Lameness intermittent

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Lameness intermittent

Intermittent claudication – the periodic occurrence of paresthesia and pain in the legs (more often in one) when walking, forcing the patient to stop; the main symptom of diseases manifested by chronic occlusion of large and medium arteries of the extremities. Manifestations are significantly reduced or completely disappear after rest (with significant occlusion, pain can occur at rest and be permanent). Most often they develop in the calves and thighs, much less often in the hands. The predominant age. In men – 40-60 years, in women – 60-70 years. The predominant gender is male (4:1). Etiology

    • Obliterating endarteritis (OE)
    • Thromboangiitis obliterans (211480, Buerger’s disease, p) is a type of OE of the lower extremities, characterized by the spread of the process from arteries to small superficial veins or vice versa
    • Nonspecific arteritis
    • Atherosclerosis
    • Diabetic angiopathy.

Risk factors

    • Smoking
    • Diabetes
    • Family history of stroke and cardiovascular disease
    • Male gender
    • Obesity
    • Elderly age
    • Lipid metabolism disorders (most often hereditary hypercholesterolemia).

Clinical picture

    • It may develop gradually or appear suddenly.
    • The patient is unable to walk long distances.
    • Symptoms range from fatigue to excruciating pain or cramps in the involved muscle group.
    • Symptoms appear distal to the location of the vessel occlusion
    • With iliac artery occlusion, discomfort is felt in the thigh or buttock
    • With occlusion of the femoral artery, pain occurs in the calf muscle
    • The pulse distal to the lesion is traditionally weakened or absent. Pulse on a peripheral artery, slightly weakened at rest, may disappear after exercise
    • The absence of discomfort at rest means that the degree of limb ischemia is still negligible.
    • Pain at rest appears with decompensation of arterial blood flow
    • Patients report intense pain, burning or stabbing, traditionally in the distal leg and arch of the foot, aggravated by lying down (sometimes it is impossible to fall asleep). Relief brings forced lowered position of the leg
    • In severe cases, tissue necrosis develops with the appearance of non-healing ulcers.
    • Hair loss, change in the nail plates, atrophy of the muscles of the affected leg.
    • Paleness of the skin of the lower limb in the raised position and congestive hyperemia in the lowered position.

Laboratory research

    • Bleeding time
    • PTI
    • Plasma glucose
    • Cholesterol
    • Fibrinogen
    • Fibrinogen nbsp; B. Special studies – see Atherosclerosis of peripheral arteries.

Differential signs of obliterating diseases of the lower extremities (according to AL Vishnevsky, 1972)

    • Onset of the disease: Atherosclerosis obliterans (OA) – traditionally after 40 years, OE – traditionally before 40 years
    • Vascular murmurs over the femoral artery: OA – appear often, OE – appear infrequently
    • Concomitant diseases of the vessels of the heart and brain: OA – often, OE – not often
    • Essential arterial hypertension: OA – often, OE – not often
    • Diabetes mellitus: OA – in about 20% of cases, OE – traditionally absent
    • Hypercholesterolemia: OA – in about 20% of patients, OE
    • traditionally absent
    • Uniform narrowing of the main arteries on the angiogram: OA – no, OE – often
    • Uneven corrugation of the contour of the arteries on the angiogram: OA – often, OE – no
    • Segmental obturation of large arteries of the thigh and pelvis: OA – often, OE – not often
    • Obturation of the arteries of the lower leg and foot: OA – not often, especially in the elderly and in diabetes mellitus; OE – usually determined
    • Arterial calcification: OA – often, OE – not often. Differential Diagnosis
    • Lumboschialgia
    • Osteoarthritis of the hip and knee joints.

Treatment – see Atherosclerosis of peripheral arteries. See also Atherosclerosis of peripheral arteries, Diabetes diabetes, Acute arterial occlusions

Abbreviations

  • OA — Obliterating atherosclerosis
  • OE – obliterating endarteritis of the ICD. 173.9 Peripheral vascular disease, unspecified