Obliterating endarteritis

Obliterating endarteritis is an autoimmune disease that affects peripheral arteries, as the disease progresses, the narrowing of their lumen and circulatory disturbance begin. This disease is also called thromboangiitis or Buerger's disease.

During the illness often there are acute periods, which are followed by remission. Narrowing of the arteries leads to a violation in the extremities of the blood flow.

At the initial stages of the disease, lack of arterial blood causes soreness in the legs after physical exertion, but over time, the pain becomes stable, long-lasting non-healing ulcers, gangrene of the feet may appear on the legs.

The disease is more susceptible to middle-aged men.

ICD-10 code

Obliterating endarteritis according to ICD 10 is included in section I70 Atherosclerosis. Includes: arteriolosclerotic disease, atheroma, obliterating endarteritis, or endarteritis with deformity. Excludes: cerebral, pulmonary, coronary, mesenteric form of atherosclerosis.

Causes of obliterating endarteritis

Obliterating endarteritis has been studied by specialists insufficiently, therefore it is not possible to establish the reasons for its development. At the first stage there is a stable spastic narrowing of the capillary vessels of the lower extremities, especially the foot. Over time, in the vascular walls, modified by spasm, inflammation begins, as a result of which the inner walls of the vessel practically stick together, until they completely clog the thrombus.

Many experts hold the view that autoantibodies (antibodies that produce the immune system to tissues or proteins of one's body) lead to the disease, which both damage the arteries, trigger the growth of connective tissue.

Some experts believe that the development of obliterating endarteritis leads to smoking, frequent hypothermia, stress.

In addition, it increases the risk of injury, chronic infections, neuritis.

As the disease was being studied, physicians and scientists identified four possible causes of this disease:

• Atherosclerosis at a young age
• Infections (in particular mycosis), poisoning
• Violation of blood clotting
• Allergy to tobacco

Physicians also identified other factors that contribute to the emergence of obliterating endarteritis:

• passion for smoking or drinking alcohol;
• stay in a state of prolonged stressful situation;
• frequent and prolonged cooling of the feet;
• walking in tight or uncomfortable shoes;
• occupations associated with frequent traumatization of the legs;
• chronic infectious diseases;
• daily abuse of fatty foods rich in cholesterol.

[1], [2], [3], [4], [5], [6], [7]

Symptoms of obliterating endarteritis

Obliterating endarteritis is manifested primarily by the weakness of the limbs, very quick fatigue. When a person is sick, one can also notice a strong fatigue after a long standing or walking, there is a feeling that the legs are "buzzing".

With the progression of the disease, the skin on the limbs becomes cool, dryness appears. At the beginning of cold extremities occur from time to time, but then the feeling of cold does not leave the person, even if he is warmly dressed or in hot weather.

Later there is numbness, a feeling of tingling or crawling. In neglected form, when the vessels have already undergone significant changes, the temperature of the extremities differs significantly from the total body temperature.

Because of the violation of blood supply, the limbs become pale, cold, the fingers become bluish-red and differ sharply in color from the rest.

Another symptom of the disease is increased perspiration of the affected limbs. In the last stages, there are pains in the shin, foot, which forces a man to rest frequently while walking. Such a symptom in the language of physicians is called intermittent claudication. There is a significant decrease in the clearance of the gastrocnemius vessels, which reduces the flow of oxygen and nutrients to the tissues, which causes spasms and severe pain.

With advanced obliterating endarteritis, walking speed decreases, a person can overcome an ever-shorter distance.

Changes also affect the nails, which become bluish, break fast, deform due to malnutrition.

With the progression of the disease, the strength of the pulsations of the arteries on the back of the foot decreases, which causes severe convulsions, which initially disturb only when walking, and later in a calm state.

If there is no treatment, the disease leads to the appearance of swelling and ulcers on the skin. The most dangerous symptom of obliterating endarteritis is necrosis of tissues.

Characteristic symptom of obliterating endarteritis

Obliterating endarteritis is manifested primarily by numbness and a feeling of heaviness in the legs, especially after a long walk. On the skin of the feet often there is "goosebumps", a feeling of cold, increased sweating. In the cold season the limbs are very cold and hurt.

A characteristic symptom is convulsions and severe pain in the calf muscles, after rest the condition is normalized.

[8], [9]

Obliterating endarteritis and atherosclerosis

Obliterating endarteritis affects small arteries, plaque formation does not occur, unlike atherosclerosis, which affects mainly large arteries and forms atherosclerotic plaques in some places of the affected vessel. With obliterating endarteritis, spasm of the entire artery occurs, narrowing of the lumen is observed, blood circulation is difficult, while the disease progresses much faster than atherosclerosis.

Obliterating endarteritis and thromboangiitis

Obliterating endarteritis is also known as thromboangiitis. Men get thromboangiitis ten times more often than the female half of the population. The average age at which the disease begins to appear is 30-40 years, but there have been cases when the disease was diagnosed in 15-16 years.

However, in addition to the above signs, the main complaint of patients is a sharp soreness in the calf muscles that appears when walking, and even makes a person stop from pain.

But back to the original signs of the disease. How can they be recognized?

First, you should examine the skin of the legs: on the pathological areas, the skin is paler than the healthy ones, and may even have a cyanotic shade. Feet cold when feeling.

At more advanced stages in the field of the feet and ankles there are poorly healing sores, necrotic areas, which in time can acquire the appearance of gangrene.

The obliterating endarteritis of the vessels of the lower limbs is conditionally divided into several stages:

• The initial stage is ischemic, which is characterized by a slowing of the blood circulation in the limb. Symptoms of stage I: a dynamically growing feeling of fatigue during walking, a feeling of periodic numbness, the appearance of convulsive muscle twitchings, cold in the lower part of the legs.
• Next, the second stage - violations of trophism of tissues (poor supply of oxygen and nutrition to tissues). Symptoms: discomfort in the legs increases, there are pain and due to them - lameness. The skin on the legs becomes bluish, dryness occurs; Nails change shape, become brittle and lifeless.
• Stage III - the appearance of areas of necrosis and ulcers. Pain in the legs is present constantly, especially when lying down. Lower limbs noticeably lose weight, calf muscles decrease. There are ulcers, mainly in the area of the fingers.
• Stage IV - development of gangrene. This happens if the patient has not made any attempts to treat the disease.

Also, there are varieties of obliterating endarteritis, depending on how often the painful sensations are observed:

• the patient can overcome from one to several kilometers before feeling pain in the legs;
• the patient passes no more than two hundred meters;
• pains appear after 20-30 meters of the traversed path;
• pains are constant, ulcers form on the legs;
• develops gangrenous lesions of the limbs.

Obliterating endarteritis can develop gradually, for several years, or rapidly. The last aggressive variant of the development of the disease is most dangerous.

Obliterating endarteritis of lower extremities

The obliterating endarteritis of the lower extremities proceeds cyclically, i.e. Periods of exacerbation of the disease are replaced by phases of temporary easing of severe symptoms or their complete disappearance.

Usually the disease proceeds in a chronic form, but in rare cases an acute course of the disease is observed.

At the first stages of the disease, there are no organic changes in the arteries, and vasospasm can occur. Over time, progressive endarteritis leads to partial or complete closure of the artery, resulting in a worsening of blood flow and the formation of ulcers or gangrene.

There are five stages of development of the obliterating endarteritis of the lower extremities:

• Dystrophy of nerve endings. At this stage, the blood flow is not disturbed, the arteries (in rare cases veins) narrow slightly. There is no bright clinical manifestation of the disease at this stage.
• Spasm of the arteries. At this stage, there is an increase in the load on the lateral branches of the blood vessels, which leads to the appearance of the first symptoms of the disease - rapid fatigue in the legs, constantly freezing legs, and eventually you may get lameness.
• Growth of connective tissue. At this stage, all layers of the walls of the vessels begin to expand actively, which causes pain not only after walking or physical exertion, but also at rest. In the arteries of the legs, pulsation is significantly reduced. The third stage of the disease is considered to be neglected.
• Thrombosis (blockage) of blood vessels. At this stage irreversible processes begin - necrosis of tissues, gangrene.
• At this stage, changes begin to affect the vessels of other organs, in particular, the vessels of the heart and brain.

Diagnosis of obliterating endarteritis

Obliterating endarteritis can be diagnosed on the first examination, taking into account the patient's complaints. To confirm the diagnosis, a specialist can assign a number of additional examinations:

• reovasography of blood vessels - helps to assess the rate of blood circulation in blood vessels.
• arterial angiography - vascular examination with radiopaque substances
• Capillaryography - a method in which capillaries are photographed to determine the state of the microcirculatory pathway
• ultrasound dopplerography - investigation of blood flow velocity using ultrasonic pulses

In the formulation of an accurate diagnosis, various diagnostic methods can help, thanks to which it is possible to assess the degree of vascular lesion. Most often, specialists resort to such diagnostic procedures as:

• Sphygmography - registration of oscillations of the walls of arteries that appear with each pulse reduction;
• plethysmography - assessment of the filling of vessels and their tone;
• capillaroscopy - study of microcirculation of organs;
• angioscanning - gives an idea of the parameters of blood circulation.

Often, diagnostic procedures are prescribed in a complex - an individual approach is applied, depending on the condition and well-being of the patient:

• Ultrasound examination with a digital radiograph will help establish the term of the disease and its stage;
• the evaluation of pulse shocks determines the characteristic of the energy channels;
• Vegeto-resonance diagnostics is used to detect the disease at the initial stages of its development;
• thermography allows you to assess the temperature changes on the skin;
• Voll's diagnosis is an electropuncture that determines and specifies the causative agent of the disease;
• observation of clinical symptoms, biochemical analyzes - allow to characterize the functionality of all systems in the body.

[10], [11], [12], [13],

Treatment of obliterating endarteritis

Obliterating endarteritis leads to the growth of connective tissue, but today in medicine there is no such tool that would completely get rid of the disease.

In the process of treatment, the process of proliferation of connective tissue slows down, which allows for some time to ease the patient's condition.

First of all, experts recommend to abandon the existing bad habits, especially from smoking. Substances that are present in alcohol and tobacco worsen the condition of the vessels and promote vasospasm.

Also, with obliterating endarteritis, a special diet is prescribed, which helps maintain a normal weight, since excessive body weight only aggravates the situation. When the disease must strictly limit the sweet, floury, fatty dishes, reduce the calorie content of foods.

With endarteritis it is useful to move more. The day is recommended not to walk at a rapid pace for at least 60 minutes, despite painful attacks.

In case of severe pain, it is recommended to rest a little (until the pain completely passes) and continue the movement. It is also useful to ride a bicycle, swimming (at a temperature of oxen at least 24 ^o C).

Particular attention should be paid to hygiene of the feet - every evening they should be washed with warm water and soap, then dry feet should be well lubricated with a fat cream.

As a treatment, physiotherapeutic procedures can be prescribed:

• heating with UHF, Bernard currents, diathermy, ozokerite applications, etc.,
• baromassage (impact on the affected limb alternately high and low pressure in the pressure chamber),
• magnetotherapy (Epifanova's spacesuit),
• treatment with ultrasonic radiation,
• electrophoresis (administration of medicinal products by means of an electric field to the affected area),
• treatment with water (mustard, coniferous, hydrogen sulfide, radon, turpentine according to Zalmanov's method, contrasting, etc.)

The doctor can recommend alternative medicine as an auxiliary therapy, but in this case it is better not to engage in self-medication, because with obliterating endarteritis there are many contraindications.

If the treatment is ineffective, the doctor can prescribe surgical treatment: shunting (creating an additional detour in the affected area of the limb with shunts), sympathectomy (excision of parts of the affected vessels), thrombinectomy (removal of the affected area), limb amputation.

From drugs with obliterating endarteritis, funds are prescribed that eliminate vasospasm, dilate the lumen, reduce blood clotting.

Among these drugs are the following:

• antispasmodics (nicotinic acid, angiotrophin, redergam, etc.);
• hormonal drugs (prednisolone, hydrocortisone);
• antithrombotic agents (acetylsalicylic acid, cardiomagnet, trental);
• complexes of vitamins with the content of ascorbic acid, tocopherol, vitamins of group B;
• drugs that prevent blood clotting (girudoven, fibrinolysin, etc.).

Medicines are prescribed by the doctor depending on the stage of the patient's illness and state of health.

If drug therapy does not have the proper effect, or if the patient is too late to see a doctor, surgical intervention can be used. The means of surgical treatment include the following methods:

• sympathectomy - a method of removing lumbar nerve nodes, which causes a retracting widening of the vessels and an improvement in blood circulation in the affected leg;
• shunting - formation of an artificial detour site of the affected vessel;
• thrombectomy - an operation to remove the thrombus, which became an obstacle to normal blood flow in the vessel;
• Amputation is an extreme surgical intervention that is performed with increasing tissue necrosis and developing gangrene, when the process of dying out is irreversible.

Treatment of obliterating endarteritis with alternative means

Obliterating endarteritis, alternative healers are recommended to be treated with herbal remedies.

There are many recipes, among which there are several most effective ones:

• collection to reduce the pain: mint, lavender, hawthorn 3 tablespoons, thyme, cottonweed, Japanese sauce for 2 tablespoons, datura, mordovnik 1 tablespoon, white mistletoe (4 tablespoons all mix the ingredients, take 2 tablespoons of the mixture and pour boiling water (3 cups), allow to stand for two hours, then strain and drink in an incomplete glass 20 minutes before meals (three times a day)
• collection to reduce spasms: cumin, periwinkle 1 tablespoon, hawthorn flowers 2 tbsp, leaves and stems of mistletoe white 3 tbsp.

Mix everything, take two tablespoons of the mixture and pour boiling water (2 cups), insist for two hours. Filtered infusion take four times a day, 60 minutes after eating (half a glass). The course of treatment is 14 days, then a break of 7 days and the course is repeated. In total it is necessary to drink three courses, repeated treatment can be carried out after six months.

Help improve the condition of infusions of valerian, fennel, icteric, St. John's wort, immortelle (1 tablespoon of any herbs for a glass of boiling water, insist half an hour, drink a day).

Such tinctures help to clean the vessels and expand them.

Also, herbs are used to take foot baths.

Haymill is an effective tool to help reduce pain and spasms in the aching limb. To make a bath you will need 300 g of hay, which is preliminarily put in a bag of cloth and pour 3 liters of boiling water, insist 60 minutes. Then filter the tincture and dilute with warm water, take a foot bath for about 20-25 minutes.

Among the methods of alternative medicine for curing the disease, mixtures of medicinal plants - phytopreparations are most often used.

Mixture of herbs to eliminate leg soreness:

• lavender, mint, hawthorn fruit (3 parts each);
• Sophora, thyme, cudweed (2 parts each);
• gardener and datura-grass (1 part each);
• mistletoe white (4 parts).

The ingredients are mixed, poured with boiling water (0.6 liters per 2 tablespoons collection). After 2 hours, the drug is filtered and consumed 20 minutes before meals, three times a day for 200 ml.

Antispasmodic infusion:

• leaf vinca, cumin (1 part);
• hawthorn (2 parts);
• mistletoe (3 parts).

Plants are combined, boiled with boiling water (0.5 liters per 2 tablespoons vegetable material), allowed to infuse for 2 hours. Use up to 4 times a day, 50-60 minutes after eating, half a cup. The course of therapy is 14 days. After a one-week break, treatment can be resumed. Once a year it is recommended to conduct three courses.

It is recommended instead of tea to drink infusion of fennel or dill, as well as herbs of St. John's wort, birch buds, valerian rootstocks. The infusion is prepared and brewed like tea, consuming one full glass throughout the day.

Foot baths from hay:

- for 300 g of chopped hay take 3 liters of boiling water, allow to brew for an hour. Next, the infusion is filtered and poured into a foot bath tank (the temperature of the infusion should approximately correspond to body temperature). The bath is taken up to half an hour.

Of course, using alternative recipes, medical care should not be ignored. Consult a doctor, consult with him about what treatment is best for you.

LFK with obliterating endarteritis

Therapeutic physical training is a necessary moment in the treatment of not only obliterating endarteritis, but also a pledge of facilitating blood circulation throughout the body, stabilizing the metabolism. Thanks to physical loads, new ones are opened - bypassing - vessels that come to replace the stricken.

Classes of physiotherapy exercises can be performed in different starting positions: lying down, sitting, standing or while walking. It is recommended to change the position of the sick limb more often, raising and lowering it. Such exercises favor the flow of blood in the vessels, activate capillary blood circulation, eliminate dryness and pallor of the skin on the legs, and reduce painful manifestations.

With obliterating endarteritis, classes consist also of respiratory and general exercises for the whole organism. It is recommended to use active swings of flexion and extensor character, lead, circle movement, using the load for all joints. It is important to alternate the tension of the muscles with their subsequent relaxation.

It is necessary to conduct morning exercises, as well as perform exercises 3 times throughout the day. A significant role is played by the dosage load on the legs in the form of walking (at least an hour a day, you can take it slowly).

If fatigue appears during exercise, then the body should be allowed to rest: it will not be through obvious strength. After a while, you should continue the exercises.

Prevention of obliterating endarteritis

Since the exact etiology of the disease is unknown, there is no specific prophylaxis of endarteritis. However, a set of general recommendations has been developed, which in many cases helps to prevent the development of vascular disease. Here are the main ones:

• getting rid of bad habits (except smoking, drinking alcohol);
• struggle against excess weight;
• Exception from the daily menu of fatty, sweet foods and muffins;
• compliance with physical activity (swimming, cycling, gymnastics, walks);
• maintenance of hygiene of feet (daily douche, it is possible contrast, use of nutritious creams at dryness of skin of legs).

If a person has already been diagnosed with an obliterating endarteritis, then preventive measures should be taken to prevent the exacerbation of the disease. What are the principles and changes in the way of life that should be discussed in such cases:

• it is necessary to avoid hypothermia and prolonged overheating of the legs;
• It is recommended to give physical exercises to the feet every day;
• avoid injuries to the lower extremities, including abrasions when wearing shoes;
• avoid foods rich in cholesterol;
• regular massage of feet, legs, as well as back and lumbar region;
• it is recommended to monitor the mental balance, avoid stressful situations, not to be nervous.

Compliance with preventive measures will avoid complications and negative consequences of obliterating endarteritis, as well as improve the prognosis of the disease.

Obliterating endarteritis, as it was said, leads to vasospasms, so preventive measures include the removal of all irritants that can provoke spasms, as well as a decrease in vascular tone, peripheral vasodilation, and increased blood circulation.

It is important to observe the hygiene of the feet, do not stay for a long time under adverse conditions (too cold, hot, raw climates), the feet should always be warm, freeze and not get wet.

Also, avoid minor injuries, use comfortable shoes that will not cause blisters or scrapes.

If the legs are prone to sweating, after washing, it is recommended to wipe them with cologne or alcohol (dry skin of feet should be lubricated daily with a fat cream, petroleum jelly).

Also, nervous shocks, mental trauma should be avoided.

Nutrition plays an important role in the prevention of obliterating endarteritis, it is necessary to limit fatty, sweet, flour dishes in the diet.

Prognosis of obliterating endarteritis

Obliterating endarteritis, even if identified at the initial stages of development, can not be completely cured. In case of a disease, the treatment prescribed by a specialist will help slow the pathological process, which will help to keep the motor activity.

If the disease is detected in the late stages, if the doctor's instructions are not followed, if there is no treatment, especially if the patient continues to smoke and drink alcohol, the development of gangrene and limb amputation is almost impossible to avoid.

Obliterating endarteritis most often affects the legs. From the disease, men suffer in young and middle age. Endarteritis is quite a dangerous disease and can cause amputation of the affected limb, as a violation of blood circulation, narrowing of the artery lumen, lack of oxygen and nutrients lead to the appearance of puffiness, ulcers, development of gangrene.