Peripheral arterial disease and intermittent claudication
VASCULAR SURGERY – EURODOCTOR.RU – 2007
What is intermittent claudication?
Intermittent claudication – pain or a feeling of weakness and fatigue in the legs, occurring when walking. This symptom appears at the beginning of physical activity, and is at rest. Intermittent claudication – a symptom of inherent disease of the peripheral arteries of the lower extremities, such as atherosclerosis.
The arteries of the heart is bleeding, enriched with oxygen and nutrients. Tissues receive oxygen and nutrients necessary for their activity and life, and give the blood products of metabolism – "slag". However, when the lumen of the artery narrows, blood flow in the tissue breaks down. Tissues and cells are less necessary and oxygen. This state is called tissue ischemia. Usually ischemia is manifested in physical activity when the tissues need a larger volume of oxygen, whereas ischemia alone may not be apparent.
When physical activity such as walking, running, to the tissues of narrowed arteries is delivered to a smaller volume of blood, and therefore less oxygen and nutrients. This leads to the fact that accumulate in the tissues of metabolic products, including lactic acid. It is the accumulation of this acid and causes pain. This mechanism is also valid for coronary heart disease.
Intermittent claudication is one of the earliest signs of peripheral arterial disease. The narrowing of the arteries occurs not only in atherosclerosis. With this disease, as occlusive disease, as there is a narrowing of the arteries, however, in contrast to the narrowing in atherosclerosis is uniform, since the endarteritis not form plaques. This disease has a slightly different mechanism of development. However, for it is characteristic of ischemic tissue of the lower limbs during walking and the manifestation of symptoms such as intermittent claudication.
The manifestations of intermittent claudication
Intermittent claudication manifests itself the emergence of of pains, feelings of fatigue and of discomfort in the legs when walking. Sometimes there may be no pain, but there are spasms in the calf muscles, weakness of the legs. The degree of manifestation of intermittent claudication depend on the degree of circulatory disorders in the tissues. In the the initial stages of this symptom is can manifest itself when walking to distances of more than a kilometer. The greater blood flow disturbance in the legs, depending on the length of the quantities a, narrowing of the arteries, the greater the manifestation of ischemic legs. In the later stages of intermittent claudication is evident even after the patient was 100 meters. Intermittent claudication may be unilateral (characteristic of atherosclerosis) and bilateral (typical endarteritis).
Causes of intermittent claudication
As mentioned above, intermittent claudication – a sign of peripheral arterial disease of lower extremities, such as atherosclerosis and occlusive disease. The main mechanism of manifestation of pain in this condition – accumulation of lactic acid in the tissues.
Risk factors for intermittent claudication
To the factors of risk intermittent lameness relate the risk factors of atherosclerosis and of other diseases arteries of the lower of extremities:
- High levels of cholesterol in the blood
- High blood pressure
- Hereditary predisposition
Methods of diagnostics intermittent lameness
Diagnosis, as with all other diseases, the patient begins with a survey, data collection and evaluation of his complaints. Next, the doctor finds the beginning and course of the disease. After that the inspection. Particular attention is given to examination of the lower extremities. Your doctor may also perform certain tests to ascertain the state of blood supply to your feet. However, the main diagnostic methods for diseases of the peripheral vessels, including arteries, are:
- Determination of ankle-arm index – is determined by arterial blood pressure on the shoulder and ankle. Normally, these figures should be the same. In diseases of the peripheral arterial pressure in the ankle is lower than in the shoulder.
- Biochemical analysis of of blood on the determination of the level of cholesterol and of lipids.
- Duplex scanning – ultrasound method, which combines conventional ultrasound and Doppler.
- Magnetic resonance angiography – a method that uses the energy of electromagnetic waves in a strong magnetic field, which allows to see the structure of tissues, including blood vessels.
- Spiral computed tomography – a method for obtaining cross-sectional images of tissue using X-rays followed by treatment with it on your computer.
- Angiography – This method also allows you to see the structure of vessels and their narrowing. To do this, through the femoral artery catheter, which is supplied in the abdominal aorta, above the place of origin of the renal arteries. After that, through the catheter and contrast material is a series of x-rays.
Typically, the study begins with a non-invasive techniques such as ultrasound, CT, magnetic resonance angiography. For more serious cases of vessels used invasive techniques such as angiography.
Treatment of intermittent lameness
Treatment of intermittent claudication is to treat the underlying cause of peripheral artery disease. Treatment includes lifestyle changes, diet, smoking cessation, exercise and reducing overweight and taking certain medications, if necessary, and methods of endovascular surgery.
Exercise for treating intermittent claudication
Exercise – this is the initial phase of treatment of intermittent claudication. Your doctor will develop a special lesson plan suitable to your specific situation. He will explain the type of exercise recommended by the intensity, duration, and frequency performance in a week. As an exercise recommended by the usual walking for 1 hour or more 3 or more times a week for at least 3-6 months, preferably under medical supervision. The purpose of the given of treatment – increase the time of 'walk without the development of intermittent lameness.
Need to go until until intermittent claudication, usually within 3-5 minutes. Further, should continue to walk until you can even tolerate the pain, usually 8-10 minutes. After this you should stop and rest until the pain is not fully take place, and then continue walking. It is necessary to repeat the walk and rest periods, gradually increasing the period of walking without pain from 30 to 50 minutes. Thus, how would you train your existing tissue to blood flow, and in addition, in the muscles of the lower limbs, new blood vessels – the so-called collaterals, in which blood flows.
Drug treatment of intermittent claudication
At present, for the treatment of lower extremity arteries, the following drugs:
- Drugs that lower cholesterol – statins
- Vasodilating preparations – nicotinic acid, but the-shpa, and others
- Vasaprostan – currently the main agent in the treatment of vascular disease, a beneficial influence on the vascular wall
- Anticoagulants and Antiplatelet agents – drugs that reduce blood clotting and its viscosity, thus reducing the risk of blood clots and increase the "flow" of blood in a small flask – capillaries. These include aspirin, klopidrogel, warfarin and other
- In the presence of diabetes – antidiabetic drugs, including insulin
The diet for the treatment of intermittent claudication
Diet is also one of the highlights of a comprehensive treatment of diseases of the arteries. Diet should be with the restriction of the content of in a diet of of cholesterol and of saturated fatty acids. We recommend eating vegetable fats – oils. In them are contained the so-called polyunsaturated acid. And also it is recommended consumption of of fish: salmon, summer salmon, mackerel, sardines. Their meat contains a substance like omega-3 fatty acids. These acids help to reduce levels of triglycerides in the blood. Soybeans and many meat substitutes based on soy also reduce blood levels of low density lipoprotein.
The methods of endovascular surgery include:
Surgical treatment of intermittent claudication
The methods of surgical reconstruction of the arteries are endarterectomy and prosthetic arteries.
CARDIOVASCULAR SURGERY in MC Imedical – ISRAEL
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CLINIC CARDIOVASCULAR SURGERY NIDERBERG – GERMANY
CENTER FOR CARDIOVASCULAR MEDICINE SURGERY JSC – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
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