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Atherosclerosis of the vessels of the lower extremities
Last reviewed: 07.06.2024
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Diseases of the circulatory system are numerous and diverse, and the disease of the peripheral arteries - atherosclerosis of the lower limb vessels or atherosclerotic angiopathy of the lower limbs - is among them (code I70.2 according to ICD-10).
Epidemiology
The prevalence of lower extremity vascular atherosclerosis among those over 70 years of age and smokers over 50 years of age is estimated to be 30%.
Leg vascular atherosclerosis accounts for more than 90% of cases of lower extremity angiopathy. [1]
Causes of the atherosclerosis of the lower extremity vessels
The causes of chronic arteriosclerotic vascular disease - narrowing or blocking the lumen of vessels obliterating atherosclerosis of the lower extremities - are related to a disorder of fat metabolism (lipid metabolism), which leads to hypercholesterolemia, i.e. An increased level of cholesterol in the blood. This is what causes the development of atherosclerosis. [2]
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Of the arteries of the lower extremities, the superficial femoral and hamstring arteries are most commonly affected (up to 80-90% of cases), but the small and tibial arterial vessels can also be affected.
Risk factors
Specialists note such risk factors for atherosclerotic lesions of peripheral vessels as: smoking (smokers have a 2.5 times higher risk of developing this disease), arterial hypertension, excessive body weight (obesity), endocrine pathologies (diabetes mellitus, hypothyroidism), hereditary predisposition, age (60 years and older).
People with cerebrovascular disease, cardiac problems of an ischemic nature, and hemodialysis-related kidney disease are at higher risk. [3]
Pathogenesis
In atherosclerotic lesions of leg vessels, pathogenesis is caused by the deposition of cholesterol and calcium accumulations in the arterial wall - between the inner wall (tunica intima) and the middle wall (tunica media) - in the form of atherosclerotic plaques. From the blood, cholesterol is transported into the vascular wall by low-density lipoproteins (LDL), which are oxidized by leukocytes or free radicals and taken up by immune blood cells - macrophages. At the same time, macrophages transform into lipid-filled foam cells and accumulate in the inner vascular wall (intima).
As a result, the wall thickens and loses elasticity; its subendothelial layer thickens; plaques undergo fibrosis and begin to protrude into the lumen of the artery, and its internal diameter decreases. [4]
Narrowing of arteries and their obstruction (occlusion) causes decreased or stopped blood flow and circulatory disorders of the legs.
Read also - Obliterative diseases of the lower extremities: causes, symptoms, diagnosis, treatment
Symptoms of the atherosclerosis of the lower extremity vessels
At first, arteriosclerotic lesions of the vessels of the legs are asymptomatic. This is stage I of the disease. Then the first signs may appear in the form of pain in the legs during short walking, which passes after rest.
The main symptoms depend on the stage of the pathological process: at stage II there is intermittent claudication, cramps and leg pain. Pain in atherosclerosis of the lower limbs is most often felt in the thighs and lower legs.
At stage III - in advanced cases - pain may be present at rest (ischemic rest pain), and at stage IV, due to the progressive deterioration of tissue trophism, marked ischemia develops. [5]
There is no pulsation in the arteries (under the knee, on the thigh, on the feet); leg hair falls out and the skin becomes pale and smooth and shiny; feet are constantly cold, fingers go numb; due to ischemia, muscle volume decreases, i.e. Their atrophy occurs. This set of symptoms is called Leriche syndrome.
There are such types as obliterative or stenosing atherosclerosis of the lower limb vessels (in which the lumen of the artery is reduced and blood flow in it decreases) and nonobliterative or non-stenosing atherosclerosis of the lower limb vessels - with damage to the vessel wall, but without its narrowing. [6]
Complications and consequences
The main complications and consequences of leg vascular atherosclerosis arise from inadequate blood perfusion in the affected limb and the associated ischemic lesion, which leads to the formation of arterial trophic ulcers in the lower leg or on the feet.
And ulcers, in turn, can provoke atherosclerotic gangrene of the leg (one or both), which in some cases requires amputation of the affected limb, the incidence of which is 3-4%.
Diagnostics of the atherosclerosis of the lower extremity vessels
Comprehensive diagnosis of atherosclerotic lesions of the vessels of the legs includes a study of the anamnesis, physical examination and complete examination of the patient.
Laboratory tests are performed: blood tests, including general, biochemical, for the level of total cholesterol, LDL, HDL, triglycerides; for the presence of serum C-reactive protein.
Instrumental diagnostics is performed: Dopplerography of the arteries of the lower extremities - ultrasound of the peripheral arteries, duplex scanning of the arteries of the lower extremities, computed tomographic angiography (CTA). To determine the state of blood circulation in the vessels of the legs, peripheral hemodynamics under load is investigated - with the help of functional tests of the lower extremities. [7]
Differential diagnosis
The differential diagnosis should exclude diabetic angiopathy, obliterative thrombangiitis (obliterative endarteritis), abdominal aortic occlusion and iliac dysplasia (which manifest as Leriche's syndrome), as well as neurogenic claudication and all other leg diseases with similar symptomatology.
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Treatment of the atherosclerosis of the lower extremity vessels
In the early stages, it is possible to medically treat leg vascular atherosclerosis, the aim of which is to reduce blood cholesterol levels and improve peripheral circulation.
For this purpose, medicines such as Simvastatin (other trade names are Simvacard, Vabadin, Vazilip), Cholestyramine (Cholestan) and other pills for high cholesterol are prescribed.
If lipid metabolism is disturbed, the preparation of thioctic (α-lipoic) acid Berlithion (Thiogamma) is used. It is also recommended to take an angioprotective agent Pentoxifylline (Agapurin, Trental, Arbiflex); vitamin PP (nicotinic acid); pangamic acid - vitamin B15; vitamin complexes, for example, Angiovit.
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In hypercholesterolemia is not excluded and treatment with herbs (contributing to the reduction of cholesterol): prepared and taken internally decoctions of meadow clover (flowers), dandelion (leaves and roots), fenugreek, yarrow. Also read - How to lower blood cholesterol without drugs?
You can use dietary supplements for atherosclerosis of the lower limb vessels with essential polyunsaturated fatty acids (omega-3), with Ginkgo biloba extract, etc., but you should keep in mind that the production of dietary supplements is not regulated and they are not medicines and are not tested for safety. But it should be borne in mind that the production of bio supplements is not regulated, and they are not medicines and are not tested for safety.
In case of trophic ulcers for their healing ointments are used: Actovegin (Solcoseryl), Methyluracil ointment or ointments with antibiotic.
Physiotherapeutic treatment with drug electrophoresis with vasodilators, ultratonotherapy, etc. Helps to improve arterial blood flow.
To activate microcirculation in the vessels, therapeutic massage can be used for atherosclerosis of the vessels of the lower extremities, but it should be superficial. And in case of pronounced obliteration of the vessel, massage is contraindicated.
Gymnastics for the legs are useful, as well as training walking in atherosclerosis of the vessels of the lower extremities with intermittent claudication and pain in the legs, the essence of which is to gradually increase the distance traveled without pain (or training time on a treadmill). [8]
Proper nutrition in atherosclerosis of the vessels of the lower extremities is not unimportant. What should be the diet for atherosclerosis of the vessels of the lower extremities, in detail in the articles:
Smoking is categorically contraindicated in atherosclerosis of the vessels of the lower extremities!
Patients with obliterative atherosclerosis of the vessels of the lower extremities - with obvious deterioration of tissue trophism and marked ischemia - require surgical treatment. Methods of surgical intervention include:
- transdermal intravascular angioplasty (with or without stent placement in the vessel lumen);
- Creating a pathway for blood flow that bypasses the sclerosed portion of the artery with a bypass;
- restoration of the lumen of the occluded vessel - endovascular recanalization of arterial occlusion.
Prevention
What is the prevention of atherosclerotic lesions of peripheral vessels?
In the monitoring of blood cholesterol and BP, normalization of body weight, rational diet and smoking cessation, in sufficient physical activity.
Forecast
How long do people with atherosclerosis of the lower limb vessels live? If you give up bad habits and change to a healthy way of life, monitor your health and follow the recommendations of your doctor, you can stop the progression of atherosclerosis and live long enough. Or you can lose a leg and get a disability.
Completely favorable prognosis of this common disease of the circulatory system can not be considered, and it depends on many factors.