Obliterating endarteritis (EA) is a disease that affects the nervous and vascular systems, in which there is a progressive narrowing of the arteries due to inflammation of their inner membranes, followed by scarring (obliteration). As a result, blood supply ceases and necrosis (gangrene) of the corresponding areas of soft tissues occurs. Mostly the lower limbs are affected. Mostly men are ill (98% of patients). Smoking, chilling or frostbite of the extremities and infectious diseases (in particular typhus), as well as flat feet, observed in almost 80% of patients, contribute to the development of EO.
Arteriosclerotic form of this disease occurs with general arteriosclerosis. The course of Obliterating Endarteritis. There are 3 main stages:
- Spastic
- Thrombotic
- Gangrenous .
1st stage. The first (with which the disease begins) is characterized by rapid fatigability of the lower extremities, a feeling of pain and cramps (especially at night) in the calf muscles, cooling of the feet and pains in individual fingers. Further, the symptom of the so-called intermittent claudication is attached to the indicated symptoms, when the patient periodically limps on the sore leg, which relieves pain in it.
2nd stage .
In the next stage of the disease, due to the narrowing of small vessels and blood clots in the foot , most often near the nail bed of the thumb, long-lasting non-healing and very painful sores can form.
3rd stage.
Then, if appropriate treatment is not carried out, the disease passes into the third, gangrenous stage, when large vessels become clogged with blood clots . Gangrene comes first to individual sections of the foot, then to the entire foot, and the process can spread higher to the lower leg and thigh. The disappearance of the pulse or its weakening in the arteries of the foot, in particular the dorsal artery, is one of the most frequent objective signs of E.O. However, it must be borne in mind that, in the norm, approximately in 21% of people it is weakened, especially with reduced total blood pressure, and in 10% it is absent. On the other hand, Endarteritis Obliterating can be with good pulsation of the superficial arteries of the feet, when deep arteries are affected and there are other signs of Endarteritis.
PREVENTION.
Do not smoke, keep your feet dry and warm, wear loose shoes that do not constrain your foot. If there is flat feet, wear arch support or orthopedic shoes.
TREATMENT OF OBLITERATIVE ENDARTHERITIS.
Individual treatment prescribed by a doctor and carried out under his supervision.
Conservative treatment:
- Exclude smoking, alcohol, hypothermia, long standing;
- Vasodilating ( ganglioblockers , adrenolytic, myotropic ) and Antispasmodic drugs: Trental, Nicotinic acid , Diprofen , Nikoverin , Papaverine, Angiotropin , No-spa and others. Some of these drugs also improve microcirculation, have antiplatelet properties and prevent thrombosis ;
- Anticoagulants and Antiplatelet drugs – drugs that reduce blood clotting and prevent blood clots , improve blood circulation: Heparin, Hirudin, Frakseparin , bishydroxycoumarin , neodikumarina , Fenilin , Warfarin . In the future, with tolerance, Aspirin, Cardiomagnyl or others can also be taken orally daily ;
- Non-specific anti-inflammatory drugs : Ibuprofen, Metindol , Diclofenac sodium and others ;
- Hormonal drugs: Sinestrol, Diethylstilbestrol , Testosterone propionate , Methyltestosterone , Hydrocortisone and others ; They have an anti-inflammatory effect, normalize vascular tone, reduce exudation and vascular permeability. Hormonal drugs are prescribed after appropriate studies.
- Antibiotics and sulfonamides to fight secondary infection.
- Desensitizing therapy. The participation of the allergic component in the pathogenesis of obliterating endarteritis has been established.
- Vitamins (B1, B12, B6, multivitamins);
- Novocainic blockade;
- Ointment dressings : Vishnevsky ointment, Heparinova and others ; Fold a large piece of gauze in several layers, soak with Vishnevsky ointment and put on a sore leg. Fasten the bandage with a bandage. It must be changed twice a day. The alternation of dressings with Vishnevsky ointment and Heparin ointment gives a good absorbable effect
- Hot foot baths; coniferous, hydrogen sulfide, hot, contrast , etc .;
- Physiotherapeutic procedures : mud therapy, UHF-therapy, electrophoresis;
- Hyperbaric oxygenation ;
- With the ineffectiveness of conservative treatment, Operation is indicated (plastic surgery of blood vessels, removal of nodes of the sympathetic nervous system, etc. ).