Angiopathy of the extremities

A number of diseases, for which a lesion of the vascular wall is characteristic, is called angiopathy. 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 this diagnosis is serious, and how to overcome the disease.

[1], [2], [3], [4]

Causes of angiopathy of the extremities

Most often doctors face diabetic angiopathy, the development of which is preceded by diabetes mellitus. With this diagnosis, the vessels can affect not only the limbs, but also the kidneys and the eye retina.

In second place in the prevalence of the disease is hypertensive angiopathy, which is formed as a consequence of severe hypertension.

Among other possible causes of angiopathy of the extremities are the following:

• traumatic vascular injury;
• disorders of nervous innervation of vascular walls;
• pathology of the hematopoiesis system;
• prolonged persistent increase in blood pressure;
• hypotension;
• work with toxic and harmful substances;
• old age;
• presence of bad habits (alcohol, smoking, drug addiction);
• autoimmune diseases, in particular, vasculitis;
• metabolic diseases;
• hereditary or congenital disorders of the structure of the walls of blood vessels.

[5], [6], [7], [8]

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 neglect of the process. The effectiveness of the subsequent treatment depends directly on the stage of the disease.

• I Art. - Absence of clinical signs, except for atherosclerotic changes in arteries during examination.
• II century. - stage of intermittent claudication. When walking for a certain distance, painful muscles appear, causing the patient to pause and rest. Sometimes pain can be replaced by weakness or heaviness in the legs.
• III century. - painful sensations appear not only when walking, but also at rest, and even when lying down. In this case, changing the position of the foot, as a rule, contributes to the disappearance of pain.
• IV century. - the most severe stage, with the development of superficial ulcers and areas of necrosis.

Among the main signs of angiopathy, we can distinguish the following:

• periodic sensations of "crawling crawling," numbness and burning sensation in the legs;
• soreness in walking (at rest, as a rule, disappears), intermittent claudication, which makes it impossible to walk for long distances;
• bleeding from the nose, gastrointestinal tract, bronchi, multiple hemorrhages on the skin, the appearance of vascular asterisks on the legs;
• disorders of trophic tissue, characterized by peeling and lethargy of the skin until the appearance of necrotic and gangrenous areas;
• deterioration of vision up to its loss.

At external survey of a leg or foot can be edematic, with gray or cyanotic shade. The feet or brushes are often cold to the touch.

Angiopathy of the lower extremities

With 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.

In the future, with the progression of the pathological process, larger vessels can 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 limbs. In patients with endocrine pathologies and metabolic disorders, angiopathy occurs four times more frequently than in other people. This is due to the fact that with such violations, a person significantly increases the risk of developing atherosclerosis. Atherosclerotic changes in most cases and become the main trigger mechanism of damage to the vascular wall - the main sign of angiopathy.

Slowing down the blood flow in the capillary and arterial bed of the legs invariably leads to a lack of nutrition of the tissues, and then to the death of some parts of the feet. Progression of the disease is accelerated with a decrease in immune defense and the attachment of infectious agents.

Unfortunately, often patients turn to the hospital for help only when the pains begin to disturb already at rest, that is, in the III stage of angiopathy, and this is already an extensive and complex process that requires immediate specialist intervention.

[9], [10], [11], [12]

Diabetic angiopathy of lower extremities

The development of angiopathy in patients with diabetes mellitus can cause severe pathologies, which subsequently often affects the work of all organs and systems of the body. Over time, angiopathy captures almost all the vessels of the limbs. Densification of the basal membranes takes place, vascular walls form deposits, the diameter and capacity of the vessel decreases, connective tissue growths are formed.

Of course, primarily angiopathy affects the urinary system, the organs of vision and limbs. One of the signs of angiopathy of the lower extremities in diabetes is considered to be a symptom of the "diabetic foot".

The essence of the disease is that the capillaries stop passing blood in the proper volume. The tissues of the foot do not receive the necessary amount of oxygen and nutrients and eventually become atrophied. First of all, the toes suffer, then the process spreads to the entire foot, the ankle and up to the thigh. At the same time, the arteries work fully, they pulsate, but the blood does not enter the tissue.

For diabetic angiopathy of the lower limbs, three main features are characteristic:

• violation of the structure of the vascular wall;
• deterioration of blood coagulation properties;
• slowed circulation.

With the help of these three factors, optimal conditions are created for the formation of microthrombi in the vessels of the legs. These thrombi are heavily susceptible to antithrombotic agents.

Angiopathy is so common in diabetes mellitus, which is often considered to be the main signs of the disease.

Over time, the process progresses, coronary and cerebral vessels are damaged, the femoral and tibial artery.

Atherosclerotic angiopathy of lower extremities

Often angiopathy of the lower extremities develops as a result of atherosclerotic vascular lesions. The signs of pathology may differ, because they depend on which vessels were most susceptible to the disease.

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

Atherosclerotic angiopathy of the lower extremities, the following changes occur:

• formation of intravascular plaques of different composition and size;
• arterial stenosis;
• Closure of the arterial lumen;
• thromboembolism of the artery;
• changes in the structure of the vascular walls.

The above changes are often accompanied by such symptoms:

• feeling of numbness and cold feet;
• pain in the legs;
• edema, darkening of the skin;
• heaviness and weakness in the legs.

The main sign of the development of angiopathy is the scarcity of blood supply, or its complete cessation. Tissues, which until now were supplied with nutrients and oxygen from the affected vessels, now suffer from their lack. This is how atrophy and necrosis of the tissues of the legs develop.

[13], [14]

Angiopathy of the upper limbs

Angiopathy of the upper limbs is much less common than leg injuries. Hand disease is nothing but a symptom of a vibratory disease - a characteristic pathology that occurs in individuals whose work is associated with prolonged exposure to vibration on their hands. These are professions that involve the use of jackhammers, perforators, industrial pneumatic devices, etc. Disorders of peripheral blood supply in the form of angiopathy are manifested by spasms of the vessels, a feeling of cold and numbness in the hands. Sometimes, muscle pain, swelling of the hands in the afternoon.

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

Vascular lesions, provoked by prolonged vibration, are permanent. They do not stop, even after a person stops contact with the vibration equipment and goes to another job.

Treatment of such a disease is long and difficult.

[15], [16], [17], [18]

Diagnosis of angiopathy of the extremities

Diagnosis of angiopathy of the extremities is carried out in various ways. First, the general condition of the patient is evaluated, then examinations are carried out, which in the future will allow to determine the degree of damage to the vascular system of the limbs and to outline the main methods of treatment.

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

• biochemistry of blood (blood sugar, amount of urea and creatinine, prothrombin index, fibrinogen, platelets);
• electrocardiogram (at rest and under load);
• X-ray of a diseased limb in two or more projections;
• if there are purulent discharges, they are sent to the bacterosseous (determine the belonging and sensitivity of the microflora);
• determination of pressure on peripheral arteries.

The following methods are used to determine the degree of vascular damage:

• measurement of arterial pressure on the ankle (for the study of hemodynamics);
• spectral analysis of Doppler blood flow signals along the limb;
• Angiography with the introduction of contrast medium in the distal bed of extremities.

As necessary, studies can be assigned to monitor changes in hemodynamics:

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

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

[19]

Treatment of angiopathy of the extremities

The main methods of treating angiopathy of the extremities depend on the initial pathology, which served as a factor in the vascular lesion.

The use of funds to lower blood sugar, to adjust blood pressure, to improve the tone of blood vessels, as well as changing the principles of nutrition can significantly slow down or slow down the process of vascular damage.

Timely detection of diabetes and the appointment of funds to stabilize blood sugar significantly slow the course of changes in vascular walls. And it is necessary to constantly determine the sugar in the blood and take the drugs that the endocrinologist has prescribed.

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

• Lymphomodulation is a promising new technique for improving blood and lymph circulation. This procedure allows you to eliminate swelling of tissues, speed up the removal of metabolic products from the affected areas. As a result, delivery of food and oxygen resumes to the affected tissues.
• Surgical intervention - the use of methods of restoration (reconstruction) of the lumen of the affected vessels, with the simultaneous plasty of soft tissues.
• Conservative treatment: administration of drugs that regulate blood pressure; means for accelerating microcirculation (xanthinol, pentoxifylline); drugs acting on the permeability of blood vessels (parmidin, lipoic acid); blood thinners (aspirin, cardiomagnesium, dipyridamole); preparations for improving trophism of tissues (ATP, cocarboxylase); vitamins of group B, and also ascorbic and nicotinic acids.

A good effect is observed from the use of physiotherapy: mud therapy, electrostimulation, plasmaphoresis.

In advanced stages, when the patient shows signs of gangrenous lesion of the limb along with the symptoms of intoxication of the body, one must resort to amputation of the limb or its elements (fingers, feet, part of the shin). In the future, prosthetics of the amputated part of the leg are carried out.

Prevention of angiopathy of the extremities

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

• fight against excess weight, proper nutrition;
• dosed physical exertion on the limbs;
• normalization of cholesterol level in the blood;
• complete disposal of bad habits (smoking, drinking alcohol and drugs);
• control of blood sugar level;
• control of blood pressure;
• strengthening of the nervous system, development of stress resistance.

Proper nutrition implies the rejection of salty, fatty and, of course, sweet dishes. The best effect is observed by the diet recommended for diabetes (diet number 9).

A good effect on the vessels is the use of vegetables, berries and fruits. It is recommended to drink fresh potato juice (1 / 3-1 / 4 cups half an hour before meals), there are raspberries, dogwood, pears. Medicinal properties in the defeat of blood vessels are lettuce, peas, mushrooms, oatmeal, bay leaf.

Prognosis of angiopathy of the extremities

The prognosis of the disease can be favorable with the timely access to the doctor. The disease is difficult, but still treatable, so you need to use all the chances to fight the disease.

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