Endarteritis obliterans

Endarteritis obliterans

Obliterating endarteritis is an inflammation of the inner membranes of the arteries, more often of the lower extremities, manifested by narrowing of the lumen of the arteries, thrombosis and disorders of the peripheral circulation up to the development of ischemic necrosis. The disease occurs mainly at the age of 20-40 years, but can be observed at 15-16 years, as well as in old age. Almost exclusively men are ill. The process is localized mainly in the distal arteries of the foot and lower leg. The lesion is usually symmetrical. Etiology. There are all sorts of theories: allergic, nervous, endocrine, hormonal.

Risk factors

• • Hypersensitivity to nicotine (however, there are also non-smokers among the sick). Smoking cessation – you will need a treatment condition
  • Long re-cooling, especially at high humidity.

Pathogenesis

• • Changes in hemodynamics as a result of gradual narrowing and obliteration of the lumen of medium and large arteries. Growth of the inner lining of the arteries and subsequent thrombosis are characteristic
  • More often the lesion spreads in the proximal direction. Thrombosis also occurs infrequently in the veins accompanying the artery (Buerger’s disease)
  • Nerve trunks are affected by secondary ischemic neuritis. Dense scars form around the vessels. The length of obliterated areas can vary significantly (from 2 to 20 cm). Collateral pathways develop around the site of occlusion. Possible spasm of the main and collateral vessels.

The classification of chronic ischemia of the lower extremities is based on the severity of the pain syndrome

• • Stage I – pain in the calf muscles occurs when walking calmly for a distance of 1 km
  • PA – the patient can walk more than 200 m before the onset of pain
  • IB – the patient before the onset of pain can walk less than 200 m at a normal pace
  • III – pains appear at rest and when walking up to 25 m 
  • IV – ulcerative-necrotic changes in the lower extremities are detected.

Clinical picture

• • Intermittent claudication (most common symptom). There may be pain at rest and tissue necrosis with the appearance of non-healing ulcers.
  • Absence of pulsation on the main arteries of the lower extremities
  • Other symptoms include hair loss, changes in the nail plates, atrophy of the muscles of the affected leg, blanching of the skin of the lower limb in the raised position, and congestive hyperemia in the lowered position.

Research methods

• • Electrothermometry
  • Rheovasography
  • Arterial oscillography
  • Capillaroscopy and capillarography
  • Volumetric sphygmography
  • Doppler ultrasound
  • Aorto-arteriography
  • Arterial angiography with digital processing

Images.

Differential diagnosis – see Lameness intermittent.

Treatment:

Surgical treatment

• • Indications for surgery: pain at rest and ulcerative-necrotic stage of ischemia of the lower extremities, as well as severe intermittent claudication in PB degree
  • Contraindications for surgery: myocardial infarction less than 3 months old, circulatory failure of III degree, severe pulmonary insufficiency, renal and hepatic insufficiency. The patient’s age is not a contraindication.
  • Reconstructive operations on vessels (for example, shunting) with obliterating endarteritis are used relatively infrequently. Often perform lumbar sympathectomy, sometimes regional periarterial sympathectomy. With the development of gangrene, amputation of a smaller or larger segment of the limb is indicated (depending on the level of complete vascular occlusion). Conservative treatment
  • Drug therapy
  • Antispasmodics (papaverine, no-shpa, halidor [benziklan], andecalin, pentoxifylline)
  • Ganglion blockers (benzohexonium, dimecolin)
  • Antiplatelet agents (for example, dipyridamole)
  • A nicotinic acid
  • B vitamins, vitamin E, ascorbic acid
  • Antihistamines (diprazine, suprastin, tavegil).
  • Physiotherapy (diadynamic currents, diathermy of the lumbar region, barotherapy, balneotherapy).

The prognosis in the absence of treatment is unfavorable. A few years later, after the appearance of the first signs of ischemia of the lower extremities, patients are subject to surgical treatment – limb amputation. Complex treatment often slows down, but does not exclude the further progression of the pathological process.

Synonyms

• • Adrenal arteriosis
  • Winivartera disease
  • Gangrene spontaneous
  • Thromangiosis obliterans
  • Friedlander’s disease

See also Atherosclerosis of peripheral arteries, Lameness intermittent ICD 170 Atherosclerosis