive angiopathy, which develops as a result of severe hypertension.

Other possible causes of angiopathy of the extremities include the following:

• traumatic vascular injuries;
• disorders of the nervous innervation of the vascular walls;
• pathologies of the hematopoietic system;
• long-term persistent increase in blood pressure;
• hypotension;
• work with toxic and harmful substances;
• old age;
• the presence of bad habits (alcohol, smoking, drug addiction);
• autoimmune diseases, in particular vasculitis;
• metabolic diseases;
• hereditary or congenital disorders of the structure of the vessel walls.

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Symptoms of angiopathy of the extremities

The clinical picture of angiopathy of the extremities depends on the stage of the process, the age of the patient and his general condition.

The course of angiopathy is divided into several stages depending on the severity of the process. The effectiveness of subsequent treatment directly depends on the stage of the disease.

• Stage I – absence of clinical signs, except for atherosclerotic changes in the arteries during examination.
• Stage II – stage of intermittent claudication. When walking a certain distance, muscle soreness appears, forcing the patient to stop and rest. Sometimes the pain can be replaced by weakness or heaviness in the legs.
• Stage III – painful sensations appear not only when walking, but also at rest, and even when lying down. In this case, changing the position of the leg, as a rule, helps the pain to disappear.
• Stage IV is the most severe stage, with the development of superficial ulcers and areas of necrosis.

Among the main signs of angiopathy, the following can be distinguished:

• periodic sensations of “crawling ants”, numbness and burning in the legs;
• pain when walking (usually disappears at rest), intermittent claudication, which prevents walking long distances;
• bleeding from the nose, gastrointestinal tract, bronchi, multiple hemorrhages on the skin, the appearance of spider veins on the legs;
• tissue trophic disorders, characterized by peeling and flaccidity of the skin up to the appearance of necrotic and gangrenous areas;
• deterioration of vision up to and including loss of vision.

On external examination, the legs may be swollen, with a gray or bluish tint. The feet or hands are most often cold to the touch.

Angiopathy of the lower extremities

In case of angiopathy of the lower extremities, the smallest vessels of the legs – the capillary system – are primarily affected. This form of the disease is called microangiopathy.

Later, as the pathological process progresses, larger vessels may also be affected: the course of the disease becomes more severe.

Endocrine diseases play an important role in the development of angiopathy of the lower extremities. In patients with endocrine pathologies and metabolic disorders, angiopathy occurs four times more often than in other people. This is due to the fact that with such disorders, a person's risk of developing atherosclerosis increases significantly. Atherosclerotic changes in most cases become the main trigger for damage to the vascular wall - the main sign of angiopathy.

Slowing of blood flow in the capillary and arterial bed of the legs inevitably leads to a lack of nutrition of tissues, and then to the death of some areas of the feet. The progression of the disease accelerates with a decrease in immune protection and the addition of infectious agents.

Unfortunately, patients often seek hospital help only when pain begins to bother them at rest, that is, in stage III of angiopathy, and this is already an extensive and complex process that requires immediate intervention by a specialist.

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Diabetic angiopathy of the lower extremities

The development of angiopathy in patients with diabetes mellitus can cause severe pathologies, which subsequently often affects the functioning of all organs and systems of the body. Over time, angiopathy affects almost all vessels of the extremities. The basal membranes become compacted, deposits form in the vascular walls, the diameter and throughput of the vessel decrease, and connective tissue growths form.

Of course, first of all, angiopathy affects the urinary system, organs of vision and limbs. One of the signs of angiopathy of the lower limbs in diabetes is the symptom of "diabetic foot".

The essence of the disease is that the capillaries stop passing blood in the required volume. The tissues of the foot do not receive the necessary amount of oxygen and nutrients and over time atrophy. First of all, the toes suffer, then the process spreads to the entire foot, the ankle area and higher, to the thigh. At the same time, the arteries work fully, they pulsate, but the blood does not reach the tissues.

Diabetic angiopathy of the lower extremities is characterized by three main symptoms:

• disruption of the structure of the vascular wall;
• deterioration of blood clotting properties;
• slow blood circulation.

With the assistance of these three factors, optimal conditions are created for the formation of microthrombi in the leg vessels. These thrombi are difficult to treat with antithrombotic agents.

Angiopathy is so common in diabetes that it is often considered one of the main symptoms of this disease.

Over time, the process progresses, damaging the coronary and cerebral vessels, the femoral and tibial arteries.

Atherosclerotic angiopathy of the lower extremities

Often, angiopathy of the lower extremities develops as a result of atherosclerotic vascular lesions. Signs of the pathology may vary, since they depend on which vessels were most susceptible to the disease.

The process of atherosclerosis development is the accumulation of protein complexes (lipoproteins) in the lumen of the arteries. Elements (so-called plaques) appear inside the vessels, interfering with the normal flow of blood. Further development of the disease can lead to spasms of the vessels and the cessation of the supply of blood and substances necessary for life through them.

With atherosclerotic angiopathy of the lower extremities, the following changes occur:

• formation of intravascular plaques of various compositions and sizes;
• arterial stenosis;
• closure of the arterial lumen;
• arterial thromboembolism;
• changes in the structure of vascular walls.

The above changes are often accompanied by the following symptoms:

• a feeling of numbness and coldness in the legs;
• pain in legs;
• swelling, darkening of the skin;
• heaviness and weakness in the legs.

The main sign of angiopathy development is a deficiency of blood supply, or its complete cessation. Tissues that were previously supplied with nutrients and oxygen from the affected vessels now suffer from their deficiency. This is how atrophy and necrosis of leg tissues develops.

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Angiopathy of the upper extremities

Angiopathy of the upper extremities is much less common than leg lesions. Hand disease is nothing more than a sign of vibration disease - a characteristic pathology that occurs in people whose work is associated with prolonged exposure to vibration on the hands. These are professions that involve the use of jackhammers, drills, industrial pneumatic devices, etc. Peripheral blood supply disorders in the form of angiopathy are manifested by vascular spasms, a feeling of cold and numbness in the hands. Sometimes muscle pain and swelling of the hands in the afternoon are disturbing.

The disease can be combined with pathological changes in bones and joints, as well as polyneuropathies of various localizations.

Vascular damage caused by prolonged vibration is permanent. It does not go away even after a person stops contact with vibration devices and switches to another job.

Treatment for this disease is long and difficult.

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Diagnosis of angiopathy of the extremities

The diagnosis of angiopathy of the extremities is carried out in a variety of ways. First, the general condition of the patient is assessed, then examinations are carried out, which will subsequently determine the degree of damage to the vascular system of the extremities and outline the main methods of treatment.

At the first stage, the following studies are carried out:

• blood biochemistry (blood sugar, urea and creatinine levels, prothrombin index, fibrinogen, platelets);
• electrocardiogram (at rest and under load);
• X-ray of the affected limb in two or more projections;
• if there is purulent discharge, it is sent for bacterial culture (the type and sensitivity of the microflora are determined);
• determination of pressure in peripheral arteries.

The following research methods are carried out to determine the degree of vascular damage:

• measurement of blood pressure at the ankle (to study hemodynamics);
• spectral analysis of Doppler blood flow signals along the limb;
• angiography with the introduction of a contrast agent into the distal bed of the extremities.

As needed, studies may be prescribed to monitor changes in hemodynamics:

• polarographic detection of oxygen in the legs (transcutaneous voltage);
• laser flowmetry;
• computer capillaroscopy.

Diagnostic procedures can be performed before or during conservative treatment of angiopathy.

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Treatment of angiopathy of the extremities

The main methods of treating angiopathy of the extremities depend on the initial pathology that served as a factor in vascular damage.

The use of drugs to lower blood sugar levels, regulate blood pressure, improve vascular tone, as well as changes in dietary principles can significantly slow down or inhibit the process of vascular damage.

Early detection of diabetes and prescription of medications to stabilize blood sugar levels significantly slow down the progress of changes in the vascular walls. Moreover, it is necessary to constantly determine blood sugar and take medications prescribed by the endocrinologist.

Angiopathy of the extremities cannot be cured quickly. However, there are modern effective methods that can help even at relatively late stages of the disease.

• Lymph modulation is a new promising method for improving blood and lymph circulation. This procedure eliminates tissue swelling and accelerates the removal of metabolic products from affected areas. As a result, the supply of nutrition and oxygen to the affected tissues is resumed.
• Surgical intervention – the use of methods for restoration (reconstruction) of the lumen of affected vessels, with simultaneous plastic surgery of soft tissues.
• Conservative treatment: administration of drugs that regulate blood pressure; agents to accelerate microcirculation (xanthinol, pentoxifylline); drugs that affect vascular permeability (parmidine, lipoic acid); blood thinners (aspirin, cardiomagnyl, dipyridamole); drugs to improve tissue trophism (ATP, cocarboxylase); B vitamins, as well as ascorbic and nicotinic acids.

A good effect is observed from the use of physiotherapy: mud therapy, electrical stimulation, plasmapheresis.

In advanced stages, when the patient shows signs of gangrenous damage to the limb along with symptoms of intoxication of the body, it is necessary to resort to amputation of the limb or its elements (fingers, feet, part of the shin). Subsequently, prosthetics of the amputated part of the leg are performed.

Prevention of angiopathy of the extremities

Preventive measures for angiopathy of the extremities include the following points:

• fight against excess weight, proper nutrition;
• measured physical loads on the limbs;
• normalization of cholesterol levels in the blood;
• complete elimination of bad habits (smoking, drinking alcohol and drugs);
• blood sugar control;
• blood pressure control;
• strengthening the nervous system, developing stress resistance.

Proper nutrition means avoiding salty, fatty and, of course, sweet dishes. The best effect is achieved by following the diet recommended for diabetes (diet No. 9).

Eating vegetables, berries and fruits has a good effect on blood vessels. It is recommended to drink fresh potato juice (1/3-1/4 cup half an hour before meals), eat raspberries, dogwood, pears. Lettuce leaves, peas, mushrooms, oatmeal, bay leaf have healing properties for vascular lesions.

Prognosis of angiopathy of the extremities

The prognosis of the disease can be favorable if you consult a doctor in a timely manner. The disease is complex, but still treatable, so it is necessary to use all chances to fight the disease.

Angiopathy of the extremities is a pathology that requires timely and qualified therapy. Of course, advanced situations, in which it is impossible to do without amputation, significantly worsen the prognosis and require long-term rehabilitation of the patient. The patient will have to master a new life, using a prosthesis. However, even in such situations, people are able to live a relatively full life. The main thing is not to lose a positive attitude, monitor your health and take care of it.