What is obliterating atherosclerosis of the vessels of the lower extremities - how to treat the pathology? Treatment of obliterating atherosclerosis Other treatment methods.

TREATMENT SCHEME for obliterating atherosclerosis of the vessels of the lower extremities. 1. Lifestyle. 1. Avoid long-term psycho-emotional stress. 2. Taking sedatives: 2 weeks - solution of sodium bromide 6, 0: 200.0, 1 tablespoon at night; 2 weeks - Mr. Bekhterev, 1 tablespoon 2-3 times a day; 2 weeks - valerian tincture 25 drops 3 times a day; 2 weeks - motherwort tincture 30 drops 3-4 times a day; 2 weeks - trioxazine, 1 tablet - morning and evening. 2. PHYSICAL ACTIVITY. 1. Morning physical exercises with diaphragmatic breathing min 2. Walking on the terenkur from cm to. 5000 m in the morning and evening, relieving vascular spasm in the legs with validol, nitroglycerin or nosh-poo (nosh-poo can be taken before starting walking). When choosing a therapeutic walking route, you should take into account the nature of the terrain, the distance and pace of walking. It is necessary to break the vicious circle: aging - decreased muscle activity - age-related hypokinesia - premature aging. 3. DIET. 1. Total calorie content of food at age: years = kcallet = kcallet = kcal over 70 years = kcal 2. Limiting the intake of simple carbohydrates (sugar!) dog. per day, if there is no diabetes. 3. Complex carbohydrates in the form of cereals, vegetables and fruits. Including increasing the consumption of vegetables to 600 g per day, fruits - to 300 g. 4. Protein intake is 1 g / kg of body weight, while the proportion of proteins from dairy products should be 60-70%. In addition, add legume proteins (peas, beans). It is better to exclude fatty meats from food.. 5. Daily fat intake should not exceed 0.8 g/kg body weight. The content of vegetable oils should be one third, one half of the total amount of fat. 6. Limit table salt intake to 6-8 g per day; the rest of the required amount of salt is contained in food. 7. Additionally, vitamins of group “B” and vitamins “C” are introduced into the diet in the form of multivitamin mixtures. 8. The optimal ratio of proteins, fats and carbohydrates is 1: 0, 8: 9. The rhythm of nutrition is strictly regulated by the hour, 4 times a day, while the distribution of food calories is as follows: breakfast - 25%, lunch - 35%, dinner - 25%, second dinner - 15% calories. 1. An approximate set of products: for breakfast - vinaigrette, kefir, tea; carrot balls with honey or cottage cheese, tea; vegetable cabbage rolls, kefir, cottage cheese; potato cutlets, tomato salad, kefir, cottage cheese; for lunch - vegetable soup, pea soup, fish soup, borscht; beef cutlets with mashed potatoes, boiled fish with vegetable side dish, fish meatballs, curd zrazy, cheesecakes, etc. p.; milk jelly, raspberries with sugar, cranberry jelly, fruit juices, compote, fruit; for dinner - fish with vegetables, buckwheat porridge, cottage cheese, boiled potatoes, kefir, rice porridge, fruit; second dinner - kefir, rosehip decoction, fruit, cottage cheese. 1. Drugs that reduce the resorption of cholesterol in the intestine: Cholestyramine (questran, cholestynol): 8 g, 2 times a day before meals: courses of 4 weeks.

There are 6 courses per year. 2. Drugs that inhibit lipid synthesis: Clofibrate (atromid-c, miscleron, atromidine, lipamide): for ages 500 mg (2 capsules) 3 times a day after meals, for ages over 75 years mg 3 times a day after meals. Treatment in courses of 4 weeks over many months (at least 6 courses per year). Complamin (xavin, xanthinol nicotinate): 1 tablet. (0, 15) 3 times a day, if necessary, the dose can be increased to 2-4 tablets 3 times a day after meals. The tablets should be swallowed without chewing.

As your health improves, the dosage is reduced to 1 table. 2-3 times a day. Treatment is carried out in courses of 4 weeks, at least 6 courses a year. Instead of complamin, nicotinic acid 0.1 g can be used 3 times a day after meals. In the absence of side effects, the dosage can be gradually increased to 3 g per day. (!) Complamin and nicotinic acid should be used together with methionine, since its methyl groups are necessary for binding and excreting excess nicotinic acid in the urine: 0.5 g 4 times a day an hour before meals. The most appropriate combination of simultaneous treatment with cholestyramine, clofibrate and complamine in combination with methionine in courses of 4 weeks, a total of 6 courses per year. In case of impaired carbohydrate metabolism (diabetes mellitus), in addition, it is necessary to take additional biguanides (metformin, phenformin, dimethylbiguanide, glybutide). 3. Drugs that change the properties of lipids circulating in the blood: HeparinED subcutaneously 1-2 times a week or atheroid 20 mg (2 tablets) 3 times a day before meals, for a long time (2-3 months). 4. Drugs with a predominant effect on metabolism in the vascular wall: Pyridinol carbamate (anginin, prodectin, parmidine): 0.25 - 0.5 g once a day for 4-6 months with repeated courses of treatment after a 1-2 month break. 5. Antispasmodic and vasodilator drugs: No-spa 0.04 - 0.08 g (1-2 tablets) 2-3 times a day or intramuscularly, 2-4 ml of 2% solution for a month.

The course of treatment is repeated after 1-2 months. Papaverine and halidor have a somewhat weaker effect. 6. Drugs that increase tissue resistance to hypoxia: Calcium pangamate: 100 mg (2 tablets) 4 times a day in courses of 4 weeks, 6 courses per year. Adenosine triphosphoric acid (ATP, phosphobion): 2 ml of 1% solution intramuscularly once a day for 4 weeks.

Adenylic acid (MAP - muscle adenyl drug): 1 teaspoon 4 times a day for 4 weeks.

Solcoseryl 2-4 ml intramuscularly and locally for an ulcer in the form of a jelly until granulation appears, and then in the form of an ointment until epithelialization.. Novocaine blockade of sympathetic ganglia. Generalized action - blockade of the 3rd left thoracic sympathetic ganglion with 0.25% novocaine solution 60 ml once a week.

There are 5 blockades per course of treatment (according to Ognev), 2-3 courses per year. Local action - bilateral blockade of the 3-4 lumbar sympathetic ganglia with 0.25% novocaine solution once a week.

There are 5 blockades per course of treatment, 2-3 times a year. 6. Hyperoxybarotherapy 1.2 - 1.5 atm 1 hour, 5-10 sessions 2 times a week. 7. Bernard current therapy (DDT) 5 sessions with an interval of 3-7 days using a special technique. 8. In the atonic phase of atherosclerosis (bluish discoloration of the feet or fingers), it is necessary to prescribe drugs that increase the tone of the veins: venoruton and venotrexan orally or parenterally and locally in the form of ointments; escusan inside.

In this phase of the disease, therapy with Bernard currents is contraindicated. 9. If localized wet gangrene is refractory to treatment, the immunological status should be checked and treatment should be prescribed with prednisolone 30 mg per day or 5-fluorouracil (the dose is selected individually). 10. Outpatient treatment schedule. 10. 1. Rational

Lifestyle

PHYSICAL ACTIVITY

Diet and vitamin therapy are maintained for the rest of your life. 2. 10. 6. 9.

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How to treat atherosclerosis of the lower extremities - medications, folk remedies, diet and exercises

In order for the treatment of atherosclerosis of the lower extremities to be as productive as possible, it is necessary not only to give up bad habits, but also to correctly select medications for the affected vessels and arteries. Otherwise, the patient has lameness, and the disease itself is fraught with disability, and the risk of gangrene is high. Treatment of obliterating atherosclerosis of the lower extremities begins with a diet and includes conservative and alternative methods implemented at home.

What is atherosclerosis of the lower extremities

This is an extensive pathology of the vascular system, in which the legs are mainly involved in the pathological process. During the course of the disease, a decrease in the permeability of peripheral vessels is observed, tissue trophism occurs, and among potential complications, doctors identify lameness, disability, and amputation of one or both limbs.

Doctors diagnose pathological changes in the popliteal, tibial and femoral arteries, while the vascular lumen is reduced by almost half. The disease is chronic, and the patient’s task is to prolong the period of remission and avoid serious complications. Therefore, the question of how to treat atherosclerosis of the vessels of the lower extremities is important to resolve in a timely manner.

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Reasons

When atherosclerotic plaques accumulate in the veins and vessels, blood is not able to move through the vessels and veins of the legs at the same speed and in the usual volume. Thickening of the walls of blood vessels is observed. As a result, the heat exchange of the pathology site is disrupted (the legs often remain cold), movements are complicated, and severe symptoms of limited mobility occur. Doctors do not rule out a genetic predisposition to the characteristic disease, but there are other pathogenic factors:

• excess cholesterolemia;
• smoking or the presence of other bad habits;
• increased body weight;
• poor diet (fatty foods with excess cholesterol);
• diabetes mellitus;
• overweight, obesity;
• genetic determination;
• arterial hypertension;
• chronic stress, emotional shock;
• vascular diseases;
• age-related changes in the body;
• reduced physical activity.

Symptoms

To cure a disease, it must be diagnosed in a timely manner. To do this, it is important to know the signs of atherosclerosis of the lower extremities in order to promptly consult your doctor at the first changes in your general health. The main symptoms of a characteristic illness are as follows, and in the absence of a timely response they only intensify:

• numbness of the feet;
• acute thrombosis, embolism;
• pain when moving;
• cramps, especially painful at night;
• the appearance of trophic ulcers;
• bloating of veins;
• formation of foci of necrosis;
• pallor, cyanosis of the skin;
• skin cyanosis;
• chronic fatigue;
• lameness, difficulty walking.

How to treat

The therapeutic diet for atherosclerosis of the blood vessels of the legs is the basis of intensive therapy, helps to increase the permeability of the walls of blood vessels and arteries, helps to avoid fat deposits and relapses of the underlying disease. In addition to proper nutrition, a daily regimen, taking medications, using alternative medicine, and therapeutic exercises for atherosclerosis of the blood vessels in the legs are necessary. More progressive methods of intensive therapy can be used, including endovascular surgical techniques.

• weight correction, giving up bad habits;
• choosing comfortable shoes made from natural materials;
• timely treatment of minor injuries, ulcers, bedsores;
• moderate physical activity;
• treatment of the underlying disease;
• prevention of systematic hypothermia of the legs;
• low fat diet.

Drug treatment of atherosclerosis of the vessels of the extremities

To dilate blood vessels and increase the elasticity of vascular walls, doctors prescribe medications externally and orally. The primary task is to treat the underlying disease that provoked a secondary illness, for example, hypertension, arthrosis, sepsis, vascular stenosis. Treatment of atherosclerosis of the lower extremities includes the following pharmacological groups of drugs:

1. Beta blockers. Provide inhibition of peripheral blood supply, represented by Anaprilin, Atenol, Nipradilol, Flestrolol.
2. Fibrates. They control the synthesis of fats in the body and are represented by such drugs as Clofibrate, Bezafibrate, Atoris.
3. Statins. They reduce the production of cholesterol by the liver and are appropriate for high blood sugar levels. These are Lovastatin, Simvastatin, Pravastatin, Atorvastatin.
4. Medicines against blood clots. Blood thinners. Control blood viscosity. A prominent representative of this pharmacological group is Aspirin, Aspecard.
5. Anticoagulants. Prevents the formation of blood clots and controls blood viscosity. These medications are Heparin and Warfarin.
6. Antiplatelet agents. Tissue nutrition products are powerful immunostimulants. This is Kurantil, Ilomedin.
7. Antispasmodics. Necessary for increasing leg mobility and eliminating acute pain. These are Pentoxifylline, Drotaverine or Cilostazol.
8. Bile acid sequestrants. To control blood cholesterol. These are medications such as Quantalan, Questran, Colestipol, Colestid.
9. Preparations to provide tissue nutrition. The most effective is the medical drug Zincteral, Trental. In addition, intravenous infusions of Trental, Tivortin, Reopoliglyukin, Vazaprostan can be performed.
10. Vasodilators.
11. Vitamin therapy.

Pills

It is necessary to take tablets for the treatment of atherosclerosis orally, according to medical indications. It is recommended to be treated with extreme caution in old age, monitor daily doses, carefully monitor your own condition and regularly visit your doctor. For extensive lesions, the course of treatment is long, and taking pills must be systematically alternated, not to forget about drug interactions.

The use of such medications is indicated to eliminate increased swelling and redness of the dermis of the legs, relieve acute pain and limited mobility. Ointments have analgesic, anti-inflammatory, regenerating and restorative properties, providing effective auxiliary treatment of atherosclerosis of the lower extremities with pathological narrowing of the lumen. Ointments such as Clopidogrel, Sophora tincture, Dimexide, Oflocain or Levomekol have proven themselves well.

Therapeutic gymnastics

In case of vascular damage, gymnastics is necessary, which is an auxiliary treatment. These are breathing exercises and lower limb training. The main goal of such exercises is to increase systemic blood flow and increase the permeability of vascular walls. It is important to supplement therapeutic exercises with a therapeutic diet in order to reduce the number of atherosclerotic plaques in the blood structure.

Vascular prosthetics of the lower extremities

If conservative methods are ineffective in practice, the doctor offers the patient radical treatment methods. During surgery, the surgeon creates an additional channel for blood flow artificially. Modern techniques have a minimum of contraindications and a limited number of side effects. Alternatively, it could be:

• laser plastic surgery;
• balloon angioplasty;
• vascular bypass;
• angioplasty and stenting;
• endarterectomy.

Diet for atherosclerosis of the lower extremities

The patient’s daily diet should contain only healthy foods, including kelp, seaweed, currants, buckwheat, cherries, oatmeal, apples, chokeberries, vegetable oils, raspberries, beans, eggs, fish, lean meats, and legumes. Prohibited ingredients are alcohol, coffee, chocolate, fatty foods, salt, sugar and spices.

Prevention of atherosclerosis of blood vessels of the lower extremities

To avoid such a disease, preventive measures should become the norm of everyday life. This is a complete rejection of bad habits and proper nutrition, exercise or moderate physical activity. For the prevention of atherosclerosis the following is indicated:

• control of blood sugar and cholesterol;
• normalization of weight, fight against obesity;
• compliance with a therapeutic diet;
• vitamin therapy.

Video: how to treat atherosclerosis of the lower extremities

The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

A drug for the treatment of obliterating atherosclerosis of the vessels of the lower extremities and a method for its treatment

The invention relates to medicine. A method for the treatment of obliterating atherosclerosis of the vessels of the lower extremities is proposed, characterized in that 2-ethyl-6-methyl-3-hydroxypyridine succinate is administered additionally for 10 days at a dose of 400 mg per day: intravenously twice a day in 200 ml of 0.9% sodium chloride. The method corrects the main pathogenetic links of the disease. 4 tables

The invention relates to the field of medicine and can be used in cardiac surgery. Atherosclerosis is the most common cause of morbidity and death from cardiovascular diseases. The commonality of etiology and pathogenesis determines the high frequency of combined damage by the stenotic process to the arteries of all vascular regions (coronary, cerebral and vessels of the lower extremities (Kukhtevich I.I., 1998; Samodai V.G. et al. 1999; Mirolyubov B.M., 2000. Tsarev O.A., 2000). This circumstance determines the need to develop a coordinated tactics for the management of patients with multiple lesions of stenotic atherosclerosis of various parts of the vascular bed by specialists of various profiles - cardiologists, neurologists, angiosurgeons. However, the problem of pharmacological correction of combined occlusive lesions of the arterial system has not been sufficiently developed. Occlusive atherosclerotic arteriopathy is the main cause of ischemic damage to the vessels of the lower extremities.

According to various authors, 15% of patients suffering from atherosclerosis have occlusion of all three arteries of the leg; with obliterating endarteritis, pathology occurs in 40% of patients (Samodai V.P. et al. 1999). According to D.V. Pokrovsky (1 person per 1 million population has critical ischemia of the lower extremities. Despite the successes of reconstructive vascular surgery, the development of endovascular treatment methods, obliterating atherosclerosis is the cause of amputation of the lower extremities in 10% of cases (Andrukhova I.V., 1988 ; Zusmanovich F.N., 1999). In addition, long-term results of surgical treatment remain unsatisfactory due to the development of restenosis and reocclusion of arteries due to the progression of the main pathological process affecting both new areas of arteries and shunts (Belov Yu.V., 1999). ).

Taking into account the role of activation of lipid peroxidation (LPO) processes in atherosclerosis, we can assume a possible beneficial effect of antioxidants on the course of ischemic damage to the vessels of the lower extremities. Since the water-soluble antioxidant - Mexidol - has a wide range of pharmacological effects, exhibiting not only antioxidant, antihypoxic, membrane protective, but also hypolipidemic, antiaggregation, anti-inflammatory and nootrotropic effects, it can be used as an angioprotective agent for the treatment of obliterating atherosclerosis of the vessels of the lower extremities.

The drugs chosen as the drugs to be compared were nicotinic acid and trental, proposed by S.A. Drozdov (1998). As angioprotective agents, patients received combined treatment with enduracin 3 g per day and trental (1200 mg/day) and aspirin 0.33 mg per day for 24 months. A significant decrease in atherogenic changes in the lipid spectrum of blood serum and an improvement in regional blood circulation were revealed. However, long-term use of the prolonged form of nicotinic acid with enduracin at a dose of 3 g per day is accompanied by side effects, including such dangerous ones as toxic liver damage, ulcerogenic effects, gout, hyperuricemia, tachycardia, arrhythmia, up to atrial fibrillation, vasodilation, hypotension, fainting ( Kukes V.G. 1999). Trental (pentoxifylline) also has a large number of adverse reactions: administration of the drug to the elderly and patients with heart failure increases decompensation, tachycardia, increases the myocardial need for O 2, and provokes myocardial ischemia.

The use of aspirin is fraught with the development of bleeding, ulcerative lesions of the stomach and duodenum, the development of bronchospasm, and allergic reactions.

In this regard, long-term use of a combination of 3 drugs (trental, enduracin and aspirin) sharply increases the likelihood of developing side effects, incl. and life-threatening.

The purpose of the present invention was to substantiate the use of the 3-hydroxypyridine-2-ethyl-6-methyl-3-hydroxypyridine succinate derivative as an angioprotective agent for obliterating atherosclerosis of the vessels of the lower extremities.

The study was conducted on 21 male chinchilla rabbits.

As our studies have shown, in rabbits the level of cholesterol in the blood serum increases by 25.3% of the initial level, -tocopherol and mexidol correct the development of hypercholesterolemia (Table 1). The concentration of β-cholesterol did not change, and the atherogenic index increased by 327% from the initial level. The comparison drug, tocopherol, did not correct the increase in the atherogenic index.

Against the background of Mexidol, which was administered at a dose of 5 mg/kg intravenously for 10 days, the atherogenicity index was the lowest and exceeded the initial data by 97%.

Experimental hyperlipidemia was accompanied by an increase in triglyceride concentrations by 54% compared to intact animals. -Tocopherol and mexidol eliminated the development of hypertriglyceridemia. The concentration of beta-lipoproteins did not change against the background of hyperlipidemia.

Thus, Mexidol effectively corrected the development of lipid metabolism disorders during experimental hyperlipidemia in rabbits, reducing the content of total cholesterol and the triglyceride atherogenicity index in the blood serum.

The use of Mexidol against the background of modeling experimental hyperlipidemia reduces the level of MDA in plasma to 63.3%, and in erythrocytes to 81% of the initial data. The comparison drug, tocopherol, was inferior in antioxidant activity to Mexidol, since the level of MDA in the blood plasma decreased only to 88% of the initial level. In contrast to Mexidol, tocopherol enhanced lipid peroxidation processes in erythrocytes - the MDA level increased by 132.6% from the initial level. Mexidol limited the activation of LPO in the aorta - the level of MDA in the aorta decreased to 88.2% under the influence of Mexidol and to 76% - tocopherol. Thus, the use of Mexidol had a beneficial effect on lipid peroxidation processes in biological media during experimental hyperlipidemia in rabbits. In contrast to the reference drug -tocopherol, mexidol did not increase the lipid peroxidation activity of erythrocytes and more effectively inhibited the growth of MDA in the plasma and aorta. Mexidol's ability to correct LPO activation in the aorta opens up the prospect of its use as an angioprotective agent with an antiatherogenic effect.

Mexidol corrected microcirculatory disorders developing during experimental hyperlipidemia in rabbits, as indicated by an increase to 70-80% in the number of functioning capillaries, normalization of the arteriole-venular ratio, and a decrease in the total index of microcirculatory disorders from 3.3 to 0.4 points.

The reference drug -tocopherol increased microcirculatory disorders in experimental hyperlipidemia, as evidenced by a decrease in the number of functioning capillaries to 25-30%, uneven narrowing of the lumen of arterioles, an increase in the arteriole-venular ratio and the index of microcirculatory disorders to 8.55 points.

Thus, Mexidol effectively affects the main links in the pathogenesis of vascular disorders that develop during experimental hyperlipidemia, correcting the development of hypercholesterolemia, hypertriglyceridemia, an increase in the atherogenic index, inhibiting excessive activation of lipid peroxidation processes and improving the state of microcirculation.

The inclusion of Mexidol at a dose of 200 mg twice a day (5% solution 2 ml) intravenously in a drip of 250 ml of isotonic sodium chloride solution into the complex therapy of patients with obliterating atherosclerosis of the vessels of the lower extremities had a positive effect on the dynamics of clinical, biochemical parameters and the state of microcirculation.

Example 1. Patient N., 74 years old, was admitted to the 1st surgical department of the MRCH on September 28, 1999 with a diagnosis of obliterating atherosclerosis of the vessels of the lower extremities, stage II-III. Nk II a. Diabetes mellitus, type II, moderate severity. Diabetic angiopathy of the vessels of the lower extremities.

The patient considers himself to be 8 years old when he first began to notice chilliness in the lower extremities and paresthesia in the form of tingling in the toes, a crawling sensation. After time, pain in the lower extremities and intermittent claudication began when walking 200 meters. Before admission to the hospital, she was treated twice as an inpatient, with slight improvement.

Complaints upon admission: pain, intermittent claudication, cramps in the calf muscles, chilliness, tingling sensation. Hospitalized in the 1st department of the MRCH. Conservative vascular therapy was carried out at the department: 0.9% sodium chloride 400.0 + 0.25% novocaine solution 150.0; physiological solution + trental 2% - 5.0, rheopolyglucin 400 intravenously. Nicotinic acid intravenously according to the scheme (from 1.0 to 10.0 IV and from 10.0 to 1.0 IV), myotropic antispasmodics + analgesics (analgin 50% - 20 + papaverine 2% - 4.0 per 200.0 - 0.9% NaCl) intravenously, xanthinol nicotinate 15% - 2.0 intramuscularly 2 times a day, vitamin B1 and B6 1.0 intramuscularly, alternating vitamin B12 500 g intramuscularly once a day. Antiplatelet agents: aspirin 0.5 once a day orally. After conservative therapy, the condition improved slightly. Therefore, it was decided to use a 3-hydroxypyridine derivative (Mexidol), which was administered intravenously with 200 0.9 NaCl + 5% - 2.0 Mexidol once a day for 10 days. On the third day, the paresthesia disappeared. On the fifth day, the convulsions stopped, on the 8th day, the chilliness in the lower extremities disappeared, complaints of pain, intermittent claudication after 10 days of a course of Mexidol began to be distinguished when walking 1000 meters. The patient is discharged in satisfactory condition without any special complaints, under the supervision of a surgeon to the clinic at her place of residence.

Mexidol also had a beneficial effect on the dynamics of biochemical parameters in this patient.

The general blood test upon admission was characterized by a decrease in HB to 111 g/l, leukopenia to 3./l, and accelerated ESR to 27 mm/h. The glycemic profile indicated uncompensated hyperglycemia: the blood glucose level was 12.0 mmol/l at 12 hours, 11.2 at 16 hours, 11.2 at 22 hours, 10.0 mmol/l at 6 hours. The content of total cholesterol was 6.02 mmol/l, -cholesterol - 1.8 mmol/l, -lipoproteins 40 units, triglycerides 1.8 mmol/l; fibrinogen - 3.552 g/l, atherogenic index was 5.33 units.

The concentration of total protein was 84 g/l, albumin 36.6%, 1 - 3.3%, 1%, - 15%, - 33%.

After complex therapy, including Mexidol infusions, this patient’s HB levels increased to 119 g/l, ESR decreased to 12 mm/h, blood sugar decreased to 8.0 mmol/l, total cholesterol decreased to 4 .58 mmol/l (24% of the outcome), the level of β-cholesterol increased to 1.98 mmol/l; the atherogenic index was only 1.31 arb. units , i.e. decreased almost 4 times, the lipoprotein content was 25 IU (38% lower than the initial data), the concentration of triglycerides decreased to 0.9 mmol/l (2 times the initial data); fibrinogen from the original data); fibrinogen decreased to 2444 mg/l (32% of the outcome), fibrinogen B disappeared.

Doppler ultrasound upon admission: According to Doppler ultrasound examination of the vessels of the lower extremities upon admission, the main blood flow through the femoral arteries was not changed. According to the data of the tibial and dorsum of the foot on the left, stenosis is up to 25%.

Doppler ultrasound at discharge: the main blood flow in the arteries of the proximal and distal parts of both extremities is not changed, collateral is reduced by 7%.

Thus, the inclusion of Mexidol in complex therapy made it possible to achieve significant positive dynamics in clinical and biochemical parameters even in an elderly patient (74 years old). Mexidol corrected disorders of lipid, carbohydrate, and protein metabolism, had an antiatherogenic effect, reduced the atherogenic index, and tolerance to physical activity increased sharply.

Example 2. Improvement in volumetric blood flow with the administration of Mexidol contributed to faster healing of trophic ulcers. We give an example from the medical history 7106/1022 of patient X. 76 years old. He was admitted to the 1st surgical department of the MRCH on November 1, 1999, and was discharged on November 26, 1999 with a diagnosis of grade II-III obliterating atherosclerosis of the vessels of the lower extremities. Nk P b. Trophic ulcer of the fifth toe of the left foot. He has considered himself sick for 9 years, when he first began to notice aches in the calf muscles, fatigue in the legs when walking, and coldness in the lower extremities. As time passed, a burning sensation in the toes, crawling, and intermittent claudication began to occur. He did not seek medical help for a long time. For the last 4 years, he has been undergoing constant inpatient treatment 2-3 times a year. On October 23, 1999, he went to the advisory clinic, from where he was referred by the MRCH. On November 1, 1999 he was hospitalized in the 1st surgical department.

Complaints upon admission: pain in the lower extremities, aggravated by walking, intermittent claudication when walking a distance of 150 meters, burning, numbness, tingling in the toes of both feet of the lower extremities, chilliness, cramps, the presence of a trophic ulcer on the fourth toe of the left foot. Conservative therapy was carried out at the department: IV infusion therapy 4: reopolyglucin 400.0 IV 10; 0.9% NaCl 200.0 + trental 5.0 10, nicotinic acid IV according to the scheme (from 2.0 to 10.0 IV and from 10.0 to 1.0 IV), glucosone-caine mixture : 5% glucose 400.0 + 0.25% novocaine 150.0, IV papaverine per 200.0 ml saline. solution. Also, nicotinol xantinate 15% IM - 2.0 ml 2 times a day 20, vitamin B1 and B6 1.0 IM 1 time a day, alternating vitamin B12 500 mcg IM 1 time a day, antiplatelet therapy: chimes 0.025 per os 4 times a day, trombonil 1 t. 3 times a day per os. After conservative therapy, the condition improved significantly: parasthesia disappeared, but pain and intermittent claudication persisted when walking 400 meters. Trophic ulcer with a tendency to heal (marginal epithelization). It was decided to use the drug Mexidol in 200 ml of saline + Mexidol 5% 2.0 (100 mg) for 10 days. On the 5th day of use, the chilliness in the lower extremities disappeared, on the 8th day a feeling of warmth appeared, the trophic ulcer became epipitalized. On the 10th day of using the drug, the pain disappeared, intermittent claudication was noted when walking meters. The patient is discharged in satisfactory condition without any special complaints.

In patient X., the use of Mexidol had a positive effect on the dynamics of laboratory parameters.

Upon admission, peripheral blood analysis showed a decrease in hemoglobin level to 118 g/l, ESR 13 mm/h, leukocytes 7./l. Blood sugar 6.0 mmol/g, total cholesterol 3.17 mmol/l, alpha cholesterol 0.88 mmol/g, atherogenic index was 2.6 conventional units, beta lipoproteins - 44 units, triglycerides 1.82 mmol /l; total protein 78 g/l, albumin 48.1% 1 - 5%,%, - 12.5%, - 19.4%, fibrinogen 2664 mg%.

When performing an ultrasound scan on November 9, 1999, the following was revealed: the main blood flow through the femoral arteries was unchanged. On the popliteal: on the left - the main unchanged, on the right - modified stenosis up to 50%. In the posterior tibial arteries and arteries of the dorsum of the foot on the left - collateral stenosis up to 75%, on the right - collateral stenosis over 75%.

After the treatment, which included Mexidol infusion, the HB content increased to 125 g/l, the number of leukocytes decreased to 4, ESR to 7 mm/h; blood sugar to 4.67 mmol/g, total cholesterol decreased to 2.38 mmol/g, triglycerides to 0.8 mmol/g, beta lipoproteins to 33 conventional units, alpha cholesterol increased to 1.73 mmol/g ( by 96%), the atherogenicity index decreased to 0.32 conventional units. (almost 8 times), the concentration decreased to 2220 mg% fibrinogen.

Doppler ultrasound on November 22, 1999, compared with the data on November 9, 1999, in the arteries of the distal section on the right, collateral high stenosis of up to 65% is recorded.

The rapid regeneration of a trophic ulcer in patient X. is due to a number of factors: improved microcirculation due to improved rheological properties of blood due to a decrease in the concentration of total cholesterol, triglycerides, fibrinogen, an increase in alpha cholesterol, as well as the ability of Mexidol to increase the resistance to hypoxia of ischemic limb tissue.

Example 3. From the medical history 7753/1126 of patient Zh., 56 years old, indicates the possibility of correcting ischemic changes in severe impairment of arterial blood flow in the vessels of the lower extremities.

Patient Zh., 56 years old, was undergoing inpatient treatment in the 1st surgical department of the MRCH since November 29. to 12/15/99 with a diagnosis of obliterating atherosclerosis of the vessels of the lower extremities, stage III-IV. Nk III b.

He considered himself sick for 16 years, when he first began to notice chilliness in the lower extremities and paresthesia in the form of tingling in the toes, burning sensation, crawling sensation, pain in the calf muscles. For a long time he did not seek medical help or receive treatment. 6 years ago he was transferred to disability group II with a diagnosis of obliterating atherosclerosis of the vessels of the lower extremities. Constantly undergoes inpatient conservative treatment 2-3 times a year.

29.11.99 went to the advisory clinic, from where he was referred to the MRCH, hospitalized in the 1st surgical department. Upon admission, complaints of systematic pain in the lower extremities, intensifying when walking 50 meters, a burning sensation, tingling, numbness in the toes of both feet, chilliness. Conservative therapy was carried out at the department: infusion therapy: rheopolyglucin 400.0 IV, isotonic sodium chloride solution 0.9% - 200.0 + pentoxifylline 2% 5.0; nicotinic acid IV according to the scheme (from 1.0 to 10.0 and from 10.0 to 1.0), Actovegin 6.0 per 200 ml of 0.9% sodium chloride solution; IM papaverine 3 times a day 2% - 2.0; xanthinol nicotinate 15% - 2.0 IM 2 times a day, vitamin B1 and B6 IM 1 time a day, alternating vitamin B 12 500 mcg IM 1 time a day, antiplatelet agents orally: chimes 0.025 per os 4 times a day. After conservative therapy, he began to notice improvement, although the pain syndrome remained, intermittent claudication when walking 250 meters, convulsions disappeared, chilliness, burning, tingling, and numbness remained. In this regard, it was decided to use a 3-hydroxypyridine derivative (Mexidol), which was administered intravenously for 10 days; Sol. Mexidoli 5% -2.0 per 200 0.9% NaCl once a day. On the third day of treatment, the numbness and chilliness disappeared. On the 5th day of treatment, the burning, tingling and numbness in the lower extremities disappeared. On the 8th day there was a feeling of warmth in the lower extremities, the pain stopped. He began to notice dull pain in the lower extremities and intermittent claudication only when walking 600 meters. The patient is discharged in satisfactory condition without complaints.

We present the results of a laboratory and instrumental examination of this patient.

Upon admission: Hb 136 g/l, 5x10; ESR 10 mm/h. There was an increase in blood sugar to 6 mmol/l, cholesterol to 6.78 mmol/l, beta-lipoproteins to 53 units. The content of alpha cholesterol was 1.3 mmol/l, triglycerides 0.89 mmol/l, fibrinogen was 4218 mg/l. The atherogenic index was 4.2 units. Total protein 82 g/l, albumin 50.8%, alpha-1 globulin 4%. Alpha-2 globulins 12.2%, beta globulins 13.4%, gamma globulins - 19.6%. ALT activity 0.82: AST - 0.82 mmol/l. Plasma MDA was 11.86 mmol/l, erythrocyte MDA was 17 mmol/l.

After complex therapy, including Mexidol, positive dynamics were observed in laboratory tests: HB was 146 g/l, 4.3 10, ESR 5 mm/h, blood sugar decreased to 3.5 mmol/l, total cholesterol decreased to 4.78 mmol/l (by 30%), the atherogenic index decreased to 3.68 units. , triglycerides decreased to 0.75 mmol/l, fibrinogen content decreased to 3330 mg/l (by 21%); the concentration of albumins increased, the protein spectrum of blood serum improved 1 33%, 1%, - 13.5%, - 14.4%). The level of MDA in blood plasma decreased to 7.3, and in erythrocytes to 10.3 mmol/l.

Thus, the inclusion of Mexidol in the complex therapy of patients with obliterating atherosclerosis had a positive effect on the dynamics of the pathological process: it accelerated the regression of the main clinical symptoms and improved blood supply in the vascular system of the arteries of the lower extremities.

Mexidol had a beneficial effect on the dynamics of the main clinical symptoms, accelerating their regression (Table 2). Significant differences in the severity of clinical symptoms were noted already on the 5th day from the start of treatment. The severity of convulsive syndrome, pain and weakness in the legs decreased by 27%, 51% and 72%, respectively, on the 5th, 8th and 10th day from the start of treatment, while in the group without Mexidol the decrease in intensity was significantly less pronounced and were 8, 33 and 70%, respectively. Neurovegetative symptoms (numbness, paresthesia, chilliness) experienced the most rapid positive dynamics when Mexidol was administered. By 5 days from the onset of the course, the severity of this symptom decreased by 64.7%, while in the group without Mexidol there was no positive dynamics. The skin temperature in the area of ​​the affected limbs also recovered significantly faster.

The improvement in arterial blood flow in the vessels during the use of Mexidol was also confirmed by Doppler ultrasound data of the vessels of the lower extremities (Table 3).

The increase in volumetric blood flow was most pronounced in the distal vessels of the foot, where the increase was 12%, while in the group without Mexidol, no increase in this indicator was detected.

The use of Mexidol in complex therapy of patients with obliterating atherosclerosis of the vessels of the lower extremities had a positive effect on the dynamics of lipid metabolism. In patients in the control group, against the background of standard therapy, the cholesterol level remained unchanged, while against the background of Mexidol, there was a significant dynamics of a decrease in cholesterol content by 25% of the initial data (Table 4), a similar trend was found in the study of β-lipoproteins - a decrease in their concentration was 19% of the initial data, while in the control group the concentration of β-lipoproteins significantly increased by 13%. High-density lipoprotein cholesterol tended to decrease during standard therapy, while in the comparison group its concentration significantly increased. The change in the ratio in the lipid spectrum under the influence of Mexidol affected the value of the atherogenic index. Thus, in the control group there was an increase in the atherogenic index by an average of 33%, while in the comparison group it decreased by 24% from the initial level. The content of triglycerides in the control group significantly increased by 28%, while against the background of Mexidol their concentration decreased by 28%. The administration of Mexidol reduced the concentration of glucose in the blood by 24%, whereas during standard therapy its level did not change.

Mexidol exhibits pronounced antioxidant activity in patients with obliterating atherosclerosis, reducing the concentration of malondialdehyde by 43% from the initial level, while in the control group there was a tendency for this indicator to increase (Table 4).

Mexidol corrects the increase in fibrinogen concentration in the blood (Table 4).

Thus, the inclusion of Mexidol in the complex therapy of patients with obliterating atherosclerosis of the vessels of the lower extremities has a beneficial effect on clinical, functional and metabolic parameters, correcting the main pathogenetic links of this disease. Mexidol corrects atherogenic changes, reducing the atherogenic index, the level of triglycerides, fibrinogen, and blood glucose. Of significant importance in the implementation of the angioprotective effect of Mexidol is its high antioxidant potential. Normalization of metabolic changes is an important factor in the positive effect of Mexidol on microcirculatory blood flow in atherosclerotic vascular lesions of the lower extremities. The overall effect of Mexidol is manifested in improved blood supply in the ischemic zone in patients with obliterating atherosclerosis.

REFERENCES 1. Drozdov S.A. The use of nicotinic acid and pentoxifylline for the treatment and prevention of progression of occlusive atherosclerotic arteriopathy //Cardiology.-1998. 9. P.16-19.

2. Mirolyubov B.M., Zamaleev Z.A. Autovenous deep-femoral popliteal bypass surgery // Thoracic and cardiovascular surgery. 1. 2000. - pp. 43-45.

3. Pokrovsky V.V. Surgical tactics for lesions of the abdominal aorta and arteries of the lower extremities in young patients // Surgery. - 1986. - 5. - p. 89-95.

4. Samoday V.G., Zvyagin A.V., Ivanov A.A. Surgical treatment of patients in the terminal stages of occlusive diseases of the peripheral arteries of the lower extremities // Bulletin of surgery. 15. T. 158. 1999. -P.29-30.

5. Tsarev O. A. Intra-arterial laser exposure as a complement to traditional methods of direct revascularization of the extremities // Angiology and cardiovascular surgery. 1998.- 2.- S..

A method of treating obliterating atherosclerosis of the vessels of the lower extremities, including the use of antiplatelet agents, anticoagulants, vasodilators, characterized in that 2-ethyl-6-methyl-3-hydroxypyridine succinate is administered additionally for 10 days at a dose of 400 mg per day: intravenously twice a day in 200 ml of 0.9% sodium chloride.

Treatment of atherosclerosis of the extremities

Conservative treatment of obliterating atherosclerosis of the vessels of the lower extremities

Hello. Today we will talk about such a disease as obliterating atherosclerosis of the vessels of the lower extremities. It is also called atherosclerosis of the legs, vascular blockage, vascular obstruction of the lower extremities, etc.

Why about him? But because the survey “What articles would you like to see on my blog?” has ended on my blog. The topic “Vascular diseases of the lower extremities” won by a large margin. And since a large number of people suffer from obliterating atherosclerosis of the lower extremities, I chose this topic.

I will only talk about atherosclerosis of the lower extremities what I know myself, what patients say. Just pure practice and my experience.

We will only discuss issues related to the conservative treatment of obliterating atherosclerosis of the vessels of the lower extremities. Many people know what atherosclerosis is. There is a lot of information on this topic on the Internet. Anyone interested can find everything on this topic.

If atherosclerotic plaques form in the lumen of the vessels of the lower extremities and lead to disruption of the blood supply to the legs due to stenosis (narrowing), occlusion (blockage) of the arteries, then this disease is called obliterating atherosclerosis.

The process itself is most often localized in large vessels (aorta, iliac arteries) or medium-sized arteries (femoral, popliteal).

Most often men suffer from this disease, starting from the age of 40 (although I have also met younger patients). But the main contingent is people of retirement and old age, 55 years and older. As a rule, atherosclerosis affects not only the vessels of the legs, but also the brain, heart, kidneys, etc.

In principle, the entire clinical picture of the disease depends on how strongly the atherosclerotic plaque narrows the lumen of the vessel and what trophic changes result in the lower extremities and how their function is disrupted.

In some cases, the plaque completely blocks the lumen of the vessel and blood does not flow through it.

How is it, you ask, that if blood does not flow to the legs, then gangrene should develop? Yes, some people develop it, but others do not.

Why? But because the second person has highly developed collateral blood circulation, while the first person does not. But we'll talk about this a little later.

For several years, obliterating atherosclerosis of the vessels of the lower extremities can be asymptomatic. But sometimes, with the appearance of the first symptoms, it begins to progress quickly.

What complaints do people with this pathology most often make? This:

Increased chilliness, usually of the fingers and toes. People say that even in the heat or in a warm room they wear felt boots or woolen socks;

There is a feeling of numbness in the feet;

At rest, pain in the legs is usually not bothersome. Pain (usually in the calf muscles) appears when walking and stops after a short rest. This is the so-called “intermittent claudication.” Depending on the stage of the disease, pain when walking occurs after meters or more. In advanced cases, the pain is constant.

What is this connected with? Here's what: normally, a healthy artery has a certain diameter and the amount of blood passing through it is sufficient to nourish the tissues of the lower extremities. The artery affected by atherosclerosis has a smaller diameter and during physical activity (walking) is not able to provide oxygen to the tissues, which is manifested by pain in the muscles. At this moment the person has to get up and stand.

At this time, the “old”, oxygen-poor blood “leaves” and “fresh” blood “comes” in its place - the pain disappears and the person moves on. But after a certain number of meters (it’s different for everyone), the pain in the legs appears again, and this whole process begins again and again;

When the aorta and iliac arteries are affected (the so-called Leriche syndrome), pain occurs in the gluteal muscles, hips, and lumbar region;

The skin of the lower extremities becomes pale, dry, hair falls out on the legs, and nail growth is disrupted. In a severe form of the disease, on the contrary, you can see when a person sits with his legs down, the foot and fingers become red. But as soon as the legs are given a horizontal position, the skin becomes pale, almost white. Sometimes such people even sleep sitting up and it’s clear why. Since in this position - legs down - more blood flows into the lower extremities than if the person were lying down;

When examined in patients with obliterating atherosclerosis of the lower extremities, hypotrophy and even muscle atrophy (usually the legs) are noted. A person notices that the leg begins to lose weight and the amount of muscle tissue decreases. But the reason is still the same - insufficient supply of blood (with nutrients and oxygen) to the tissues of the lower extremities;

A common symptom of atherosclerosis in the aorto-iliac segment is impotence, since the blood supply to the system of internal iliac arteries is disrupted. This symptom occurs in 50% of patients.

Obliteration (narrowing and occlusion) of the vessels of the lower extremities does not occur immediately, but gradually and the body manages to partially adapt to the new conditions. This is manifested by the development of collateral circulation, i.e. the blood “looks” for workarounds. And she finds them in the form of small arterial trunks, which seem to “bypass” the affected area of ​​the artery, i.e. the body forms a kind of shunt.

So why can gangrene occur?

According to my observations, this happens when:

Part of the atherosclerotic plaque comes off and the blood flow clogs the underlying vessels,

On the plaque itself there are always thrombotic masses, which, when torn off, also clog the vessels, and all this happens suddenly and the person may require emergency surgery,

And finally, the slower development of gangrene is when the collateral circulation is so weak that there is no effect from it, and trophic changes quickly increase, turning into gangrene.

For young people. After an examination by a vascular surgeon, it is of course advisable to carry out surgical treatment.

And there are many types of surgical intervention. This includes laser removal of atherosclerotic plaques, and balloon dilatation of a stenotic vessel, and prosthetics of an entire section of the affected vessel (a part of the artery is removed and an artificial (or from the patient’s vein) vascular prosthesis is sewn in its place), and bypass surgery (the obliteration site is “bypassed” with a vascular prosthesis) (see picture).

The main problem is that a large number of patients are elderly, with a bunch of concomitant diseases, for which surgical treatment is simply contraindicated. Well, perhaps only amputation of the lower limb for gangrene for health reasons.

Why do the majority of sick people with gangrene undergo amputation at the hip level?

Previously, in our conditions, we performed pre-amputations within a year. Some underwent amputation at the level of the lower leg. This had no effect, and the leg continued to rot further, only on the lower leg. We amputated a little higher - the effect was the same - the gangrene did not stop and we amputated the limb at the level of the hip. Only then did the process stop. Apparently, this happens because there is not a good enough blood supply to the lower leg, the vascular network is not developed, and there is no good collateral circulation.

Most patients should undergo conservative treatment 2 times a year.

What are the basic principles of such treatment of patients with obliterating atherosclerosis of the vessels of the lower extremities?

1 Considering that atherosclerosis is plaques, and plaques are cholesterol, drugs that lower cholesterol levels in the blood are used:

Statins – block the formation of cholesterol in the liver. These include: simvastatin, lovastatin, pravastatin and others.

Fibrates - increase the amount of high-density lipoproteins and reduce total cholesterol. They should be taken with great caution after consultation with a cardiologist. These are drugs such as bezafibrate, clofibrate, gemfibrozil, fenofibrate.

Nicotinic acid derivatives greatly dilate blood vessels, so use with caution. The drug enduracin has practically no such side effects.

Other drugs such as colestipol, probucol, guarem, lipostabil, benzaflavin and eikonol also help lower cholesterol levels. They block the formation of atherosclerotic plaques.

2. Drugs that improve the rheological properties of blood: various heparins, warfarin, small doses of aspirin, clopidogrel, etc.

3. Medicines aimed at improving microcirculation and developing collaterals. These are pentoxifylline, trental, chimes, etc.

4. Physiotherapeutic treatment:

Barotherapy for lower extremities

SMT on the lumbar region (ganglia)

And now I will briefly show you the treatment regimens that I provide to patients with atherosclerosis of the lower extremities on an outpatient and inpatient basis.

Trental or Pentoxifylline 400 mg 2 times a day for a month

Cardiomagnyl 75 mg 1 time per day in the evening after dinner (continuous use is possible)

Wessel Due 1 t - 2 times a day

Actovegin 0.2 - 2 times a day

Nikoshpan 1t - 2 times a day

Vitamin E - 2 capsules, 2 times a day.

For local erosions on the skin, you can use Curiosin powder. When cleaning the wound, Actovegin or Solcoseryl ointment can be applied to clean granulations.

In terms of examination, in addition to general clinical tests, be sure to take a biochemical analysis of blood lipids and their fractions.

Undergo an ultrasound scan of the vessels of the lower extremities to determine the stage, extent and level of arterial damage.

Inpatient treatment includes:

Intravenous infusion therapy: alternate - Reopoligluca 400.0 + Novocaine 0.25% -100.0 - 1 day, 2nd day - Trental (or Pnthoxiphylline) 5.0 + Phys. solution 0.9% -250.0; Potassium chloride 4% -20.0, Analgin 50% -2.0, Diphenhydramine 1% -1.0, Riboxin 10.0, Ascorbic acid 5% -2.0, Magnesium sulfate 25% -3.0. The course of infusion therapy is 20 days.

Papaverine 2% -2.0 + Nicotinic acid 2.0 intramuscularly for 10 days.

Actovegin 2.0 intramuscularly at night for 10 days.

You can take (better for diabetic angiopathy) Sulodexide 250 LRU 2 times a day during the day between meals.

Courses of conservative therapy should be carried out 2 times a year, preferably in spring and autumn.

In addition to this, be sure to read my blog article HERE.

To be honest, obliterating atherosclerosis of the vessels of the lower extremities is an incurable disease, but if you follow the above-described methods of conservative treatment, you can significantly improve your quality of life and avoid such a terrible complication of atherosclerosis of the lower extremities as gangrene.

Health to everyone. A. S. Podlipaev

Recommendations are given for informational purposes only and are of a preliminary informational nature. Based on the recommendations received, please consult a doctor, including to identify possible contraindications! Taking recommended medications is possible ONLY IF THEY ARE GOOD TOLERATED BY PATIENTS, TAKEN INTO ACCOUNT OF THEIR SIDE EFFECTS AND CONTRAINDICATIONS!

If atherosclerosis of the arteries of the lower extremities is suspected, the following studies are performed: Non-invasive studies - do not cause discomfort to the patient during the study, and can be performed on an outpatient basis.

1. Pulse examination is the primary assessment of blood circulation in the lower extremities; when determining normal pulsation by a vascular surgeon, the presence of significant atherosclerotic changes in the arteries of the lower extremities is unlikely.
2. Arterial blood pressure - after measuring blood pressure in the arms and legs using an ultrasound Doppler (a device for determining blood flow), the obtained figures are compared and a general conclusion is made about the presence of arterial blood flow disorders in the lower extremities
3. Duplex (triplex) scanning of arteries - ultrasound vascular examination allows you to detect narrowing or blockage of the artery and measure the diameter of the vessel. Provides information about the condition of the saphenous vein of the leg, in order to decide on the use of the saphenous vein as a bypass (shunt) to bypass the blocked section of the artery.
4. Computed angiography CT angiography is a study performed on a spiral computed tomograph with the simultaneous injection of contrast into the saphenous vein of the arm, providing information about the presence and extent of narrowing, blockage, and dilatation of the arteries. Invasive examination - the examination is carried out by injecting contrast into the arteries under X-ray control.
5. Angiography/Angiogram is the most valuable study in patients with atherosclerosis of the arteries of the lower extremities for whom, according to preliminary examination and examination, surgical treatment is indicated and planned. Contrast is injected into the artery and a special x-ray is used to show the exact location of the blockage or narrowing of the artery and the condition of the arteries above and below the affected area. Angiography is necessary when there is a question about endovascular intervention or surgical treatment of atherosclerosis of the arteries of the lower extremities.

Treatment of atherosclerosis of the arteries of the lower extremities

The treatment complex is aimed at relieving pain, lameness and other symptoms in the lower extremities caused by narrowing or blockage of the arteries of the lower extremities by atherosclerotic plaque. Atherosclerosis today cannot be completely cured or prevented, however, the progression of the disease can be stopped by reducing the risk factors for the disease. This requires a change in the patient's lifestyle.

Smoking: Avoidance of any form of tobacco is essential. Long-term cigarette smoking is the most unfavorable risk factor causing the progression of atherosclerosis of the arteries of the lower extremities. Nicotine contained in tobacco causes arteries to spasm, thereby preventing blood from reaching organs and tissues and increasing the risk of developing atherosclerosis. In addition, smoking reduces the amount of oxygen in the blood, and can lead to thickening of the blood and an increased risk of blood clots (thrombi) forming inside the vessels.

High blood pressure: High and uncontrolled blood pressure (hypertension) causes the heart to work harder and puts extra strain on the arteries. Blood pressure should be checked regularly by the patient, as hypertension often occurs without obvious signs. If you have hypertension, you must follow the treatment prescribed by your doctor, even if you feel well.

Diet: The risk of atherosclerosis can be reduced by following a diet and carefully monitoring your blood cholesterol levels. It is necessary to exclude from food foods high in cholesterol (fatty meats, cheese, egg yolks). It is necessary to consume vegetable fats and vegetable oil. A low-salt diet is necessary to reduce blood pressure and swelling. If you are overweight, you need a general diet to lose weight. It is necessary to control serum cholesterol levels. If, while following a diet, cholesterol remains high, then treatment is prescribed to lower cholesterol. Training walking is important in the complex treatment of patients with lameness. Often patients, fearing pain when walking, limit their movements and switch to a sedentary (sedentary) lifestyle. It has now been proven in international studies that training walking at least a day in patients with atherosclerosis of the arteries of the lower extremities leads to the development of roundabout (collateral) blood circulation and an increase in the distance without painful walking.

Diabetes: The presence of diabetes contributes to the early development of atherosclerosis and its rapid progression. It is important to control blood sugar and treat diabetes in patients with atherosclerosis of the arteries of the lower extremities. Foot care: if blood circulation in the lower extremities is impaired, with any minor injury (wound) to the leg, serious complications can occur (infection, poor healing, trophic ulcers, gangrene ). It is necessary to examine your feet daily. Consult a doctor immediately if you notice any damage or wounds on the skin of your leg.

Pharmacological therapy: In addition to other recommendations from your doctor, the following medications may be prescribed:

• Antiplatelet drugs - these drugs reduce the risk of heart attacks (angina, myocardial infarction) or strokes and transient brain disorders associated with atherosclerosis of the arteries. They can also increase pain-free walking distance (distance walked without stopping) by increasing blood flow to organs and tissues: Aspirin - One aspirin tablet taken daily. Clopidogrel (Plavix ®) 75 mg, a more modern antiplatelet agent. International studies are currently being conducted to determine the effectiveness and benefits of this drug.
• Anticoagulants - these drugs prevent blood clotting and the formation of blood clots: Warfarin (Coumadin ®) - a drug in tablets, its administration requires monitoring of the blood INR analysis Clexane, fraxiparine, fragmin, heparin - anticoagulants in injections, as a rule, treatment with these drugs is carried out in conjunction with taking warfarin and ends when the therapeutic effect of warfarin is achieved. Drugs that improve blood circulation in the arteries of the lower extremities: Pentoxifylline, Trentaltab x3 times a day (1200 mg per day), for at least a month

Surgical treatment

Surgical treatment for atherosclerosis of the arteries of the lower extremities is used in cases where conservative treatment is not effective and (or) there are signs of disease progression that limit the patient’s lifestyle.

The main task before surgical treatment is to determine the exact location of the narrowing (stenosis) or blockage (occlusion) of the artery. For this purpose, ultrasound duplex scanning and (or) computed angiography of the arteries of the lower extremities are used. A mandatory test for patients undergoing surgical treatment is angiography (angiogram). The examination is performed under local anesthesia. Through a puncture in the groin area, a special catheter is inserted into the femoral artery. Contrast (dye) is injected through the catheter. During the administration of contrast, a special X-ray examination is performed. Angiography complements the previously obtained information and allows you to see the extent of narrowing or blockage of the artery, and assess the condition of the arteries above and below the affected area of ​​the vessel.

After determining the location and extent of the blockage or stenosis of the artery, two treatment methods can be used: angioplasty (endovascular treatment) or surgery (open surgery).

Angioplasty is a procedure that can be performed during an angiography. To perform angioplasty, a special balloon is used to widen the narrowed section of the artery. Through a puncture in the groin, the balloon is inserted into the lumen of the artery and is located at the level of the narrowing of the artery. The balloon is inflated, which causes the artery to widen at the site of narrowing. To prevent the dilated vessel from narrowing again, a special device, a stent (frame), is brought and installed in the area of ​​the artery where angioplasty was performed. The patient's stay in the clinic after angioplasty is usually within 24 hours.

If the patient has severe damage to the arteries by atherosclerosis, and it is not possible to perform angioplasty. open surgery is required. Shunt operations are used to restore blood flow. During the operation, a suitable section of the artery is found above and below the site of blockage (occlusion). And a shunt (bypass) is sewn between these two sections of the artery. To perform bypass surgery, the patient's own saphenous vein or a synthetic prosthesis is used as a bypass. The operation can take from 2 to 5 hours. The patient's stay in the clinic is 3-7 days after surgery. In 10% of cases during surgery, the patient requires a blood transfusion.

Angioplasty and open surgery are safe procedures with good results. Factors that may reduce the success of each procedure include: - the number and severity of blockages and narrowing of the arteries, - the general health of the patient. Strict monitoring of risk factors for atherosclerosis of the arteries of the lower extremities after the procedure is necessary. The most significant risk factor that influences early deterioration. smoking treatment result. Therefore, lifelong smoking cessation is necessary.

Conclusion

Atherosclerosis of the arteries of the lower extremities may manifest as mild intermittent claudication. With progression of the disease and lack of necessary treatment, extensive gangrene and loss of the lower limb (amputation) may develop. The rate of disease progression depends on the number and severity of risk factors for the development of atherosclerosis (smoking, diabetes, hypertension, obesity, etc.) Timely treatment, quality medical care, smoking cessation, control and correction of blood pressure, daily exercise, timely angioplasty or surgery can significantly reduce the symptoms of the disease, save the leg and improve the quality of life and prognosis in patients with atherosclerosis of the arteries of the lower extremities.

Treatment of atherosclerosis of the lower extremities

There are many diseases that lead to disability and, in the worst case, death. One of the highest positions in this list is occupied by obliterating atherosclerosis of the lower extremities. Most often, this disease occurs in older people and almost always in men.

This is a disease that affects the large and medium-sized arteries in the legs. They can no longer properly supply blood to the lower extremities, as blood circulation is hampered by narrowing of blood vessels and blockage by plaques and blood clots. It appears due to cholesterol and fat on the walls of blood vessels. Tissue viability is impaired, which leads to problems with movement, the appearance of ulcers and necrosis.

If you do not start treatment for atherosclerosis of the lower extremities at least at this stage, then there is a high chance of developing gangrene and then the leg will have to be amputated.

Causes of atherosclerosis of the lower extremities

Among the main reasons for the development of atherosclerosis is an unhealthy lifestyle. They lead to him:

• smoking;
• excessively fatty diet;
• lack of physical activity;
• obesity.

It can also be caused by:

• diabetes mellitus;
• frostbite;
• heredity;
• metabolic disorders, including cholesterol;
• hypertension;
• infections affecting the kidneys.

All these reasons make obliterating atherosclerosis of the lower extremities truly the scourge of our century, which, along with varicose veins, affects our legs.

Symptoms of atherosclerosis of the vessels of the lower extremities

During the first months, the disease often occurs without obvious signs and does not cause any particular problems. However, once it enters a more severe phase, numerous symptoms appear and progress rapidly. Among them:

• lameness;
• pain in the legs when walking, as well as their rapid fatigue;
• pain in the legs at rest;
• numbness of the feet;
• temperature changes - the legs “chill”, they feel colder to the touch than healthy limbs;
• the appearance of wounds and ulcers that do not heal;
• darkening of the toes and skin of the feet (they become purple-bluish in color), the development of necrotic changes on them;
• hair loss in the area of ​​the affected arteries.

It is very important to consult a doctor at the first signs of the disease for diagnosis, because it is one of those that can be fully cured only in the early stages. In the complicated form, modern treatment methods are much less effective and often only manage to relieve symptoms, which return after a while.

Diagnosis of atherosclerosis of the lower extremities

In our clinic, treatment of any disease, including obliterating atherosclerosis, begins with a comprehensive diagnosis. This approach allows us to find out all the nuances, make an accurate diagnosis and not miss moments that can play a vital role in the further healing of the patient.

In this case, our doctors can give an initial conclusion after examining the patient, especially when we are talking about a rather acute stage with visible differences between the diseased and healthy limbs. Further diagnostics include:

• tomography;
• listening to noise and pulsation of arteries;
• Vascular ultrasound;
• angiography – diagnostics of blood vessels using a contrast agent.

And, if necessary, other studies.

Using this, we not only establish the presence or absence of signs of atherosclerosis of the lower extremities, but also find its causes, places of blockage, and determine the severity of the disease. This is the only way to then select effective treatment methods.

Treatment of atherosclerosis of the vessels of the lower extremities

Just as we approach diagnosis, we also approach the treatment of atherosclerosis of the lower extremities, that is, in a comprehensive manner. At our clinic, we believe that there is no point in dealing with symptoms if the cause is not eliminated.

In the initial stages of the disease, it is enough to cure the source of the disease and take preventive measures - lose weight, monitor sugar and blood pressure, give up bad habits, go on a diet. Also, doctors at our clinic can prescribe medications that help improve blood supply and vascular patency, and relieve spasms.

In our clinic, clinical studies of bone marrow cell transplantation for obliterating diseases of the lower extremities have been carried out since 2002. When using unfractionated MNC, instrumental indicators (perfusion index, transcutaneous oxygen pressure) make it possible to register a decrease in ischemia to varying degrees in all patients. In 50-82% of cases, growth of collateral vessels was noted according to angiography. Improvement in subjective symptoms was noted by more than 85% of patients. At the same time, bone marrow MNC transplantation made it possible to avoid limb amputation in 90% of patients with critical ischemia.

Legs are an opportunity to walk that none of us are willing to give up. Unfortunately, sometimes they do not want to cooperate with us, one of the reasons for this is obliterating atherosclerosis of the lower extremities. This is a serious disease, dangerous, but not invincible.

In our clinic, highly qualified doctors with extensive experience in diagnosing and treating vascular diseases will do everything to restore the function of your arteries as much as possible and slow down the further development of the disease. The sooner you come to us, the greater the chance that it will recede forever.

Chronic obliterating diseases of the lower extremities account for more than 20% of all types of cardiovascular pathology, which corresponds to 2-3% of the population. They are characterized by a steadily progressive course, an increase in limb ischemia and severe pain. Despite the use of modern methods of conservative and surgical treatment, critical degrees of ischemia with gangrene of the limb develop in 15–20% of patients.

Numerous experimental studies have shown that implantation of bone marrow mononuclear cells (MNCs) into the ischemic area can cause the formation of new vessels (angio- and vasculogenesis) as well as an increase in blood flow through existing collaterals. In this case, both hematopoietic stem cells and progenitor cells, as well as bone marrow stromal cells, have angiogenic properties. The ability of hematopoietic and mesenchymal stem cells of the bone marrow to transdifferentiate into endothelial cells, myocytes and pericytes, directly participating in the formation of new vessels, has been demonstrated. In addition, in the area of ​​ischemia, bone marrow MNCs produce a complex of cytokines necessary for the formation and growth of blood vessels from local tissues.

In rodent experiments with femoral artery ligation, implantation of bone marrow-derived MNCs into the gastrocnemius muscle resulted in a 50 percent or more increase in the number of capillaries, increased blood flow, and improved exercise tolerance. In experiments on large animals, after the introduction of bone marrow MNCs, an increase in capillary density by 2.5-3 times was noted, as well as remodeling of collateral vessels with a 5-fold increase in blood flow velocity.

Clinical trials of bone marrow MNC transplantation for obliterating diseases of the lower extremities have been conducted since 2002. When using unfractionated MNC, instrumental indicators (perfusion index, transcutaneous oxygen pressure) make it possible to register a decrease in ischemia to varying degrees in all patients. In 50-82% of cases, growth of collateral vessels was noted according to angiography. Improvement in subjective symptoms was noted by more than 85% of patients. At the same time, bone marrow MNC transplantation made it possible to avoid limb amputation in 90% of patients with critical ischemia.

To evaluate the effectiveness of intramuscular (into the calf muscle) administration of autologous bone marrow MNCs in the treatment of patients with obliterating diseases of the lower extremities, as well as possible complications.

• Obliterating atherosclerosis of the arteries of the lower extremities.
• Obliterating endarteritis of the lower extremities

• Men and women aged 30 to 65 years inclusive.
• The presence of obliterating atherosclerosis or obliterating endarteritis of the vessels of the lower extremities with grade 3-4 limb ischemia.
• Patients must be mobile enough to follow the rehabilitation program and visit schedule.
• Patients must be able to give informed consent, and this consent must be obtained before treatment begins.
• With grade 4 ischemia, necrotic changes are limited to the toes and trophic ulcers, i.e. no high limb amputation required.

• Simultaneous participation in another clinical trial.
• Inconsistency with study criteria.
• Presence of autoimmune diseases.
• Presence of signs of inflammation according to test data.
• Any known or history of malignant disease.
• The presence of an acute infectious disease.
• The presence of other diseases that impair the function of the limb.

Bone marrow sampling will be carried out under aseptic conditions (the operating room of the surgical department of the Immunopathology Clinic. Local or general anesthesia (depending on the psycho-emotional lability of the patient). The puncture site is the wing of the ilium, 2-3 cm posterior to the anterior superior spine.

Isolation of the mononuclear fraction of bone marrow

Isolation of the mononuclear fraction will be carried out in the laboratory of cellular biotechnology of the Research Institute of Clinical Immunology.

Introduction of bone marrow MNCs

A suspension of bone marrow MNC (first and second parts) will be injected locally into the calf muscles of the points. If the level of stenosis is high, it is also possible to inject a cell suspension into the thigh muscles. The cells will be injected under local anesthesia in a fan-shaped manner, i.e. from one injection you can introduce cells into 7-10 points. Immediately after administration, bed rest with isometric contractions of the muscles of the lower leg and thigh is required for 2 hours. Subsequently, no specific regime restrictions are required.

All patients during their stay in the hospital and during subsequent outpatient treatment will receive standard complex conservative treatment using antispasmodics (papaverine, drotaverine, etc.), antiplatelet agents (pentoxifylline, asetylsalicylic acid, etc.), metabolic drugs (solcoseryl, actovegin) , vasoprotectors (pyricarbate, etc.), antiatherosclerotic agents (cholestyramine, ciprofibrate, simvastatin, etc.).

Efficacy and safety assessment

Control examinations of patients after bone marrow MNC transplantation will be carried out after 1 week, 1 month, 3 months, 6 months and then at intervals of 1 year. If the patient's condition worsens associated with the disease being studied, an examination using the necessary additional methods will be carried out immediately.

The safety of the intervention will be assessed by the presence or absence of possible complications associated with the introduction of MNCs - allergic reactions, infectious complications at the injection site, significant progression of limb ischemia. The general somatic status will also be assessed (based on a physical examination, general clinical tests) to exclude the adverse effect of transplantation on concomitant diseases. Particular attention will be paid to oncological pathology.

Obliterating atherosclerosis is a circulatory disorder in peripheral arteries, provoked by a narrowing of their lumen or complete occlusion and threatening ischemia of the lower extremities. Obliterating atherosclerosis of the vessels of the lower extremities is coded with code 170.2 according to the ICD 10 classification.

Obliteration of the vessels of the lower extremities is the gradual destruction of their lumen with replacement by connective tissue, which stops the blood supply and leads to chronic oxygen starvation of the corresponding tissues. Obliterating atherosclerosis is caused by excess cholesterol on the walls of the arteries of the lower extremities.

The veins of the legs in this disease are just the area of ​​maximum damage by cholesterol plaques. Systemic atherosclerosis is provoked by a combination of several factors affecting the condition of blood vessels:

• heredity;
• hypertension;
• increased blood clotting;
• kidney and liver diseases;
• hypercholesterolemia;
• dyslipidemia;
• diabetes mellitus;
• tuberculosis;
• rheumatism;
• smoking;
• poor nutrition;
• alcoholism;
• obesity;
• physical inactivity;
• hypothermia and frostbite of the lower extremities;
• leg injuries.

Elderly people and men are primarily at risk.

Symptoms and stages of pathology

Obliterative vascular diseases are characterized by symptoms caused by acute or chronic ischemia of various tissues and organs (skin, muscles, bones, joints, vascular wall) of the lower extremities, occurring both during movement and at rest.

• Muscle pain in the thighs and calves of the legs when moving, because a sufficient amount of blood does not enter the working muscle tissue. The patient walks intermittently, waiting out attacks of pain. As OASNK progresses, the pain becomes chronic.
• Hot-cold foot syndrome. Since insufficient blood flows into the limb with the affected vessels, it appears colder than the healthy one.
• Feelings of coldness, tingling and numbness in the feet as a result of poor blood flow and damage to nerve sensitivity.
• Regarding the area of ​​vascular damage, pain in the feet or legs, thighs and buttocks, inability to retain gases and problems with potency.
• The formation of non-healing ulcers, thickening or brittle nails, impaired hair growth, darkening of the skin.

There are 4 phases of OASNK. The first two phases are reversible with the proper level of therapy.

1. At first, pain in the lower extremities makes itself felt only after serious physical exertion. Pain-free walking distance of at least one kilometer. The disease is detected only by laboratory testing of the blood condition, indicating that the permissible cholesterol level is exceeded.
2. At the second stage, the first physical symptoms of obliterating atherosclerosis become noticeable. The legs become cold and numb, and cramps occur. When walking for a distance of no more than 1000 meters, your legs begin to hurt. As OASNK progresses, the pain-free distance is shortened to only 250 meters.
3. The third phase is characterized by pronounced clinical signs. The skin becomes thinner and easily damaged. When you lift the affected leg, the skin turns pale, and when you lower it, it turns red. The blood flow deteriorates so much that pain in the legs occurs even after 50 meters. The pain also bothers me when I am not moving, especially at night. To relieve pain, patients take a forced lying position with their leg lowered.
4. Lameness and pain in the feet and toes become constant. The skin turns black, areas of necrosis of the skin, fiber and muscles appear. Muscle atrophy occurs. Mobility is sharply limited, and then the patient becomes completely unable to move independently. There is a risk of the formation of trophic ulcers and gangrene of the fingers and heels, which may require amputation of the limb. Without timely surgery, death is possible.

Diagnosis of obliterating atherosclerosis

To confirm the diagnosis of obliterating atherosclerosis and clarify the area of ​​vascular damage, a series of laboratory tests are performed (coagulogram, detailed blood test for lipid, fibrinogen, glucose levels) and instrumental examination.

Initial examination

The clinical picture of the disorders is obvious, therefore, when diagnosing, the immediate examination of the patient by an angiologist and the study of pathognomonic signs come to the fore. Obliterating atherosclerosis is not an independent disease, so concomitant diseases and injuries of the lower extremities are carefully studied.

Blood pressure measurements are taken in the legs and arms, and pulsation in the arteries of the lower extremities is checked. As the disease develops, the pulsation below the area of ​​occlusion is weakened or absent, and a systolic murmur is heard above the narrowed vessels.

Duplex scanning of leg vessels

Scanning makes it possible to determine the condition of the arteries, the degree of their elasticity and the level of blood circulation in OASNK. The method is based on determining the speed at which sound waves are reflected from moving blood elements, and makes it possible to identify the presence of obstacles to blood flow.

Duplex scanning does not require special preparation. Before the procedure, the patient must undress from the waist down. The sensor is moved from top to bottom - from the inguinal ligament area, along the inner side of the thigh and under the knee, and ends on the calves. During the procedure, the doctor may ask you to change your body position several times, as well as stand up and walk a little.

The study lasts approximately 45 minutes. Duplex scanning has no age restrictions. Pregnant women and children can also be examined. This is a non-invasive, harmless, painless and safe procedure.

Peripheral arteriography

Diagnosis of the condition of the arteries using an X-ray machine and injection of a contrast agent containing an iodine compound.

Preparation includes giving up alcohol two weeks and avoiding eating four hours before the procedure. To reduce sensitivity to contrast agents, antiallergic drugs are prescribed. Upon completion of the examination, it is recommended to drink as much plain water as possible to speed up the removal of the contrast agent from the body.

Arteriography has a number of contraindications: allergy to contrast agent, pregnancy, renal failure, severe diabetes mellitus, some thyroid diseases, heart failure, multiple myeloma, weight over 130 kg. Therefore, additional examination is required before the procedure.

The method makes it possible to detect aneurysms and vascular blockages. As a rule, one study is performed to choose from: scanning or arteriography.

Studying the condition of blood vessels using a magnetic resonance imaging scanner. The procedure is carried out in cases where the diagnosis of obliterating atherosclerosis of the vessels of the lower extremities needs to be confirmed after angioscanning or arteriography, which turned out to be insufficient. As a rule, the disease can be accurately determined after one of these methods.

Contraindications: pregnancy, the presence of metal implants in the body (for example, pacemakers), claustrophobia.

It is forbidden to drink alcohol three days before, smoke one day before, or eat or drink 6–8 hours before the procedure. The duration of the examination is up to 1.5 hours.

MR angiography has a number of advantages over other methods. It displays the condition of blood vessels in as much detail as possible and detects even minor pathologies in their structure and blood circulation. The method makes it possible to avoid exposure to X-ray radiation on the patient’s body and contrast agent in most cases. MR angiography can be performed with or without contrast agents.

Treatment of the disease

After confirmation of the diagnosis, a treatment program is developed taking into account the stage and other nuances of the development of the disease. Therapy also involves the treatment of concomitant pathologies that contribute to the formation of obliterating atherosclerosis.

It is possible to completely cure obliterating atherosclerosis only with the help of artery replacement. However, such a radical method of solving the problem is resorted to only in the last stages of the disease. In the first two phases, the use of medications is limited.

Drug treatment

Treatment with drugs can eliminate the pain characteristic of obliterating atherosclerosis and stop the further formation of cholesterol plaques.

The patient may be prescribed:

• statins (Fluvastatin, Rosuvastatin), which regulate the amount of cholesterol in the blood;
  

  
  
  

• antispasmodics (No-shpa, Galidor, Papaverine) and ganglion blockers (Pentamin), which relieve vasospasm and help improve blood circulation in small arteries;
  

  
  
  
  
  
  

• anticoagulants (Heparin, Warfarin) and antiplatelet agents (Aspirin), which help reduce blood clotting and prevent the formation of blood clots;
  

  
  

• painkillers (Novocaine) to relieve acute attacks of pain;
  
  
• antioxidants (ascorbic acid) to protect arterial walls at the cellular level.
  
  

Drug therapy is also required after successful surgery. With systemic atherosclerosis, there is always the possibility of relapses. You will have to take the pills for life.

Medicine has developed several gentle and radical methods of surgical intervention. Minimally invasive surgeries are safer, but they are used only when the disease affects a small area of ​​the artery.

1. Balloon angioplasty is a minimally invasive intravascular operation that allows you to restore the normal patency of a vessel by inserting a special balloon into its cavity, expanding the lumen.
2. Bypass surgery is a procedure to restore blood flow by bypassing the site of narrowing using a shunt (part of the patient's healthy vein or its artificial equivalent).
3. Stenting is the installation of a frame into the lumen of a vessel to expand in diameter and support the walls of the area narrowed by the pathological process.
4. Autodermoplasty of the skin - reconstruction of an area of ​​the skin with extensive trophic lesions.
5. Vascular replacement is the removal of an occluded vessel and its replacement with a graft.
6. Vascular endarterectomy - cholesterol plaque is removed from the vessel along with the altered inner lining of the vessel wall.

In case of irreversible pathological processes in the limb, amputation is used. This is a necessary measure to stop gangrenous infection and avoid death. After surgery to remove a limb, continued vascular treatment is required.

Folk remedies

Traditional medicine is an effective addition to medical therapy, but cannot be its replacement, especially at stages 3–4 of atherosclerosis. Before using a traditional recipe, you should consult your doctor for any contraindications.

The plant helps reduce cholesterol levels. Recipes:

• Mash 200 g of fresh ripe berries, pour a glass of alcohol. Leave for 3 weeks, filter. Take one teaspoon half an hour before meals and before bed.
• One teaspoon of lingonberries and one tablespoon each of hawthorn and immortelle are poured into 1 liter of boiling water and infused for 3 hours in a thermos. Drink one glass a day.

Relieves inflammation, heals wounds, strengthens blood vessels and improves blood circulation. 20 grams of crushed peel or flowers are poured into 1 liter of water and boiled for 30 minutes in a water bath. After straining, boiling water is added to compensate for the water evaporated in the bath. Dosage - 2 tablespoons per day.

An effective remedy for lowering cholesterol levels. 2 glasses of fresh red clover flowers are poured with 1 liter of vodka and left for 2 weeks, shaking occasionally. After straining, take 1 tablespoon before breakfast and dinner.

Helps relieve swelling. Moisten gauze with pharmaceutical tincture and apply to areas of swelling for several hours.

Lifestyle and diet

If you only take pills, but do not change the lifestyle that led to the destruction of your health, the treatment will not be effective. First of all, you need to give up bad habits.

Alcohol increases swelling, and nicotine causes vasoconstriction and poor circulation in the extremities, so you need to stop drinking and smoking.

To normalize metabolism and improve blood circulation, therapeutic exercises are indicated. Walking exercises are especially useful. You can start with short distances and a slow pace, gradually increasing the load. Exercises should be regular, since their implementation prevents further damage to the muscles involved in exercise by atherosclerosis.

Overexertion is also not recommended, so the degree of stress should be regulated by a doctor depending on the condition of the body. General tonic exercises must be alternated with breathing exercises that help saturate tissues with oxygen.

To treat atherosclerosis, it is necessary to adjust the diet in order to reduce cholesterol levels and normalize weight. You should adhere to fractional meals (small portions 5–6 times a day), and do fasting days. It is recommended to replace smoked and fried foods with boiled and stewed ones, and limit the consumption of hot seasonings and salt. Preference should be given to lean dishes, and red meat should be completely abandoned. You should also exclude strong tea and coffee, sugar, sweets, store-bought mayonnaise and ketchup, and flour products.

Forecast and prevention of obliterating atherosclerosis

The disease is easier to prevent than to treat. If a person is at risk, he needs to monitor his health and undergo regular preventive examinations.

Basic preventive measures:

1. Quitting bad habits. First of all, smoking.
2. Follow dietary recommendations. Exclude canned, fatty foods, as well as sweet and flour products. Weight correction will reduce the load on the lower limbs and avoid many other diseases.
3. Do not overcool your feet. Avoid uncomfortable shoes and heels to avoid blood stagnation.
4. A sedentary lifestyle and staying in one position for a long time also provokes problems with blood circulation. To maintain the circulatory system in good shape, regular physical exercise is recommended: swimming, walking, running, skiing. Aerobic exercise is the most beneficial, thanks to which working muscles are maximally saturated with oxygen.

Timely seeking medical help allows you to save the limb and improve the prognosis for this severe pathology.

Atherosclerosis is a chronic progressive disease of the arteries, in which cholesterol is deposited on the inner walls of blood vessels. A very common pathology, leading in morbidity and mortality in the world. According to statistics, 100% of the population suffers from vascular atherosclerosis. Mortality in adults from its complications in developed countries is 50%, in the structure of heart and vascular pathology - 75%. Of all patients, 25% die suddenly and unexpectedly from sudden death of arrhythmogenic origin, the cause is ventricular fibrillation.

Risk factors

Atherosclerosis affects vessels of different sizes. Given the localization of the process, clinical manifestations may differ. Therefore, to treat atherosclerosis, drugs are used that target the etiological factor and all links of pathogenesis. Signs of the disease are sometimes absent for a long time. Its first manifestations may be an acute circulatory disorder (ACS or acute stroke). Then the treatment of vascular atherosclerosis will be aimed at carrying out emergency measures. Planned therapy for the disease will continue only after the condition has stabilized.

The mechanism of atherosclerosis formation depends on several risk factors that play a primary role:

• disruption of fat metabolism processes;
• physiological or pathological state of the vessel wall;
• heredity.

Numerous studies have proven that arterial hypertension, hypercholesterolemia, and nicotine increase the risk of heart attack up to 8 times compared to their absence.

Cholesterol as a risk factor

Cholesterol is classified as a lipid in its chemical structure. Its functions are varied: it is part of some vitamins (D 3 - cholecalciferol), hormones (androgens, estrogens, corticoids), and one of the components of cell membranes.

Cholesterol is synthesized by liver cells (85%), small intestine (10%), skin (5%): the body produces approximately 3.5 g of cholesterol per day, 0.3 g comes with food.

The liver is the organ where the process of cholesterol oxidation occurs, which leads to the formation of free bile acids. Low and high density lipoproteins (LDL - beta lipoproteins, HDL - alpha lipoproteins) transport it throughout the body. Cholesterol, released after the destruction of cell membranes, is delivered from the arteries to the liver cells with the participation of HDL. There it is oxidized to bile acids, after which it is eliminated in the feces. If the process of formation and excretion of bile acids is disrupted due to various diseases, the bile is saturated with cholesterol. Gallstones form and gallstone disease develops. Cholesterol levels rise sharply (hypercholesterolemia), which in turn leads to the development of atherosclerosis.

HDL cannot cope with the load, the walls of blood vessels accumulate lipids. Atherosclerotic changes depend on the amount of LDL: they are atherogenic, their increase (respectively, a decrease in HDL) leads to the formation of a plaque under the endothelial layer of cells, which contains 70% of all plasma cholesterol.

It is important to take into account the atherogenicity index (the so-called cardiovascular development factor, or risk factor). It is calculated as the ratio of total cholesterol to HDL cholesterol:

• low risk - 2, - 2.9;
• average - 3.0 - 4.9;
• high - above 5.0.

Cholesterol plaques are a leading factor in vascular pathology

With atherosclerosis, the lumen of blood vessels narrows and blood flow slows down. Composition of an atherosclerotic plaque: low-density lipoprotein cholesterol (LDL-CL), some fats (triglycerides, phospholipids), calcium. These layers form under the endothelium at the site of damage to its cells. If the blood cholesterol content is low, the plaque also contains little of it, therefore it is stable for a long time. This relates to age-related changes in blood vessels and improves the prognosis for all types of coronary artery disease. With hypercholesterolemia, the plaque becomes loose, its wall is thin and ulcerated. Over time, it may break off and a blood clot will form. Atherothrombosis is the main factor in the development of ACS and progression.

Any vessels are susceptible to the development of atherosclerosis, but medium-sized and large-caliber arteries account for 90-95% of the damage. Its development occurs in all organs of any part of the body (brain, lower extremities, intestines, kidneys and others). These changes disrupt the functions of the organ. With multifocal atherosclerosis, the vessels of many areas (pools) are affected simultaneously. The clinical picture becomes so varied that it is difficult to make a diagnosis without special examination methods.

Considering the location of the lesion, atherosclerosis may develop:

• heart disease (acute and chronic forms of coronary artery disease, complicated by rhythm disturbances, heart failure);
• acute cerebrovascular disorders (ischemic stroke or transient ischemic attack);
• damage to the lower extremities up to gangrene;
• changes in the aorta, renal vessels, intestines (infarction of mesenteric vessels).

Methods of treating the disease

For vascular atherosclerosis, treatment is always complex and long-term. Its goal is to reduce manifestations and inhibit the further development of pathology. It is possible to stop the progression of the disease before plaque appears. The process of its development relates, rather, to lifestyle, rather than to disease. Therefore, giving up bad habits, changing taste habits, physical activity, and following a certain diet is already half the success in treatment.

In patients with atherosclerosis, treatment is carried out in several areas:

• change in lifestyle;
• diet therapy;
• medicinal methods;
• surgical interventions.

How to treat vascular atherosclerosis is decided by taking into account the number and location of lesions. The most common reasons on which the clinical picture and treatment of the disease directly depend are:

• hypertension;
• smoking;
• diabetes mellitus;
• hypercholesterolemia.

Anti-cholesterol diet

The diet is aimed at strengthening the vascular wall and improving fat metabolism.

To achieve these goals, it is necessary to adhere to several principles:

• reducing the calorie content of food eaten by 15% due to the reduction of fats and carbohydrates;
• frequent split meals in small portions;
• weekly fasting days (fruit or cottage cheese).

The diet should mostly be vegetables and fruits, with a high content of pectin. It prevents the absorption of cholesterol in the intestines. Dietary rules for atherosclerosis:

1. The diet should contain legumes: they consist of fiber, which enhances intestinal motility (cholesterol is excreted in the feces).
2. Poultry and rabbit meat, which is easily digestible, is recommended.
3. Consumption of products containing lecithin (liver, nuts, wheat bran). It improves the absorption of fats and prevents them from settling under the vascular epithelium.
4. Citrus fruits, greens, and black currants are also needed, which strengthen vascular walls thanks to vitamins A, E, and C.
5. Avoid eating fatty meats, canned food, and sausages, since cholesterol is formed from animal fats. I only boil food, but do not fry or stew.

Application of these rules will help to significantly reduce the doses of medications used and will ensure successful treatment of atherosclerosis.

• Therapy with moderate cardiovascular risk. Treatment of moderate-risk atherosclerosis (IRR)< 5), уровнем общего холестерина более 5 ммоль/л без клинических проявлений заключается в модификации привычного образа жизни. После достижения нормальных показателей (общий холестерин - менее 5,0 ммоль/л, холестерин ЛПНП менее 3 ммоль/л) осмотр у лечащего врача должен быть 1 раз на протяжении 5 лет. Если уровень превышает 3 ммоль/л, происходит накапливание холестерина эндотелием. При ЛПНП крови < 3 ммоль/л, клеточное содержание его близко к нулю.
• Treatment of atherosclerosis with high CVR. For atherosclerosis with high cardiovascular risk (CVR > 5), total cholesterol > 5 mmol/l, the first stage of treatment is a qualitative change in lifestyle for a period of 3 months. After a specified period of time, a laboratory examination is carried out. If target levels are achieved, annual monitoring of lipid profiles is necessary. If the high risk remains, you need to switch to drug therapy. When atherosclerosis is accompanied by clinical manifestations, lifestyle modification with drug therapy is recommended in all cases. Drug treatment begins after the use of an anti-cholesterol diet has been ineffective for 6 months.

Quitting smoking is part of treatment

Smoking is one of the officially recognized high-risk factors that accelerate the development of atherosclerosis, and, therefore, coronary artery disease. Nicotine is a poison for blood vessels. It acts on the vascular center of the medulla oblongata, causing the adrenal glands to release adrenaline. This leads to vasoconstriction, angina attacks, and pressure surges. The elasticity of the walls decreases, they become sluggish, and nicotine hypertension develops. Blood viscosity increases, the ratio of triglycerides to cholesterol is disrupted. Toxic substances contained in smoke damage the epithelium. It becomes thinner, LDL cholesterol settles, and the formation of plaques accelerates. Constant spasm of the small vessels of the legs causes obliterating endarteritis with convulsions and pain. This occurs in every 7 smokers, and in severe cases it leads to gangrene and amputation. After consuming one cigarette for several tens of minutes, all blood vessels are in a spasmodic state. Toxic substances contained in smoke are distributed throughout the body in 20 - 30 seconds - in one blood circulation. Blood supply to all organs and tissues decreases, since each puff reduces the amount of oxygen in the blood.

Conservative therapy

Only a doctor can explain and help how to cure atherosclerosis after examination and studying the results of the study.

Lipid-lowering drugs (HLPs) of several groups are prescribed:

• statins (lova -, simva -, prava -, fluva -, atorva -, rozuva -, pitustatins);
• fibrates (pheno-, hemo-, bezafibrates);
• lipid-lowering drugs from natural sources: estrogens, omega - 3 - polyunsaturated fatty acids (Omacor), folic acid, flavonoids (wines, juices, tomatoes, nuts)

There are three more groups of drugs:

• nicotinic acid (Niocin);
• cholesterol absorption inhibitors (Esitamb);
• fatty acid sequestrants (Colestyramine, Colestilol).

To improve the prognosis, in addition to GLP, antithrombotic drugs of various groups are prescribed (Aspirin, Plavix, Clexane), and, if indicated, antihypertensive therapy (drugs from the group of ACE inhibitors or sartans, beta-blockers).

Statins are the basis for the treatment of atherosclerosis

In recent years, statins have played a major role in treatment, the early administration of which leads to good results. Statins are the leading class of lipid-lowering drugs. They are comparable in importance to the discovery of penicillin by Fleming.

Prescribed to all patients without exception:

• with arterial hypertension;
• with high and very high CVR even with normal cholesterol (example: a middle-aged man who smokes - 3 risk factors).

Statins block an enzyme in the chain of cholesterol formation, resulting in:

• decrease in its synthesis by the liver;
• increased reuptake of LDL-C by hepatocytes.

The most studied and effective atorvastatin is Liprimar (Atoris, Atorvastatin, Torvacard and others). So far, only Liprimar has demonstrated high safety in reducing LDL-C to levels lower than currently recommended targets. It significantly improves the prognosis for . Thousands of studies and authoritative meta-analyses have shown the safety of its maximum permitted dose among not only elderly people, but also senile people. It is advisable to drink it for at least several days, starting immediately with the maximum dosage - 80 mg/day. Take once for a long time, limit or stop drinking alcohol. Then you can switch to a dose of 40 mg/day. There are no forms for parenteral administration, but research is ongoing. The drug is necessary for ACS in everyone after an ischemic stroke, regardless of the level of LDL cholesterol. It is not prescribed after a hemorrhagic stroke.

If a statin of another group is prescribed during treatment, the dosage depends on the initial data and the patient’s condition: the higher the risk of vascular complications, the higher the initial dose. Statins significantly reduce the development of complications after atherosclerosis:

• reduce the risk of arrhythmias after CABG;
• significantly reduce the rate of progression of atherosclerotic lesions of the renal arteries, increase cardiovascular prognosis in CKD (improves glomerular filtration rate);
• improves the prognosis with already developed CHF (with systolic insufficiency of ischemic etiology).

In addition to therapeutic effects for atherosclerosis, statins have a number of positive effects on the body as a whole - pleiotropic effects:

• have anti-inflammatory properties;
• reduce the risk of cancer: with statins, the incidence of cancer is 9.4%, if they are not used - 13.2%.

Since you have to take the drugs for a long time, almost for life, you need to know that statins are hepatotoxic and cause muscle pain with the development of rhabdomyolysis. Discussion continues about their toxic effect on the liver and research is being conducted due to the fact that an increase in the level of transaminases (ALT, AST) is not always directly dependent on taking statins. However, if you have to take drugs of this group, it is necessary to monitor aminotransferases before prescribing statins, and then after 2 weeks, 3 months, and then once every 6 months throughout the entire treatment. If transaminase levels are normal, you can continue taking the statin and, if necessary, increase the dose. When the indicators have increased by 1.5 times, you can continue to take it at the same dosage, but monitor ALT and AST after 4 weeks. Exceeding the norm by 1.5 - 3 times - the dosage remains the same, but monitoring is necessary after 2 weeks. If transaminases increase more than 3 times and the values ​​remain at these levels for 2 weeks, it is necessary to reduce the dose or discontinue the drug. In case of muscle side effects, due to the great importance of statins for further prognosis, it is recommended to continue taking atorvastine: 5 mg once every 2 - 3 days.

Fibrates in the complex treatment of atherosclerosis

Fibrates (Trikor) activate special receptors, stimulating the synthesis of oxidation of free fatty acids (FFA), as a result, they powerfully reduce the concentration of fatty acids.

Five components of the non-lipid and lipid action of fibrates were identified and studied.

Lipid:

• increased TG breakdown;
• reduction and formation of TG;
• increasing their transport;
• increasing the formation of “good” HDL cholesterol;
• reduction of LDL cholesterol (enlargement of their particles).

Non-lipid:

• reducing the size of atherosclerotic plaque;
• local anti-inflammatory effect;
• reduction of ACS (acute coronary syndrome) stress;
• decreased activity of the RAAS (renin-angiotensin-aldosterone system, which regulates blood pressure and blood volume in the body);
• reduction of advanced glycation end products.

Fibrates in the complex treatment of atherosclerosis:

• are safe to combine with statins,
• reduce total cholesterol by 20 - 25%;
• reduce triglyceride content by 40 - 45%, this is especially important for smokers, patients with diabetes and arterial hypertension;
• reduce the amount of small particles of LDL cholesterol by 50%;
• increase “useful” HDL cholesterol by 10 - 30%;
• increase the particle size of LDL cholesterol;
• reduce uric acid by 25% - uricosuric effect.

The use of fibrates is especially effective and important when there is diabetes. Due to the long half-life, drink it once a day. The tablets must be swallowed whole - it is not advisable to break them. If a statin and a fibrate are taken in combination, take the fibrate in the morning, the statin in the evening: this way you can avoid crossover of peak concentrations.

It should be noted that vitamin E does not play any role in the prevention of atherosclerosis.

Nicotinic acid

Nicotinic acid (Niacin, Niashpan) has nothing in common with nicotinamide - it is a different drug. It is the first of the lipid-lowering drugs to show a reduction in mortality from vascular pathology associated with atherosclerosis.

The main effect of its use is an increase in HDL cholesterol. Nicotinic acid significantly increases the mobilization of FFA from adipose tissue, thus reducing the substrate for cholesterol synthesis. Increases the content of “good” HDL cholesterol in the blood.

The daily dose for the effect on HDL is from 1.5 - 2.0 to 4.0 g. The dosage should be increased gradually, starting from 0.1 x 2 times a day with meals. Niashpan can be used once in the evening.

Cholesterol absorption inhibitors result in the small intestine receiving less of it: it is blocked by taking Ezentib. This significantly reduces the concentration and reduces the flow of cholesterol to the liver. Combined with statins, used to control dyslipidemia. It is taken once, the daily dose is 10 mg.

Omega - 3 - polyunsaturated fatty acids

Omega-3 polyunsaturated fatty acids (PUFAs) are not synthesized by the body. The original drug is Omacor. PUFAs also contain fish oil, Vitrum-cardio, Epadol-Neo. In atherosclerosis they have the following effects:

• vasodilator;
• antiarrhythmic;
• anti-inflammatory;
• antiplatelet.

Taking these drugs for 3 months after acute myocardial infarction leads to:

• reducing the risk of sudden death by 50%,
• reducing overall mortality;
• stabilization of atherosclerotic plaque;
• reducing the number of reocclusions after CABG;
• reducing the rate of progression of glomerulosclerosis and chronic renal failure with glomerulonephritis.

Daily dose - 2 capsules.

Fatty acid sequestrants

Fatty acid sequestrants (Cholestyramine Regular, Cholestilol).

Contribute to:

• accelerating the removal of cholesterol from the liver with bile;
• an increase in the number of new active liver receptors for LDL cholesterol.

This leads to a decrease in the concentration of LDL in the blood. The drug binds to bile acids thanks to intestinal cells, the result of these reactions is the formation of insoluble compounds that are excreted from the body in feces.

Cholestyramine is indicated for:

• for the prevention of atherosclerosis;
• with newly diagnosed hypercholesterolemia, as well as with its asymptomatic course;
• in the treatment of pathologies of the digestive system associated with impaired excretion of bile acids, their high concentration, accompanied by painful itching of the skin.

Contraindications are pregnancy and lactation, complete blockage of the biliary tract, phenylketonuria, drug intolerance.

Release form - powders of 4 grams. Take individually, taking into account the daily dose of 4 - 24 grams. The drug is insoluble in water; when taken orally, it is not absorbed by the mucous membranes. It is not affected by digestive enzymes. It is used daily for 4 weeks, only after this period the therapeutic effect begins to develop, positive changes in the lipid profile occur, and itching, if any, disappears. Long-term use of the medicine leads to bleeding (blood prothrombin decreases). Various digestive disorders appear due to impaired absorption of fats, fat-soluble vitamins (A, D, K) and folic acid. During the entire period of taking drugs of this group, you need to drink a lot of water, unless there are contraindications. 80 ml of water is added to the powder, the mixture is thoroughly mixed, left for 10 minutes to form a suspension, and then drunk. Increased caution should be observed when used by patients over 60 years of age.

Herbal preparations

Preparations based on vegetable oils have become widespread. Pumpkin seeds are popular, as is the combined herbal preparation Ravisol. Pumpkin seed oil can be prescribed for atherosclerosis for prevention, and for newly diagnosed hyperlipidemia - for treatment. Due to the large amounts of saturated fatty acids present, it has a hypolipidemic effect. Despite all the positive properties, it has recently been rarely used for this purpose, since it has a different, more effective range of applications.

Ravisol is a tincture of 7 herbal components. Consists of periwinkle, hawthorn, Japanese sophora, horsetail, mistletoe, horse chestnut, clover. It is prescribed in combination with other therapeutic agents. Take 1 teaspoon before meals, diluting with water. The treatment course is 10 days. Reduces cholesterol, triglycerides. Proper use improves blood flow to the brain and myocardium, and reduces peripheral vascular resistance. The drug has a diuretic and antiplatelet effect.

When taking Ravisol, it is necessary to monitor pulse and blood pressure: it enhances the effect of antiarrhythmic, antihypertensive, hypnotics, sedatives, and cardiac glycosides.

Combination drugs

Often, in case of atherosclerosis, the use of combination drugs is justified. As a rule, these are two-component drugs: an antihypertensive with a blood lipid-lowering drug or 2 lipid-lowering drugs from different groups with a different mechanism of action.

Ineji is a combination drug consisting of simvastatin with a cholesterol adsorption inhibitor (ezentimibe). Release dosages are different: 10/10, 20/10, 40/10 mg - the dose of the statin changes. The drug acts using the mechanism of both medicinal components of different hyperlipidemic groups:

• simvastatin helps reduce the concentration of LDL cholesterol with triglycerides, increases HDL (“useful” lipoproteins);
• ezentimibe blocks the absorption of cholesterol by the small intestine, thereby dramatically reducing its transport to the liver.

Ineji is effective for newly diagnosed hypercholesterolemia, for preventive purposes, for the treatment of atherosclerosis, if statin monotherapy was insufficient. At the initial stages of treatment, it is prescribed as an additional drug method to the diet, as well as lifestyle modifications.

The dosage of the drug and its regimen are selected individually. It depends on the purpose of treatment and the severity of atherosclerosis. After 4 weeks of use, basic blood parameters are monitored. If there is no effect or it is insignificant, the therapy is reviewed.

Atorvastatin in combination with the cholesterol adsorption inhibitor ezentimibe - Azi-Tor, Statezi. The dosage of the drugs is the same: 10/10 mg. Due to the interaction, the level of cholesterol and triglycerides is much more effectively reduced than when using each of them separately. Indications for use are dyslipidemia. Prescribed when statins, as well as non-pharmacological treatments, are insufficiently effective. Accepted once. The therapeutic effect occurs after 14 days. To clarify the effectiveness, a lipid profile is assessed.

Surgical treatment

The treatment strategy for atherosclerosis depends on a number of factors. Age, length of service, and severity of the disease are taken into account. In the initial stages, conservative treatment and lifestyle changes have a good effect. When the disease is advanced, therapeutic methods are no longer effective. For advanced changes in the structure of the vessel, surgical treatment is used.

There are many surgical techniques for correcting damaged vessels in atherosclerosis:

1. Balloon angioplasty - a special balloon is used to expand the lumen of a narrow, pathologically altered vessel.
2. Arterial stenting is a surgical treatment method aimed at stopping the development of atherosclerosis using a special “spacer” for a narrowed vessel.
3. Bypass surgery - the essence of the operation is to create an additional path around the damaged vessel, ensuring normal blood flow.
4. Prosthetics is the replacement of a damaged vessel.
5. Endarterectomy - removal of a section of the affected vessel along with an atherosclerotic plaque.
6. When gangrene has developed in the lower limb, dead tissue is removed and a prosthesis is installed.

Balloon angioplasty (percutaneous transluminal balloon angioplasty) is not inherently a purely surgical procedure. This procedure is minimally invasive. Transluminal - means treatment through natural openings (vessels). A miniature balloon restores normal patency of a narrow vascular lumen. At the same time, stenting is used to fix the operated vessel. A structure made of the finest mesh – a stent – ​​is installed. This permanently normalizes blood circulation in the vascular segment affected by the atherosclerotic process. After treatment, to improve the prognosis and prolong the effect, antithrombotics are prescribed: Aspirin 75-100 mg after meals with Clopidogrel 75 mg constantly under the cover of proton pump inhibitors (Pantaprazole 40 mg before meals) for up to 12 months.

When a bypass is performed from the patient's vein or from artificial material, a bypass path is created to move the blood flow past the area damaged by atherosclerosis. As a rule, the large saphenous vein is taken, which stretches along the lower limb and reaches the groin. The vein is turned over before sewing in so that the existing valves do not interfere with blood flow. The lower extremities will not suffer much harm, since the legs have an expanded venous network that can compensate for the absence of a small area. If it is impossible to use this vein, others are found, or grafts (artificial vessels) are used. Usually the operation is performed on the coronary or peripheral arteries of the lower extremities. In the same way, intervention is performed on vessels of other locations.

If the aorta is affected, there is a high risk of developing an aneurysm (protrusion) with rupture of the wall, causing rapid death from massive blood loss. Treatment is only surgical: the enlarged part of the aorta is removed, followed by prosthetics or bypass surgery.

In coronary artery bypass grafting (CABG), which is used for, arteries, rather than veins, are used for the shunt. Preference is given to the radial, internal thoracic. This method is used when stenting is no longer possible due to the large number of atherosclerotic plaques on the vessel wall.

Before bypass surgery, as before any vascular surgery, an examination is necessary. To identify the nature and extent of the pathological process, the following diagnostic procedures are carried out:

• duplex ultrasound of blood vessels, which determines abnormalities in the damaged artery and the volume of blood flow in it;
• magnetic resonance angiography is a study using a magnetic field and radio waves; the size of atherosclerotic lesions and the degree of reduction in blood circulation are assessed;
• computed tomography: with its help, layer-by-layer “slices” are made, the severity of atherosclerotic changes is determined. If the presence of an atherosclerotic plaque is detected, as well as a vessel narrowed due to it, the next stage of the examination will be contrast angiography;
• Angiography makes it possible, after the introduction of a radiopaque substance, to determine the degree of damage to the vessel and decide on the method of surgical intervention: angioplasty with stenting or bypass surgery. An incision is made in the femoral artery, a catheter is inserted, and a special substance is inserted through it. After the study is completed, the catheter is removed and the contrast is gradually excreted in the urine. The extent of the operation is determined by the degree of vascular damage.

Traditional methods of treatment

In complex treatment of the disease, it is possible to use traditional medicine methods. For this, infusions, decoctions and teas are prepared from various plants, their leaves, and fruits. The effect of this treatment can be expected in the early stages of atherosclerosis, when there are no deep vascular changes, and laboratory tests show normal values.

Traditional methods of treatment can only be an addition to basic drug therapy, or used to change lifestyle. It is believed that the fruits of hawthorn, rose hips, and garlic have a certain effect on vascular atherosclerosis. Infusions are prepared from them (separately from each): crushed fruits or garlic are poured with alcohol and infused for two days. Then use: tincture of hawthorn fruit - 1 teaspoon before bedtime, rose hips - 20 drops once a day, garlic - 8 drops of infusion diluted with water (20 ml) and drunk 3 times throughout the day.

For the decoction, a mixture is taken from strawberries, St. John's wort, dill, coltsfoot, and marsh cudweed. Apply 2/3 cup of decoction three times throughout the day (the collection of these plants is boiled and infused for 2 days).

Violet, buckthorn bark, mistletoe leaves, and rue are also considered effective. These components can be used to prepare a decoction or tea, using individual plants, or all at once for brewing.

Most often, onions, garlic, celery, lemon, honey, and walnuts are used to treat atherosclerosis.

A medicinal mixture of garlic and lemon is widely popular for treatment. To prepare it, chop the peeled head of garlic, lemon and zest, add 500 ml of cooled boiled water, leave for 3 days. Drink 2 tablespoons before meals for 2 months. The method is effective and works gently.

In addition to those listed, there are many different recipes with other ingredients. It is important to choose the right treatment for yourself, but be sure to use it with medications prescribed by your doctor after the examination.

Atherosclerosis is a disease that progresses throughout life. Appropriate treatment, compliance with all medical recommendations, and elimination of risk factors can delay its development.

The condition of bradycardia is usually referred to by cardiologists as a certain type of disorder of normal sinus rhythm, physiologically controlled by a first-order pacemaker. This disruption of the normal functioning of the heart can be characterized by a significant decrease in the frequency of myocardial contractions, when the pulse rate drops to 50 or even 30 beats per minute.

As a rule, the development of bradycardia can be caused by a decrease in the automatic function of the so-called first-order pacemaker or sinus node.

This type of disturbance in the functioning of the heart can occur against the background of: sclerotic changes in the myocardium, exposure to cold, a sharp increase in intracranial pressure, poisoning, hypothyroidism. And this is not a complete list of factors included in the concept of the cause of bradycardia.

In addition, a decrease in heart rate is often observed in well-trained, young people who are professionally involved in sports - and in this case, bradyarrhythmia is not a pathology at all, but is considered a variant of the norm!

Taking into account all of the above, many will probably want to understand: how does this rhythm disorder manifest itself, how to treat bradycardia and should it be done? Let's try to answer such questions in today's publication.

• What signs allow you to independently recognize the disease?
• How is it diagnosed in medical institutions?
• Why does this disorder occur?
• First aid at home for the development of pathology
• When can you not do without a doctor?
• Treatment options in hospital or at home

What signs allow you to independently recognize the disease?

First of all, I would like to note that bradycardia, the symptoms of which we will consider, is not at all a final diagnosis or a specific pathology; rather, it is a certain diagnostic conclusion confirming a decrease in heart rate in a particular patient.

In other words, the state of bradycardia is a symptom that may indicate some changes (physiologically normal or pathological) occurring in the human body!

At the same time, the state of bradycardia, the symptoms of which are quite simple and understandable, can be easily recognized independently, because the main indicator of heart rate is the pulse, which is easily palpable at home.

But, in addition, to independently determine the problem, you need to know the normal heart rate indicators in adults and children, and then remember the deviation indicators characteristic of the bradyarrhythmia state.

So, taken as the norm, heart rate indicators should correspond to the following figures:

• for children over one year old and up to ten or even twelve years old - the limits of normal heart rate are 70 to 130 beats per minute;
• children over ten or twelve years old; for adults, the normal pulse is sixty or one hundred beats per minute;
• for professional athletes, the boundaries of normal heart rate can range from forty to sixty beats per minute.

If the heart rate drops significantly, the pulse indicators are below generally accepted norms (for these groups of patients), doctors record an attack of bradyarrhythmia.

Moderate rhythm disorders of this type often do not cause any subjective discomfort in patients - then doctors can record physiological bradyarrhythmia associated with fatigue, hypothermia, and occurring during sleep.

But sometimes an attack of decreased heart rate manifests itself too clearly (pulse indicators drop below forty beats per minute), complemented by other pathological symptoms:

In such situations, doctors talk about the development of an attack of pathological rhythm disorder, possibly associated with the most serious cardiac (or other) pathology in the body. To understand whether treatment for bradycardia is required and what it should be, it is important to be able to clearly diagnose the problem, which can only be done in a medical institution.

How is it diagnosed in medical institutions?

Pathological bradyarrhythmia is recognized taking into account the patient’s complaints (outlining the symptoms described above), collecting anamnesis, and performing a standard electrocardiogram. On electrocardiogram recordings, an attack of bradyarrhythmia manifests itself as follows:

• there is a clear reduction in heart rate, less than age norms, usually less than forty beats per minute;
• sinus rhythm is maintained, which is confirmed by the presence of P waves before all QRS complexes;
• sinus rhythm remains correct, which is manifested by the preservation of RR intervals or their difference of less than ten percent;

In addition, sinus bradyarrhythmia of extracardiac etiology is characterized by a rapid increase in the frequency of heart contractions during elementary physical exertion or upon administration of a dose of atropine. An attack of such bradyarrhythmia can be considered a variant of sinus respiratory arrhythmia.

An attack of organic sinus bradyarrhythmia (in intracardiac form) is in no way associated with respiratory arrhythmia - when using atropine, the reduced heart rhythm does not change, physical activity can very slightly increase the frequency of contractions of the heart muscle.

Why does this disorder occur?

The causative factors that cause a decrease in heart rate are incredibly varied. The following may cause the problem to develop:

In addition, as we have already noted, a decrease in heart rate is often observed in trained professional athletes, which, in the absence of other pathology, is considered a variant of the norm.

First aid at home for the development of pathology

When an attack of bradyarrhythmia occurs, when a person notices certain unpleasant symptoms described above, it is first recommended to sit down and try to count the pulse.

If your heart rate differs slightly from the norm (the average adult's heart rate is at least 50 beats per minute), you can try to help cope with the attack as follows:

• drink a cup of warm sweet tea or coffee, perhaps adding a few drops of ginseng or belladonna tincture to the drink;
• if possible, warm up, perhaps take a warm foot bath;
• If you feel relatively normal, do some physical exercise.

But, if an attack of bradyarrhythmia is accompanied by severe dizziness, fainting, or disturbances of consciousness, first aid to the patient should be somewhat different. In such a situation it is important:

• lay the patient down and try to warm him up;
• be sure to call an ambulance;
• for disorders of consciousness, give the patient a sniff of ammonia.

Attention, important! An attack of bradyarrhythmia, in some cases, can be extremely dangerous, leading to the development of heart failure or sudden cardiac arrest.

That is why independent treatment of bradycardia is categorically unacceptable! When providing first aid to a patient, it is unacceptable to use any medications without consulting a cardiologist, since this can lead to the most serious side effects, the development of exacerbations of the pathology that caused a decrease in heart rate.

When can you not do without a doctor?

It is generally accepted that minor heart rhythm disorders do not pose a direct threat to the patient’s life. But, if attacks of a moderate decrease in the frequency of contractions of the heart muscle occur with a certain frequency, you should definitely seek advice from a cardiologist as soon as possible. It is unacceptable to leave such phenomena unattended.

At the same time, there are situations when, with the development of bradyarrhythmia, medical assistance is urgently needed. So, you should urgently call an ambulance in the following situations:

It should be noted that in such situations, the patient urgently needs medical help; we can say that these are situations when the count of time (in which a person can be saved) is literally minutes!

Treatment options in hospital or at home

The choice of tactics for treating bradycardia always depends on the type of pathology and the reasons for the development of a slowdown in rhythm. Sometimes this condition, in principle, may not require treatment.

However, if the reduction in heart rate is due to cardiac causes, it is extremely important to identify these causes and begin treatment of the underlying disease.

If the state of decreased heart rate is associated with certain hemodynamic disorders, doctors can prescribe belladonna preparations, tincture of ginseng root, sometimes eleutherococcus extract, ephedrine, caffeine and other general restoratives to the patient. The dosage is always selected strictly individually.

If bradyarrhythmia is accompanied by signs of disruption of the correct sinus rhythm, angina pectoris, changes in blood pressure, and manifestations of heart failure, conservative treatment may include:

• prescription of drugs from the group of antiarrhythmic drugs;
• taking medications from the group of beta blockers or calcium channel blockers;
• the use of medications that correct blood pressure or other drugs.

It cannot be said that in complex conditions, treatment of the pathology in question can be prompt. For example, the development of Morgagni-Adams-Stokes syndrome against the background of primary pathological bradyarrhythmia requires an urgent solution to issues related to the implantation of a pacemaker in a patient.

Sometimes complex treatment of the disease in question can be supplemented by the use of folk recipes. Among the most popular folk recipes that help cope with bradycardia, doctors name the following:

It is important to say that any treatment for heart rhythm disorders must always be agreed with a doctor, and drug therapy, in principle, cannot be prescribed independently!

Clinics in Moscow and St. Petersburg that provide comprehensive complex therapy for bradyarrhythmia will be presented in the table below.

In conclusion, it should be noted that the state of bradycardia, unfortunately, can be completely unpredictable. Sometimes this problem goes unnoticed by the patient, without requiring specific treatment.

But sometimes the problem can be complicated by the most serious and life-threatening conditions, including cardiac arrest and death.

This is why most practicing doctors never tire of repeating themselves: detecting signs of bradyarrhythmia is a reason to visit a cardiologist. Independence in the treatment of any heart rhythm disorders (bradyarrhythmia, including) is strictly unacceptable!

• Do you often experience discomfort in the heart area (pain, tingling, squeezing)?
• You may suddenly feel weak and tired...
• I constantly feel high blood pressure...
• There is nothing to say about shortness of breath after the slightest physical exertion...
• And you have been taking a bunch of medications for a long time, going on a diet and watching your weight...

Atherosclerosis of the blood vessels of the legs: occurrence, treatment, prognosis

Atherosclerosis of the vessels of the lower extremities is one of the most serious and dangerous diseases of the arteries of the legs. It is characterized by the fact that due to blockage of blood vessels by atherosclerotic plaques or blood clots, a partial or complete cessation of blood flow in the lower extremities occurs.

With atherosclerosis, narrowing (stenosis) or complete blocking (occlusion) of the lumen of the vessels that deliver blood to the lower extremities occurs, which prevents the normal flow of blood to the tissues. With arterial stenosis of more than 70%, the speed and nature of blood flow change significantly, insufficient blood supply to cells and tissues with oxygen and nutrients occurs, and they cease to function normally.

Damage to the arteries leads to pain in the legs. If the disease progresses, as well as with insufficient or improper treatment, trophic ulcers or even necrosis of the limbs (gangrene) may appear. Fortunately, this happens quite rarely.

Obliterating atherosclerosis of the arteries of the lower extremities is a very common disease of the blood vessels of the legs. The largest number of cases is detected in the age group over 60 years old - 5-7%, in the age group of 50-60 years - 2-3%, 40-50 years old - 1%. But atherosclerosis can also be diagnosed in younger people - in 0.3% people aged 30–40 years are affected by it. It is noteworthy that men suffer from atherosclerosis 8 times more often than women.

Fact: Men over 50 who smoke are at greatest risk of developing atherosclerosis obliterans.

Main causes of atherosclerosis

The main cause of atherosclerosis is smoking. The nicotine contained in tobacco causes the arteries to spasm, thereby preventing blood from moving through the vessels and increasing the risk of blood clots in them.

Additional factors that provoke atherosclerosis of the arteries of the lower extremities and lead to an earlier onset and severe course of the disease:

• increased cholesterol levels due to frequent consumption of foods rich in animal fats;
• high blood pressure;
• excess weight;
• hereditary predisposition;
• diabetes mellitus;
• lack of sufficient physical activity;
• frequent stress.

Symptoms of atherosclerosis of leg vessels

The main symptom to look out for is pain in the legs. Most often, pain occurs when walking in the calf muscles and thigh muscles. When the muscles of the lower extremities move, the need for arterial blood increases, which delivers oxygen to the tissues. Narrowed arteries during physical activity cannot fully satisfy the tissue's need for arterial blood, which is why oxygen starvation begins in them, and it manifests itself in the form of intense pain. At the beginning of the disease, the pain goes away quickly enough when physical activity is stopped, but then returns again when moving. The so-called intermittent claudication syndrome occurs, which is one of the main clinical signs of obliterating atherosclerosis of the arteries of the lower extremities. Pain in the thigh muscles is called high claudication pain, and pain in the calves is called low claudication pain.

In old age, such pain is easily confused with painful sensations in the joints inherent in arthrosis and other joint diseases. Arthrosis is characterized not by muscle pain, but by joint pain, which is most intense at the beginning of movement, and then weakens somewhat when the patient “paces.”

In addition to pain in the leg muscles while walking, obliterating atherosclerosis of the arteries of the lower extremities can cause the following symptoms in patients (one of them or several at once):

1. Coldness and numbness in the feet, aggravated by climbing stairs, walking or other activities.
2. Temperature differences between the lower extremities (the leg affected by vascular atherosclerosis is usually slightly cooler than the healthy one).
3. Pain in the leg without physical activity.
4. Non-healing wounds or ulcers appear in the area of ​​the foot or lower third of the leg.
5. Darkened areas form on the toes and feet.
6. Another symptom of atherosclerosis may be the disappearance of the pulse in the arteries of the lower extremities - behind the inner ankle, in the popliteal fossa, on the thigh.

Stages of the disease

According to the existing classification of arterial insufficiency of the blood vessels of the legs, the above symptoms can be divided into 4 stages of the development of the disease.

• Stage I - pain in the legs that appears only after heavy physical activity, such as walking long distances.
• Stage IIa - pain when walking over relatively short distances (250–1000 m).
• Stage IIb – pain-free walking distance is reduced to 50–250 m.
• Stage III (critical ischemia) – pain in the legs appears when walking a distance of less than 50 m. At this stage, pain in the muscles of the lower extremities can begin even if the patient is at rest, this is especially evident at night. To relieve pain, patients usually lower their leg out of bed.
• Stage IV - at this stage, trophic ulcers occur. Typically, areas of blackened skin (necrosis) appear on the toes or heel areas. In the future, this can lead to gangrene.

In order not to bring obliterating atherosclerosis to the extreme stage, it is important to diagnose it in time and treat it in a medical institution.

Treatment of atherosclerosis of the arteries of the lower extremities

This disease requires an individually tailored treatment regimen for each individual patient. Treatment of atherosclerosis of the vessels of the lower extremities depends on the stage of the disease, its duration, and the level of damage to the blood arteries. In addition, when diagnosing and drawing up a clinical picture, the presence of concomitant diseases in the patient is also taken into account.

If atherosclerosis obliterans is detected at an early stage, it may be sufficient to eliminate risk factors to improve the condition. In this case, the following will help:

1. Mandatory cessation of smoking and other bad habits.
2. Following a diet low in animal fats and reducing blood cholesterol levels.
3. If you are overweight or obese – weight correction.
4. Maintaining normal blood pressure at a level of no more than 140/90 mmHg. Art.
5. Regular physical activity (walking, swimming pool, exercise bike, etc.).
6. For patients with diabetes – control of blood sugar levels.

In case of vascular atherosclerosis, the consumption of the following products is strictly prohibited: butter, margarine, lard, margarine, fatty meat, sausages, pates, offal, high-fat dairy products, fried potatoes, ice cream, mayonnaise, flour cakes.

Important: A sedentary lifestyle makes blood vessels less elastic and accelerates the progression of the disease.

At other stages, the following methods are used to treat atherosclerosis of the vessels of the lower extremities:

• Conservative;
• Endovascular (minimally invasive);
• Operational.

Conservative treatment

It can also be used at the initial stage of the disease, as well as in cases where the patient’s condition does not allow the use of other methods (in case of complications with concomitant pathology). Conservative treatment involves the use of medications, physiotherapy and includes pneumopressure therapy, dosed walking and physical therapy.

Unfortunately, there are no medications that completely restore normal blood circulation in a blocked artery and cure atherosclerosis. Drug treatment can only provide support and affect the small vessels through which blood flows bypassing the blocked section of the artery. Treatment with drugs is aimed at expanding these “bypass pathways” and compensating for the lack of blood circulation.

To relieve spasm from small arterial vessels, thin the blood and protect the artery walls from further damage, special medications are used, some of which must be taken in courses, while others must be taken continuously.

In addition to medications, patients are prescribed pneumopressure therapy - massage of the soft tissues of the leg using special equipment. By alternating low and high pressure in a cuff placed on a limb, peripheral arteries dilate, blood flow to the skin, muscles and subcutaneous tissue increases, and blood vessels are stimulated.

Endovascular treatment

The most common treatment methods for atherosclerosis of leg vessels are endovascular methods - arterial stenting, balloon dilatation, angioplasty. They allow you to restore normal blood circulation through the vessel without surgical intervention.

Such procedures are carried out in a cath lab using special equipment. At the end, a pressure bandage is applied to the patient’s leg, and he must remain in bed for 12–18 hours.

Surgical treatment

If the blocked artery sections in the legs are too long for endovascular methods to be used, one of the following types of surgery is used to restore blood circulation in the legs:

1. Prosthetic replacement of a section of an artery with an artificial vessel (alloprosthesis);
2. Bypass surgery is the restoration of blood flow by redirecting blood flow through an artificial vessel (shunt). A segment of the patient’s own saphenous vein can be used as a shunt;
3. Thrombendarterectomy - removal of atherosclerotic plaque from the affected artery.

Surgical methods can be combined or supplemented with other types of operations. If the operation is performed at stage IV of the disease, when dead areas have already appeared, surgical removal of these areas is performed and the trophic ulcers are covered with a skin flap.

If obliterating atherosclerosis has reached an extreme stage, when the patient has developed gangrene of the lower extremities, and it is no longer possible to restore blood flow, amputation of the leg is performed. Sometimes this becomes the only way to save the patient’s life.

How to avoid getting sick?

Prevention of atherosclerosis includes primarily:

• Quitting smoking.
• Proper nutrition, cholesterol-free diet.
• Physical activity.

These are three pillars that will reduce the risk of atherosclerosis of the lower extremity vessels. You don’t have to exhaust yourself with physical exercise; you can just take walks every day and do leg exercises. In addition, special acupressure and traditional medicine recipes help as a preventative measure.

Read more about comprehensive prevention of atherosclerosis here.

Video: atherosclerosis of leg vessels, presentation

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Is it possible to cure atherosclerosis? There is no clear answer to this question, as it depends on many factors. By following a special diet, taking medications, and being active physically (especially on the muscles of the lower extremities), it is possible to reduce the symptoms of the disease and prolong life for many years. However, only complex treatment of atherosclerosis can bring a clear result, and alone, even surgical intervention, will not give a long-term effect.

Lifestyle with atherosclerosis

Treatment of atherosclerosis consists not only of proper nutrition, the use of medications and surgical or minimally invasive methods. It is important to maintain a correct daily routine, give up bad habits, have daily physical activity and breathe fresh air.

Losing weight will help reduce excess fat in the body, which will have a positive effect on the condition of blood vessels. Regular physical activity will help strengthen the blood vessels and muscles of the limbs and stop the progression of the disease, subject to all other recommendations.

Nutrition for atherosclerosis

For drug treatment to be effective, it is important to follow a certain diet. It has been scientifically proven that the development of atherosclerosis is mainly associated with endogenous cholesterol. Also, if cholesterol metabolism within the body is disrupted, the introduction of excess amounts of bad fats with food will have a detrimental effect on the condition of blood vessels. Therefore, the main goal of the diet for atherosclerosis is to reduce the amount of fat consumed.

In addition, you should limit your sugar intake. When there is an excess amount of it in the body, the production of endogenous (internal) cholesterol is stimulated.

Animal fats should be replaced with products of plant origin, fish and seafood. These foods are rich in unsaturated fatty acids, which are cholesterol antagonists. They are also called “healthy” fats. In addition, seafood is a source of minerals that are good for bones, hair and nails.

It would be rational to arrange fasting days once a week. The basis of such days can be fruits and low-fat dairy products. They will help activate metabolism and begin to use body fats from reserves.

Drug treatment

To date, many drugs have been invented that affect various processes in the body.

Drugs that affect cholesterol metabolism:

• inhibit the absorption of cholesterol from food;
• inhibit the synthesis of internal cholesterol;
• affect the physical and chemical components of cholesterol that circulates in the blood;
• enhance the removal of cholesterol.

Also, for the treatment of atherosclerosis, drugs are used that prevent the progression of pathological processes that provoke the development of the disease:

• affecting vascular permeability (reducing permeability);
• affecting blood clotting;
• affecting electrolyte metabolism.

Beta-sitosterol

Belongs to a group of drugs that interfere with the absorption of cholesterol in the intestines. Take three times daily with meals. The course of treatment is at least 1 year. There are no side effects.

Cetamphen

This drug not only reduces cholesterol synthesis, but also promotes enhanced removal from the body. Should be taken 3 times a day. The course of treatment is at least 1 year.

Methionine

This drug is an amino acid. It promotes choline production. If there is insufficient amount of it, fat deposition occurs in the liver. Available in both powder and tablet form. Take 3 times a day. The course is at least 1 year.

Deliping

A complex preparation that includes ascorbic acid, pyridoxine and methionine. Apply once three times a day. Course – 1 month. But the course of treatment with delipin should be repeated.

Linetol

A drug that consists of linoleic and linolenic acids. It is a herbal medicine. Dyspeptic disorders may occur as side effects. The course of treatment is at least 1 year.

Iodine preparation

Considered one of the oldest methods of treating atherosclerotic disease. Its action is associated with the effect on the thyroid gland and liver. Lipid metabolism improves, which will soon normalize lipids in the blood. In the absence of diseases of the thyroid gland, iodine preparations are prescribed in large quantities. On average, 10 drops per 1 glass of milk. The course is no more than a month (in summer or late spring).

Vitamins

Treatment of atherosclerosis cannot take place without taking vitamins. Particularly popular are: B1, B2, B12, ascorbic acid. They all have a positive effect on the liver and metabolic processes in the body. In addition to reducing the concentration of cholesterol, the amount of phospholipids increases. Take vitamins 1 tablet and 1 spoon morning and evening. An alternative administration may be intramuscular injections. The course of treatment is three months. It is advisable to repeat taking vitamins once a year.

Hormones

In some cases, hormonal drugs are prescribed. However, they have a large number of side effects, so they are rarely used in medical practice. They are prescribed if the problem of atherosclerosis lies in the pathology of an organ, the treatment of which can only be with hormonal drugs. examples may be: estradiol, thyroidin.

Interventional and surgical treatments

Drug treatment is not the only option for atherosclerosis. Surgical intervention is possible at a late stage, when drugs do not bring the desired effect. Even after radical measures, comprehensive treatment is needed, which can reduce the number of atherosclerotic plaques and prolong the patient’s life. For each person, treatment is selected individually, as it depends on the stage of the disease and the degree of damage to organs and tissues.

Angioplasty and stenting

These methods have different meanings, but are used together to prevent the development of complications. The benefit of angioplasty is that it allows you to cover the affected area with synthetic tissue. Next, it is necessary to stent the vessel to avoid spasm and re-damage to the artery. With this treatment, the disease will be less pronounced, and if the lower extremities are affected, the pain syndromes will decrease or disappear altogether. But do not forget that treatment of atherosclerosis will be effective with an integrated approach. If the lower extremities are affected, it is worth focusing specifically on training the legs to avoid the risk of recurrence of the injury.

Coronary artery bypass grafting

This shunting must be done when the disease has reached its final stage and conservative treatment methods do not bring relief to the patient. Most often, symptoms manifest as persistent angina (chest pain), which is not relieved by nitroglycerin. During this operation, bypass blood flow is built at the site of the affected area of ​​the artery. This intervention is radical and is done when stenting is no longer possible due to a large number of atherosclerotic plaques.

Veins of the lower extremities are taken for shunts. Since the vein has valves, it is turned over before sewing it on, thereby ensuring blood flow without obstruction. The vessels will provide assistance to the heart, since the blood flow will not slow down due to atherosclerotic plaques, but will pass through “new” vessels. For the lower extremities, this operation will not cause serious harm, since the legs have a large venous network that can compensate for the loss of several centimeters.

The risk that the disease will return is minimal, but increases with every 10th anniversary. Treatment must be comprehensive, that is, it must include a correct lifestyle, proper nutrition and constant use of medications. Only in this case can the risk of repeated sclerosis and worsening of the condition be reduced.

Reconstruction of cerebral arteries

A disease such as atherosclerosis affects almost all arteries of the body. The vessels of the brain are no less susceptible to sclerosis than the vessels of the limbs or heart. Therefore, their own treatment methods have been invented for the arteries of the brain.

The cause of blockage of a vessel can be either the atherosclerotic plaque itself or an embolus or thrombus that has broken off from the vessels (for example, the lower extremities) and entered the brain. Surgery is used to remove the plaque or embolus. A special patch is sewn to this place, which will prevent the vessel from expanding or contracting and will restore blood flow.

If this operation is not performed on time, then after a short period of time a stroke is possible. This is due to the fact that brain cells are very sensitive to a lack of oxygen and nutrients, since they do not have reserves that could provide the cells in need with energy during ischemia.

Treatment of aortic aneurysm

Dilation of the arterial wall is a complication of atherosclerosis. With an aneurysm of the vessels of the lower extremities, a severe course of varicose veins is possible. The most dangerous sprain is considered to be aortic sprain; when it ruptures, the patient dies within a few minutes from massive blood loss.

Most often, the expansion is localized in the abdominal region, since this is where the largest number of branches are located. With a high degree of damage, the patient feels sharp pain in the abdomen and lower back. No amount of help in the form of medications or heat brings relief.

Treatment methods for aortic aneurysm are only surgical. It is necessary to remove the convex area followed by prosthetics, bypass surgery or resection of the affected area. The choice of method for closing the lumen in the aorta depends on the degree of damage to the vessel. With this treatment, the disease can return if the rules of nutrition, lifestyle and medication are not followed.

Laser irradiation

Laser irradiation of blood will only help reduce the amount of circulating cholesterol. With a high degree of vascular damage, the help from this method will be insignificant. In addition, irradiation is only an addition to the main treatment, and it is not advisable to use it as a main method. High efficiency rates can be recorded at the initial stage of the disease. Reducing the amount of lipids in the blood and improving the contractile function of the heart will help stop the disease at this stage and prevent the development of complications (damage to the aorta, cerebral vessels and lower extremities).

Atherosclerosis is a disease that affects all blood vessels (both the brain and the lower extremities). Treatment is possible, but will require considerable effort on the part of the patient. It is important to take medications regularly, following the dosage. The course of treatment should be at least a year, since only with long-term treatment is a lasting positive effect possible. Active physical activity is a must. It is especially worthwhile to load the muscles of the lower extremities, as they train the heart muscle, blood vessels and prevent the appearance of varicose veins.

Find out how to improve blood circulation in your legs

Poor circulation in the lower extremities is a dangerous phenomenon that can negatively affect your overall health. In the first stages, the problem may seem minor and not cause serious discomfort, but if left untreated, a person will inevitably face unpleasant consequences. What diseases and pathologies can cause this symptom, and how to improve blood circulation in the legs?

Causes and symptoms

Abnormalities in blood circulation in the legs can be caused by many diseases, including atherosclerosis, inflammation of the vascular walls, spasms and blockages of blood vessels, varicose veins, endarteritis, and diabetes. In addition, this phenomenon is provoked by reasons such as poor lifestyle, excess weight and bad habits, especially smoking.

Symptoms of poor circulation in the lower extremities include:

• discomfort and pain that manifests itself after a long walk or standing;
• rapid fatigue of the lower extremities;
• tingling and numbness in different parts of the legs;
• minor swelling;
• cramps, cold skin of the feet;
• the appearance of vascular “mesh”, “stars” and “spiders”.

As the pathological process develops, the signs become more pronounced and appear not only after physical exertion, but also at rest.

Associated symptoms

The symptoms that accompany circulatory problems in the legs depend on the disease that caused it. With diabetes, patients experience increased sweating and thirst, weakness and dizziness, weight loss, and excessive urination. Inflammatory diseases (vasculitis, etc.), in addition to discomfort in the lower extremities, are accompanied by general symptoms - increased body temperature and blood pressure, heart rhythm disturbances, loss of appetite. Varicose veins, atherosclerosis, endarteritis and other similar pathologies cause changes in the shade of the skin, minor hemorrhages on their surface, hair loss, intense pain and lameness.

Diagnosis for violations

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To identify the cause of poor blood circulation in the legs, the patient must consult a phlebologist and undergo a comprehensive diagnosis, which includes instrumental and clinical research methods.

1. Doctor's examination. Allows you to identify external changes in the lower extremities (vascular network, etc.), atrophic processes in soft tissues, absence or decrease in pulse rate in the arteries.
2. Ultrasound with Doppler. A research method that can be used to assess the condition of blood vessels, diagnose inflammatory processes and other damage, as well as their extent.
3. Rheovasography. It is carried out to determine blood flow disorders in the vascular system of the lower extremities.
4. Arteriography. The examination is based on the introduction of a special pigment into the blood, which makes it possible to detect narrowing and obstruction of blood vessels.
5. Infrared tomography. When carrying out diagnostics, a special device is used that measures thermal radiation on the lower extremities: in places where blood circulation is impaired, it will be significantly lower.

How to improve?

In the first stages of diseases, when hemodynamic disturbances are not too pronounced, blood circulation in the legs can be improved independently. To do this, you must follow the following rules and recommendations:

• stop smoking, alcohol and caffeine abuse;
• eat a balanced diet and, if necessary, lose excess weight;
• engage in light physical activity;
• do exercises to improve blood circulation in the legs (“bicycle”, lifting legs up and down);
• After a long walk or standing on your feet, do a leg warm-up or a light massage.

Positive changes will not be noticeable immediately, but after some time there will be a significant improvement in blood circulation in the legs, and pain and other unpleasant symptoms will gradually disappear.

Medicines

Medications can quickly get rid of the manifestations of poor blood circulation, but they can only be used as prescribed by a doctor, taking into account contraindications and possible side effects.

Antiplatelet agents

Antiplatelet agents are a group of drugs that affect the blood clotting mechanism and prevent platelets from sticking together.

This helps improve hemodynamics and blood circulation in the legs, prevents thrombosis and related complications.

Anticoagulants

Anticoagulants are also used to reduce the risk of thrombosis and improve blood circulation, but have a different mechanism of action - they prevent the conversion of prothrombin to thrombin, thus preventing the formation of blood clots.

They are available in different forms, but to improve blood circulation in the lower extremities it is better to use ointments for the legs.

Statins

Cilostazol (Pletal, Plestazol) is an antithrombotic drug that is superior in its effects to known anticoagulants and antiplatelet agents. The main indication for use is intermittent claudication, which is associated with peripheral arterial disease and impaired blood supply to the legs. Contraindicated in cases of severe dysfunction of the liver, kidneys, heart, ulcerative lesions of the gastrointestinal tract, complications of diabetes mellitus, and hypersensitivity. The cost is about 19 thousand rubles.

Medicines for diabetes

Circulatory disorders in the legs are a common phenomenon in diabetes mellitus, which can lead to the formation of trophic ulcers and other complications, and therefore require treatment with special medications.

Diuretics

Diuretics are usually prescribed for diabetes mellitus, arterial hypertension and other diseases that are characterized by deterioration of blood circulation in the lower extremities due to edema.

Other drugs

In addition to the above drugs, venous insufficiency in the lower extremities is reduced by thrombolytics (Streptokinase, Alteplase), antispasmodics (No-spa, Eufillin) and vitamins, especially groups B and C.

It is not recommended to take these medications on your own - only a doctor can answer the question of how to restore blood circulation in the legs with the help of medications.

Diet

Improving blood circulation in the legs is necessary not only with medications, but also with an appropriate diet. Useful products include:

• vegetables (especially beets, garlic, pumpkin, eggplant);
• fruits and berries;
• vegetable oils;
• seaweed;
• fish and seafood;
• fermented milk products.

The list of prohibited products that can worsen the patient’s condition with atherosclerosis and other pathologies includes:

• fatty, smoked, salty dishes;
• offal and sausages;
• semi-finished products;
• sweets and baked goods;
• carbonated drinks.

Surgical methods

In severe cases, surgical methods are used to restore blood flow in the legs: angioplasty and bypass surgery. With varicose veins, some patients require sclerotherapy, laser and radiofrequency ablation, venectomy - operations that are designed to restore the patency of the veins and reduce the risk of complications.

Massage and acupuncture

Massage and acupuncture can only be used in combination with conservative therapy under the supervision of a physician. They stimulate nerve function, restore elasticity of muscles and blood vessels, and increase immunity.

Massage is especially useful, which in the early stages can be performed independently, stroking and lightly rubbing the legs from the knee down.

Traditional medicine

To improve blood circulation in the legs, many patients use folk remedies, but do not forget that they have a number of contraindications and can cause side effects.

1. Air. Take 3 tablespoons of calamus, add a liter of water, leave for 15 minutes. Add to water for washing your feet, and there is no need to wipe them after the procedure - the infusion should be absorbed into the skin.
2. Bay leaf. Pour half a pack of bay leaves with a glass of warm vegetable oil, leave for a week, and apply to your feet with massage movements.
3. Marsh rosemary. Steam a teaspoon of the plant in a glass of water, boil for a few minutes, leave for half an hour, filter. Drink a tablespoon three times a day for 3 weeks.

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Other treatments

In addition to conservative and surgical treatment methods, alternative methods are used to improve poor blood circulation in the legs - hirudotherapy and therapeutic mud. With their help, you can improve blood characteristics, eliminate the risk of blood clots and improve metabolic processes in tissues.

Treatment prognosis

With the right approach to treatment, the prognosis for poor blood circulation in the legs is favorable - with the help of medications, physiotherapeutic methods and proper nutrition, the patient’s condition can be significantly improved and dangerous consequences can be avoided. Surgical operations are usually used for advanced stages of varicose veins, atherosclerosis and other diseases, as well as when it is necessary to improve blood circulation in the legs of elderly people.

Further prevention

Prevention of venous insufficiency consists of a healthy lifestyle, a balanced diet and giving up bad habits.

To avoid problems with blood circulation, you should engage in light physical activity and walk in the fresh air as often as possible.

Deterioration of blood circulation in the legs in the absence of treatment and non-compliance with preventive measures can become a serious problem, so you need to start fighting the pathology as early as possible. Timely diagnosis and consultation with an experienced specialist will help avoid unpleasant consequences and maintain healthy feet.

Atherosclerosis of the arteries of the lower extremities - causes, diagnosis and treatment

1. What is atherosclerosis of the arteries
2. Causes of the disease
3. Main manifestations of the disease
4. Treatment
5. Principles of conservative treatment
6. Minimally invasive treatment methods
7. Surgical treatment
8. Using traditional methods

Atherosclerosis of the arteries of the lower extremities is a dangerous vascular pathology that develops mainly in old age. At the initial stage, the disease does not manifest itself with characteristic symptoms; in advanced cases, limb amputation may be required to prevent serious complications.

Timely examination at the first signs of arterial atherosclerosis will allow the doctor to prescribe an effective conservative course of therapy to the patient.

What is atherosclerosis of the arteries

Unmodified arteries of any part of the body have such a lumen that ensures unhindered movement blood and, accordingly, tissue nutrition.

Atherosclerotic narrowing of the main arteries of the extremities is a consequence of the accumulation of fat on the internal walls. Forming plaques are first fixed in the intercellular space; this stage of pathology development is usually designated by the term “fat spot”.

The changes occurring at this stage can still be stopped, but such plaques are most often discovered by chance during examination of blood vessels.

Gradually, atherosclerotic plaques become larger, and this leads to the fact that the diameter of the vessels becomes smaller and, accordingly, the physiological blood supply is disrupted. Lack of oxygen and nutrients causes a decrease in the elasticity of the affected vessels, their increased fragility and changes in nearby tissues.

Gradually, calcium accumulates inside the fatty plaque and it becomes hard. Atherocalcinosis significantly impairs blood supply, and tissue necrosis occurs as a result of hypoxia. Another danger is the possible detachment of a blood clot from the final sections of the plaque, which can clog a large artery and cause irreversible changes.

Stenosing atherosclerosis of the arteries of the lower extremities is more common among elderly patients over 60 years of age, but the disease is occasionally diagnosed in young people under 40 years of age. Men get sick almost 8 times more often than women, and long-term smoking plays a significant role in the narrowing of blood vessels and the deposition of plaques in the arteries.

Causes of the disease

Stenosing atherosclerosis of the main arteries of the lower extremities occurs under the influence of a variety of factors provoking the disease.

The likelihood of developing pathology increases in people:

The risk of atherosclerosis increases with age, and the more provoking factors act on the human body, the higher the likelihood of vascular damage.

It has been noted that atherosclerosis of the arteries of the extremities often begins to develop after extensive frostbite, serious trauma, or abdominal surgery.

Main manifestations of the disease

With careful attention to your health, even the initial symptoms of atherosclerosis of the extremities can be suspected independently.

• Itching and periodic crawling in the legs. Often patients determine the similarity of such symptoms with those that appear after prolonged compression of a limb. But discomfort in the legs with atherosclerosis occurs without associated causes.
• Feeling of coldness in the affected limb. This symptom is also observed in the warm seasons of the year.
• Pale skin.
• Reduction of fat and muscle layers on the legs, thighs, and feet. Tissue degeneration is associated with a lack of nutrients and oxygen.
• Peeling of the skin, cracks on the legs, discoloration of the nails. Against the background of atherosclerosis, fungal diseases often develop.
• Hair loss on the legs without subsequent hair regrowth. This change is also associated with degenerative processes in the skin.
• Pain. At first, painful sensations appear during physical activity; at the initial stage, “intermittent claudication” appears. In advanced cases, pain can occur at rest.
• The appearance of an unnatural burgundy coloration of the skin of the feet and legs. Darkening indicates thrombus formation and is a harbinger of necrosis.
• Trophic, non-healing ulcers on the legs, most often they form in the foot area.
• Gangrene. Tissue necrosis occurs at the last stage of atherosclerosis; complications develop more quickly in people with diabetes and a number of other concomitant pathologies.

The disease is classified depending on changes in the arteries and symptoms of the disease.

There are 4 stages of pathology:

An experienced doctor may suspect damage to the arteries of the lower extremities when examining the patient. Attention is paid to skin coloring, tissue atrophy, and arterial pulsation.

To accurately establish the diagnosis, the following is prescribed:

The diagnosis and degree of atherosclerotic lesions are made only after assessing all examination data. Treatment is selected depending on the identified pathologies.

Treatment

If the patient is lucky and the pathology is identified at the initial stage of development, then to prevent further changes and to neutralize existing disorders, it may only be necessary to eliminate the influence of provoking factors on the body.

Necessary:

• First of all, stop smoking;
• Eat in such a way that your body gets as little animal fat as possible, which is a source of bad cholesterol;
• Lose weight if you have extra pounds;
• Do not allow blood pressure to rise above 140 mm Hg. st;
• Increase physical activity. Hiking, cycling, swimming are useful for the blood vessels of the legs; you can exercise on an exercise bike at home;
• Treat chronic diseases. If you have diabetes, you need to constantly maintain normal blood glucose levels.

Treatment of stenosing atherosclerosis of the arteries of the lower extremities in the second and subsequent stages of the pathology is divided into conservative, minimally invasive and surgical.

Principles of conservative treatment

Conservative methods of therapy include taking medications and physical therapy. Courses of taking medications specially selected depending on the identified changes are designed for 1.5-2 months, they need to be repeated up to 4 times a year.

The most commonly used medications are:

The prescription of statins is indicated to normalize cholesterol levels in the blood. For atherosclerosis, enzyme preparations are often used, since the disease in most cases is accompanied by changes in the functioning of the pancreas.

Some medications must be taken once, others are used periodically, and in some cases medications will need to be taken for life. Features of the selection of a treatment regimen depend on the stage of the pathology and concomitant ailments.

Minimally invasive treatment methods

Innovative methods of treating patients with atherosclerosis of the lower extremities - balloon dilatation, angioplasty, stenting of affected arteries. These minimally invasive procedures restore blood flow without extensive surgery.

They are carried out using special equipment, the rehabilitation period takes little time and the patient can recover at home.

Surgical treatment

Minimally invasive techniques cannot always be used. If the blocked areas of the vessels are large, then surgical intervention is required to restore blood circulation. The patient is offered one of the types of surgery:

In cases where gangrene is diagnosed and there are no conditions for restoring blood circulation, amputation of the limb is necessary. This operation is prescribed to save the patient's life.

Using traditional methods

Recipes from traditional medicine are useless for atherosclerosis if you do not use medications prescribed by a doctor. But various herbal decoctions, special baths, tinctures help improve the condition of blood vessels and blood composition, and strengthen the body’s overall resistance.

Recommended use:

• Decoctions of horse chestnut and common hop. These herbs increase blood circulation.
• Nettle baths. Their use improves microcirculation and helps reduce discomfort in atherosclerosis.
• Garlic medicine. 10 cloves of garlic need to be peeled, crushed and poured with a glass of unrefined vegetable oil. The mixture should infuse for a day, after which it can be treated. For treatment, mix a teaspoon of garlic oil with a tablespoon of freshly squeezed lemon juice and drink the drug three times a day.

You definitely need to stick to your diet. It is recommended to eat more vegetables and fruits; for atherosclerosis, grapefruit, melon, viburnum, nuts, cheese, and fatty fish are useful. It is always necessary to remember that the consumption of butter, fatty meat, sausages, pates, offal, baked goods, and lard mayonnaise in case of atherosclerosis should be almost completely eliminated.

Following a diet will not only restore the elasticity of blood vessels, but will also have a positive effect on the condition of the entire body. You need to drink more; drinking pure water, compotes, green tea or tea with lemon, and decoctions of some herbal remedies are helpful.