Obliterative endarteritis

Obliterating endarteritis is an autoimmune disease that affects the peripheral arteries, as the disease progresses, their lumen begins to narrow and blood circulation is impaired. This disease is also called thromboangiitis or Buerger's disease.

During the disease, acute periods are often observed, which are replaced by remission. Narrowing of the arteries leads to disruption of blood flow in the extremities.

In the early stages of the disease, a lack of arterial blood causes pain in the legs after physical exertion, but over time the pain becomes persistent, and long-term non-healing ulcers and gangrene of the feet may appear on the legs.

Middle-aged men are more susceptible to the disease.

ICD-10 code

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

Causes of obliterating endarteritis

Obliterating endarteritis has not been studied sufficiently by specialists, so it is not possible to establish the causes of its development. At the first stage, a stable spastic narrowing of the capillary vessels of the lower extremities, especially the feet, appears. Over time, inflammation begins in the vascular walls, modified by the spasm, as a result of which the internal walls of the vessel practically stick together until they are completely blocked by a thrombus.

Many experts are of the opinion that the disease is caused by autoantibodies (antibodies produced by the immune system to the tissues or proteins of the body itself), which affect the arteries and trigger the process of connective tissue growth.

Some experts believe that the development of obliterating endarteritis is caused by smoking, frequent hypothermia, and stress.

In addition, injuries, chronic infections, and neuritis increase the risk of developing the disease.

As doctors and scientists studied the disease, they identified four possible causes for the development of this disease:

• Atherosclerosis at a young age
• Infections (particularly mycoses), poisoning
• Blood clotting disorder
• Tobacco allergy

Doctors have also identified other factors that contribute to the development of obliterating endarteritis:

• passion for smoking or drinking alcohol;
• being in a state of prolonged stress;
• frequent and prolonged cooling of the feet;
• walking in tight or uncomfortable shoes;
• activities that involve frequent leg injuries;
• chronic infectious diseases;
• daily abuse of fatty foods rich in cholesterol.

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Symptoms of obliterating endarteritis

Obliterating endarteritis manifests itself primarily by weakness of the limbs, very rapid fatigue. When the disease occurs, a person may also notice severe fatigue after prolonged standing or walking, and a feeling appears that the legs are “buzzing”.

As the disease progresses, the skin on the extremities becomes cool and dry. At first, the extremities become cold from time to time, but then the feeling of cold does not leave a person, even if he is warmly dressed or in hot weather.

Later, numbness, tingling or crawling sensations appear. In advanced cases, when the vessels have already undergone significant changes, the temperature of the extremities differs significantly from the general body temperature.

Due to the disruption of blood supply, the limbs become pale, cold, the fingers become bluish-red and sharply differ in color from the rest of the body.

Another symptom of the disease is increased sweating of the affected limbs. In the last stages, pain appears in the shin and foot, which forces a person to often rest while walking. In medical terms, this symptom is called intermittent claudication. There is a strong decrease in the lumen of the calf vessels, which reduces the supply of oxygen and nutrients to the tissues, causing spasms and severe pain.

When obliterating endarteritis is advanced, walking speed decreases and a person can cover less and less distance.

The changes also affect the nails, which become bluish, break quickly, and become deformed due to insufficient nutrition.

As the disease progresses, the pulsation force of the arteries on the dorsum of the foot decreases, causing severe cramps that initially bother only when walking, and later also when at rest.

If left untreated, the disease causes swelling and ulcers on the skin. The most dangerous symptom of obliterating endarteritis is tissue necrosis.

A characteristic symptom of obliterating endarteritis

Obliterating endarteritis manifests itself primarily as numbness and a feeling of heaviness in the legs, especially after a long walk. Goose bumps, a feeling of cold, and increased sweating often appear on the skin of the legs. In the cold season, the extremities are very cold and painful.

A characteristic symptom is cramps and severe pain in the calf muscles; after rest, the condition returns to normal.

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Obliterating endarteritis and atherosclerosis

Obliterating endarteritis affects small arteries, plaques do not form, unlike atherosclerosis, which mainly affects large arteries and forms atherosclerotic plaques in some places of the affected vessel. With obliterating endarteritis, the entire artery spasms, the lumen narrows, blood circulation is difficult, and 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 women. The average age at which the disease begins to manifest itself is 30-40 years, but there have been cases when the disease was diagnosed at 15-16 years.

However, in addition to the above symptoms, the main complaint of patients is a sharp pain in the calf muscles, which appears when walking, and even forces a person to stop from pain.

But let's get back to the initial signs of the disease. How can they be recognized?

First, you should examine the skin of your feet: in pathological areas, the skin is paler than healthy skin and may even have a bluish tint. The feet are cold to the touch.

At more advanced stages, poorly healing ulcers and necrotic areas appear in the area of the feet and ankle joints, which over time can take on the appearance of gangrene.

Obliterating endarteritis of the vessels of the lower extremities is conventionally divided into several stages:

• The initial stage is ischemic, which is characterized by slowing of blood circulation in the limb. Symptoms of stage I: a dynamically increasing feeling of fatigue while walking, a feeling of periodic numbness, the appearance of convulsive muscle twitching, cold in the lower part of the legs.
• The next, stage II – tissue trophism disorders (poor oxygen and nutrition supply to tissues). Symptoms: discomfort in the legs increases, pain appears and as a result – lameness. The skin on the legs acquires a bluish color, dryness occurs; nails change shape, become brittle and lifeless.
• Stage III – the appearance of necrosis areas and ulcers. Pain in the legs is constant, especially when lying down. The lower limbs noticeably become thinner, the calf muscles become smaller. Ulcers appear, mainly in the toe area.
• Stage IV – development of gangrene. This happens if the patient has not made any attempts to treat the disease.

There are also different types of obliterating endarteritis, depending on how often the painful sensations are observed:

• the patient can travel from one to several kilometers before feeling pain in the legs;
• the patient walks no more than two hundred meters;
• pain appears after 20-30 meters of walking;
• the pain is constant, ulcers form on the legs;
• gangrenous lesions of the extremities develop.

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

Obliterating endarteritis of the lower extremities

Obliterating endarteritis of the lower extremities occurs cyclically, i.e. periods of exacerbation of the disease are replaced by phases of temporary weakening of severe symptoms or their complete disappearance.

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

In the early stages of the disease, no organic changes occur in the arteries, and vascular spasms are possible. Over time, progressive endarteritis leads to partial or complete blockage of the artery, resulting in deterioration of blood flow and the formation of ulcers or gangrene.

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

• Dystrophy of nerve endings. At this stage, blood flow is not impaired, arteries (in rare cases, veins) are slightly narrowed. There is no pronounced clinical manifestation of the disease at this stage.
• Arterial spasm. At this stage, the load on the lateral branches of the blood vessels increases, which leads to the appearance of the first symptoms of the disease - rapid fatigue in the legs, constantly cold feet, and over time, lameness may appear.
• Connective tissue growth. At this stage, all layers of the vessel walls begin to actively grow, which causes pain not only after walking or physical activity, but also at rest. Pulsation in the arteries of the legs decreases significantly. The third stage of the disease is considered advanced.
• Thrombosis (blockage) of blood vessels. At this stage, irreversible processes begin – tissue necrosis, 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 at the first examination, taking into account the patient's complaints. To confirm the diagnosis, the specialist may prescribe a number of additional examinations:

• rheovasography of vessels – helps to assess the speed of blood circulation in the vessels.
• arterial angiography – examination of blood vessels using radiopaque substances
• capillarography - a method in which capillaries are photographed to determine the state of the microcirculatory bed
• Doppler ultrasound - a study of blood flow velocity using ultrasound pulses

Various diagnostic methods can help in establishing an accurate diagnosis, thanks to which it is possible to assess the degree of vascular damage. Most often, specialists resort to such diagnostic procedures as:

• sphygmography – recording of arterial wall vibrations that occur with each pulse contraction;
• plethysmography – assessment of vascular filling and tone;
• capillaroscopy – study of organ microcirculation;
• Angioscanning – provides an idea of the parameters of blood circulation.

Often, diagnostic procedures are prescribed in a complex – an individual approach is used, depending on the patient’s condition and well-being:

• An ultrasound examination with a digital radiograph will help to determine the duration of the disease and its stage;
• assessment of pulse impulses determines the characteristics of energy channels;
• vegetative resonance diagnostics is used to detect the disease at the initial stages of its development;
• Thermography allows you to assess temperature changes on the skin;
• Voll's diagnostics is an electropuncture that identifies and specifies the causative agent of the disease;
• observation of clinical symptoms, biochemical analyses – allow us to characterize the functionality of all systems in the body.

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Treatment of obliterating endarteritis

Obliterating endarteritis leads to the proliferation of connective tissue, but today in medicine there is no remedy that would allow one to completely get rid of the disease.

During the treatment, the process of connective tissue growth slows down, which allows for some relief of the patient’s condition.

First of all, experts recommend giving up existing bad habits, especially smoking. Substances present in alcohol and tobacco worsen the condition of blood vessels and contribute to vascular spasms.

Also, with obliterating endarteritis, a special diet is prescribed, which helps maintain normal weight, since excess body weight only worsens the situation. With the disease, it is necessary to strictly limit sweets, flour, fatty dishes, reduce the calorie content of foods.

With endarteritis, it is useful to move more. It is recommended to walk at a leisurely pace for at least 60 minutes a day, despite pain attacks.

If severe pain occurs, it is recommended to rest a little (until the pain completely passes) and continue moving. Cycling and swimming (at a water temperature of at least 24 ^o C) are also useful.

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

Physiotherapy procedures may be prescribed as treatment:

• warming up with UHF, Bernard currents, diathermy, ozokerite applications, etc.,
• baromassage (exposure of the affected limb to alternately high and low pressure in a pressure chamber),
• magnetic therapy (Epifanov's spacesuit),
• ultrasound treatment,
• electrophoresis (administration of drugs using an electric field into the affected area),
• water treatment (mustard, pine, hydrogen sulphide, radon, turpentine baths according to Zalmanov's method, contrast, etc.),

The doctor may recommend folk remedies as an adjuvant therapy, but in this case it is better not to self-medicate, since obliterating endarteritis has many contraindications.

If the treatment is ineffective, the doctor may prescribe surgical treatment: bypass (creation of an additional bypass in the affected area of the limb using shunts), sympathectomy (excision of parts of the affected vessels), thrombointimectomy (removal of a section of the affected vessel), amputation of the limb.

For obliterating endarteritis, medications are prescribed that eliminate vascular spasms, expand the lumen, and reduce blood clotting.

Among such drugs, the following are distinguished:

• antispasmodics (nicotinic acid, angiotrophin, redergam, etc.);
• hormonal drugs (prednisolone, hydrocortisone);
• antithrombotic agents (acetylsalicylic acid, cardiomagnyl, trental);
• vitamin complexes containing ascorbic acid, tocopherol, and B vitamins;
• drugs that prevent blood clotting (hirudoven, fibrinolysin, etc.).

The doctor prescribes medications depending on the stage of the disease and the patient’s well-being.

If drug therapy does not have the desired effect, or if the patient seeks medical attention too late, surgical intervention may be used. The following methods are considered surgical treatments:

• sympathectomy is a method of removing lumbar nerve nodes, which causes a reciprocal expansion of the bypass vessels and improved blood circulation in the affected leg;
• bypass – formation of an artificial bypass section of the affected vessel;
• thrombectomy – an operation to remove a blood clot that has become an obstacle to normal blood flow in a vessel;
• Amputation is an extreme surgical intervention that is performed in cases of increasing tissue necrosis and developing gangrene, when the process of death is irreversible.

Treatment of obliterating endarteritis with folk remedies

Traditional healers recommend treating obliterating endarteritis with herbal infusions.

There are many recipes, among which we can highlight several of the most effective:

• collection to reduce pain: mint, lavender, hawthorn 3 tbsp each, thyme, immortelle, Japanese pagoda tree 2 tbsp each, datura, eryngium 1 tbsp each, white mistletoe (4 tbsp. mix all the ingredients, take 2 tbsp. of the mixture and pour boiling water (3 cups), let stand for two hours, then strain and drink an incomplete glass 20 minutes before meals (three times a day)
• collection to reduce spasms: caraway, periwinkle 1 tbsp each, hawthorn flowers 2 tbsp, leaves and stems of white mistletoe 3 tbsp.

Mix everything, take two tablespoons of the mixture and pour boiling water (2 cups), leave for two hours. Take the strained infusion four times a day, 60 minutes after meals (half a cup). The course of treatment is 14 days, then a 7-day break and repeat the course. In total, three courses must be taken, repeated treatment can be carried out after six months.

Infusions of valerian, fennel, celandine, St. John's wort, and immortelle will help improve your condition (1 tablespoon of any herb per glass of boiling water, leave for half an hour, drink during the day).

These tinctures help cleanse blood vessels and expand them.

Herbs are also used for foot baths.

Hay dust is an effective remedy to help reduce pain and spasms in the sore limb. To prepare a bath, you will need 300g of hay dust, which you first put in a cloth bag and pour 3 liters of boiling water over it, leave for 60 minutes. Then strain the tincture and dilute it with warm water, take a foot bath for 20-25 minutes.

Among the methods of traditional medicine, mixtures of medicinal plants – herbal preparations – are most often used to cure diseases.

Herbal mixture to relieve leg pain:

• lavender, mint, hawthorn berries (3 parts each);
• sophora, thyme, immortelle (2 parts each);
• eryngium and datura (1 part each);
• mistletoe (4 parts).

The ingredients are mixed and poured with boiling water (0.6 l per 2 tbsp of the mixture). After 2 hours, the medicine is filtered and consumed 20 minutes before meals, three times a day, 200 ml.

Antispasmodic infusion:

• periwinkle leaf, caraway (1 part each);
• hawthorn blossom (2 parts);
• mistletoe (3 parts).

The plants are combined, brewed with boiling water (0.5 l per 2 tbsp of plant material), and left to brew for 2 hours. Use up to 4 times a day, 50-60 minutes after meals, half a glass at a time. The course of therapy is 14 days. After a week's break, treatment can be resumed. It is recommended to conduct three courses once a year.

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

Hay foot baths:

- for 300 g of chopped hay take 3 liters of boiling water, let it brew for an hour. Then filter the infusion and pour it into a container for foot baths (the temperature of the infusion should be approximately equal to body temperature). Take the bath for up to half an hour.

Of course, when using folk remedies, you should not ignore medical help. Consult a doctor, consult with him about what treatment will suit you best.

Exercise therapy for obliterating endarteritis

Physical therapy is a necessary moment in the treatment of not only obliterating endarteritis, but also a guarantee of facilitating blood circulation throughout the body, stabilizing metabolism. Thanks to physical exercise, new - bypass - vessels open, which replace the affected ones.

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

In case of obliterating endarteritis, the exercises also consist of breathing and general exercises for the whole body. It is recommended to use active swings of flexion and extension nature, abduction, circular movements, using the load for all joints. It is important to alternate muscle tension with their subsequent relaxation.

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

If you feel tired while doing gymnastics, you should give your body a rest: forcing yourself to do it will not bring any obvious benefit. 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 prevention of endarteritis. However, a set of general recommendations has been developed that in many cases help prevent the development of vascular damage. Here are the main ones:

• getting rid of bad habits (excluding smoking, drinking alcohol);
• fight against excess weight;
• exclusion of fatty, sweet foods and baked goods from the daily menu;
• maintaining physical activity (swimming, cycling, gymnastics, walking);
• maintaining foot hygiene (daily shower, possibly a contrast shower, use of nourishing creams for dry skin on the feet).

If a person has already been diagnosed with obliterating endarteritis, then preventive measures should be aimed at preventing an exacerbation of the disease. What principles and lifestyle changes should be discussed in such cases:

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

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

Obliterating endarteritis, as mentioned, leads to vascular spasms, so preventive measures include eliminating all irritants that can provoke spasms, as well as reducing vascular tone, dilating peripheral vessels, and increasing blood circulation.

It is important to maintain foot hygiene, not to stay in unfavorable conditions for a long time (too cold, hot, damp climate), feet should always be warm, not freeze or get wet.

You should also avoid minor injuries and wear comfortable shoes that will not cause blisters or abrasions.

If your feet tend to sweat, after washing, it is recommended to wipe them with cologne or alcohol (dry skin on your feet should be lubricated daily with a greasy cream or Vaseline).

You should also avoid nervous shocks and mental trauma.

Nutrition plays an important role in the prevention of obliterating endarteritis; fatty, sweet, and flour-based foods should be limited in the diet.

Prognosis of obliterating endarteritis

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

If the disease is detected at a late stage, 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 amputation of the limb is almost impossible to avoid.

Obliterating endarteritis most often affects the legs. Young and middle-aged men suffer from the disease. Endarteritis is a rather dangerous disease and can cause amputation of the affected limb, since circulatory disorders, narrowing of the artery lumen, lack of oxygen and nutrients lead to swelling, ulcers, and the development of gangrene.