Arteriopatiya
Description:
Arteriopatiya can characterize as group of inborn and acquired diseases with various etiological factors and pathogenetic mechanisms of which clinic the ischemic syndrome is the cornerstone. In a pathogeny of diseases of arterial vessels, along with developing of a hypoxia in fabrics, the large role is played by frustration in system of a homeostasis and hemorheology
Symptoms Arteriopaty:
Clinical physicians of the different countries and schools use special terms which combine the diseases causing HAPN: "vasculopathy", "angiopatiya", "arteriopatiya", "arteritis", "angiitis", "vasospasm", "ангиоригоз", "трофоангионевроз", etc.
The clinical picture of arteriopatiya is characterized by development of an ischemic syndrome. In its current it is possible to allocate two stages:
functional (spastic),
obliterating (organic).
At a spastic stage of a disease of the patient feels numbness, an itch, paresthesias, a chill, causeless fatigue and weight in extremities. As a rule, these complaints have passing character, and patients do not see a doctor.
In an obliteration stage clinical symptoms are stabilized. At HAPN in this stage there are typical trophic damages of skin (ulcer) and its appendages (disappearance of hair follicles, changes of nails). The pulsation on peripheral arteries is lowered or is absent. Allocate 4 extents of disturbances of blood circulation at HAPN in an obliteration stage:
I - functional compensation;
II - a decompensation at an exercise stress (emergence of the alternating lameness at HAPN of the lower extremities);
III - a rest decompensation (emergence of pains at rest);
IV - destructive (necrotic, gangrenous).
The current of arteriopatiya happens acute (malignant), subacute (the alternating aggravations and remissions), chronic (gradually progressing).
Reasons Arteriopaty:
The Acute Arterial Peripheral Insufficiency (AAPI) connected with an embolism or local thrombosis of the main vessel is followed by suddenly developing ischemia symptom (pain, pallor, paresthesia, a poikilothermism, lack of pulse, paralysis).
Unlike OAPN, at the chronic arterial peripheral insufficiency (CAPI) there are not always well-marked reasons and symptoms of ischemia (see the table).
Nevertheless obliterating atherosclerosis which meets generally in an age group of 55-65 years (man) and 60-80 years (woman) is considered the main reason for HAPN and OAPN. The peripheral form of aorto-arteritis is the reason of development of HAPN, the second for frequency, (at 9% of patients). It occurs among patients at the age of 45-50 years.
Structure of the diseases causing HAPN:
obliterating atherosclerosis - 81,6%;
nonspecific aorto-arteritis - 9,0%;
diabetic angiopatiya - 6,0%;
obliterating thromboangitis - 1,4%;
Raynaud's disease - 1,4%;
other diseases - 0,6%
Treatment Arteriopaty:
With arteriopatiya the differentiated approach considering weight of arterial insufficiency is the cornerstone of treatment of patients.
Most of patients with this pathology asks for medical care at development of functional compensation at a stage of organic changes (obliteration).
At this stage treatment practically all arteriopatiya (an exception - HAPN of the main vessels caused by atherosclerosis, aorto-arteritis, a prelum syndrome) - conservative. Therapy of a disease at this degree of an obliteration includes the main stage - out-patient, and incidental - stationary, and also sanatorium. At an out-patient stage enter a complex of medicamentous therapy: vasodilating drugs, vitamins of group B (B1, B6), niacin, sedative drugs, tranquilizers.
From vasodilating drugs are used:
ganglioblokator (Mydocalmum, Bupatolum);
the drugs operating on smooth muscles of arteries (Nospanum, Halidorum, a papaverine, вазодилан, баметол sulfate);
the drugs operating on peripheral holinoreaktivny systems (Padutinum, андекалин, angiotrophine, depot-kallekrein, прискол, вазоластин).
Among physiotherapeutic methods of treatment of HAPN at initial manifestations of a stage of an obliteration the diathermy, diadynamic currents are effective. Sanatorium treatment can include a balneoterapiya (radonic, hydrosulphuric, narzan, coniferous and pearl and oxygen bathtubs), and also mud applications.
At the II extent of development of a stage of an obliteration during medicamentous therapy are added to above-mentioned medicines
the antiinflammatory, improving a trophicity drugs (ATP, фосфаден, solkoserit or Actovegin, Escuzanum, indometacin, Prednisolonum);
antioxidants (vitamin E, probucol);
the means possessing multicomponent action (вазапростан, aspirin (100-300 mg), пентоксифиллин (trental), Wessel дуэ ф);
Enzymes (Wobenzym, flogenzy);
multicomponent drugs (Tanakanum, тиклопидин, synthesis inhibitors Cholenzymum, sekvestrant of bile acids, GMG KOA inhibitors of reductase, fibrata, antagonists of calcium, garlic drugs).
Prevention of infectious complications is carried out by prescription of antibiotics. Apply to intravenous infusions реополиглюкин. Besides, use a photohematotherapy (Ural federal district blood, laser therapy), hemosorption, a plasma exchange.
At the III extent of development of a stage of an obliteration (a rest decompensation) purposes of corticosteroids, dezagregant (aspirin, curantyl), anticoagulants of direct and indirect action (heparin, Phenilinum, фраксипарин, клексан, Wessel дуэ ф), analgetics are obligatory. From vasodilating drugs it is necessary to apply only those which influence smooth muscles (Nospanum, Halidorum, Nicospanum). Arterial, epidural blockade, blockade vertebralny sympathetic ганглиев are carried out.
Treatment of destructive changes at a stage of an obliteration includes intra arterial infusions, surgical interventions, disintoxication and antibacterial therapy (duration of an antibioticotherapia has to average 10 weeks, from them 4 weeks with a parenteral way of introduction). At prescription of antibiotics of a broad spectrum of activity character of microflora is considered (anaerobic). Apply generation cephalosporins II-III (clindamycin, imipeny).
