How to treat atherosclerosis of the lower extremities

Atherosclerosis of the lower limbs - is a chronic vascular disease, which develops due to disorders of lipid metabolism, leading to the formation of atherosclerotic plaques, thickening of the artery walls and reduce vascular leg lumen.

All of these variations can lead to partial or complete cessation of blood flow. Initially, this pathology is almost nothing reveals itself, but with the progression of the disease, atherosclerotic plaques more narrow the lumen of blood vessels and can completely cover it, resulting in ischemic necrosis and even the lower fabric limbs. Such a development of the disease can end the development of gangrene and loss of feet.

What it is?

Atherosclerosis - a form of atherosclerosis. In this disease, the walls of the arteries of cholesterol plaques are formed, they disrupt normal blood flow, causing vasoconstriction (Stenosis) or complete blockage, called an occlusion or obliteration, so talk about occlusive-stenotic lesions leg arteries.

According to statistics, the prerogative of the presence of disease belongs to men older than 40 years. lower extremities atherosclerosis occurs in 10% of the world's population, and that number is steadily growing.

Causes of

The main cause of atherosclerosis is smoking. Nicotine in tobacco causes artery spasm, thereby preventing the blood moving through the vessels and increasing the risk of blood clots in them.

Additional factors that provoke atherosclerosis of the lower extremity arteries and lead to an earlier onset and severity of disease:

• high cholesterol at frequent eating foods rich in animal fats;
• high blood pressure;
• excess weight;
• genetic predisposition;
• diabetes;
• lack sufficient physical load;
• frequent stress.

risk factor can also be a long-term cooling or frostbite feet, transferred at a young age frostbite.

development mechanism

The most commonly atherosclerosis of lower extremities seen in the elderly and is caused by disorders of lipoprotein metabolism in the body. Development Mechanism following stage passes.

1. Received in body cholesterol and triglycerides (which are absorbed in the intestine walls) are captured by specific transport proteins, proteins - chylomicrons and transported into the bloodstream.
2. The liver processes the resulting material and synthesizes specific fatty complexes - VLDL (very low density cholesterol).
3. In the blood of VLDL molecules affects the enzyme lipoprotein lipase. In the first step of the chemical reaction proceeds in VLDL intermediate density lipoproteins (or LPPP), and then in the second stage reaction is transformed into LPPP LPNA (low density cholesterol). LDL - a so-called "bad" cholesterol, and it is more atherogenic (i.e., capable of provoking atherosclerosis).
4. Fatty fraction to the liver for further processing. There is formed a high-density cholesterol (HDL), which has the opposite effect and is able to clean the walls of blood vessels by layers of lipoprotein cholesterol (LDL and LPPP). This so-called "good" cholesterol. Part of the fatty alcohol is converted into digestive bile acids necessary for normal food processing and sent to the intestine.
5. At this stage liver cells can give a "failure" (genetically caused or explained by older age), in whereby instead of the output low-density HDL fraction fat remain intact and go into the blood direction.

Equally, or perhaps more atherogenic and are mutated or otherwise modified lipoproteins. For example, oxidized under the influence of H2O2 (hydrogen peroxide).

1. Low-density fat fraction (LDL) are deposited on the walls of the lower extremity arteries. Prolonged exposure of foreign substances into the lumen of blood vessels contributes to inflammation. However, no macrophages or white blood cells to deal with cholesterol fractions can not. If the process is delayed, forming layers of fatty alcohol - plaque. These deposits have a very high density and impede normal blood flow.
2. Deposition of "bad" cholesterol is encapsulated, and the capsule rupture or damage occurs thrombus formation. Occlusive thrombi have an additional effect and further clog arteries.
3. Gradually, cholesterol fractions, in conjunction with taking blood clots rigid structure due to deposits of calcium salts. walls of the arteries lose their normal stretch and become brittle, resulting in possible gaps. In addition to all formed stable ischemia and necrosis of surrounding tissue due to hypoxia and lack of nutrients.

stage

During limb arteriosclerosis obliterans of the lower stage are isolated:

1. Step I (initial manifestations stenosis) - tingling feeling, skin blanching, cooling sensation and chilliness, excessive sweating, rapid fatigue while walking;
2. A stage II (intermittent claudication) - the feeling of tiredness and stiffness in the calf muscles, gripping pains while trying to pass about 200 m;
3. II B stage - the pain and tightness is not allowed to pass 200 m;
4. Stage III - squeezing pain in the calf muscles become more intense and occur even at rest;
5. Stage IV - on the surface of the legs, there are signs of trophic disorders, long non-healing ulcers and signs of gangrene.

On the lower extremities atherosclerosis advanced stages of gangrene often leads to a complete or partial loss of a limb. The lack of adequate surgical care in such situations can lead to death of the patient.

As the prevalence of atherosclerosis is divided into stages:

1. Segmental obliteration - portion of microcirculation falls only one fragment of a limb;
2. A common occlusion (grade 2) - unit surface femoral artery;
3. Lock and femoral popliteal artery patency with impaired bifurcation;
4. Complete blockade of microcirculation femoral arteries and the popliteal - 4 degree. In the pathology of blood flow through the system is stored deep femoral arteries;
5. Defeat deep femoral artery with damage femoropopliteal area. 5 degree characterized by severe hypoxia and necrosis of the lower extremities, trophic ulcers or gangrene. Serious condition lying patient is difficult to fix, so treatment is only symptomatic.

Types of occlusive-stenotic lesions of atherosclerosis are 3 types:

1. Defeat distal portion of tibial and popliteal arteries in which blood flow to the tibia is stored;
2. Occlusion of vessels shin. Preserved patency of the tibia and popliteal arteries;
3. Occlusion of vascular femur and tibia while maintaining patency of arteries by separate taps.

symptoms

OASNK symptoms in the initial stages, as a rule, fairly well lubricated or non-existent. Therefore, the disease is considered treacherous and unpredictable. That is arterial disease tends to develop gradually, and the severity of clinical signs will depend on the stage of the disease.

The first signs of arteriosclerosis obliterans of the lower extremities (the second stage of the disease):

• begin to constantly feel cold feet;
• feet often go numb;
• there swelling of the feet;
• if the disease struck one foot, then it is always colder than healthy;
• pain in the legs after a long walk.

These manifestations occur in the second step. At this stage, the development of atherosclerosis, a person can walk 1000-1500 meters without pain.

People often do not attach importance to symptoms such as merzlyavost, intermittent numbness, pain when walking long distances. And in vain! After starting treatment in the second stage of pathology, you can 100% prevent complications.

The symptoms that appear on 3 steps:

• nails grow more slowly than before;
• on the feet begin to fall out hair;
• Pain may occur spontaneously during the day and night;
• pain appear after walking a short distance (250-900 meters).

When a person has Stage 4 feet obliterating atherosclerosis, he can not walk 50 meters without pain. For such patients, a daunting task becomes even shopping trip, and sometimes out into the yard, as the ascent and descent of the stairs becomes a torture. Often, patients with stage 4 disease can move around the house only. And as far as complications are no longer wake up at all.

At this stage, the treatment of disease arteriosclerosis obliterans of the lower extremities frequently becomes powerless, it can only temporarily relieve symptoms and to prevent a further increase in complications, such as:

• darkening of the skin on the feet;
• ulcers;
• gangrene (this complication requires amputation of the limb).

Features of a current

All the symptoms of the disease develop gradually, but in rare cases, atherosclerosis of the lower extremities is manifested in the form of arterial thrombosis. Then, in place of artery stenosis, there is a blood clot, which quickly and firmly closes the lumen of the artery. Such pathology for the patient develops a sudden, he felt a sharp deterioration of health, the skin turns pale legs become cold. In this case, a quick treatment (by time to irreversible phenomena - the clock) to the vascular surgeon allows you to save a man's leg.

With concomitant illness - diabetes, for obliterating atherosclerosis it has its own characteristics. The history of such pathologies are not rare, the disease develops so rapidly (a few hours to several days), that in a short time leads to necrosis or gangrene in the lower limbs. Unfortunately, doctors are often in such a situation, recourse to amputation of the legs - it is the only thing that can save a life.

diagnosis of the disease

The diagnosis "atherosclerosis of the lower limbs" made on the basis of the following data:

1. Typical patient complaints (pain, intermittent claudication).
2. On examination, there are signs of soft tissue atrophy of the limbs.
3. Rheovasography limbs show marked reduction of the index in the legs and feet.
4. Reduced ripple level on the arteries feet, legs, thighs and popliteal arteries. When aortic bifurcation lesion may lack ripple at both femoral arteries (Leriche syndrome).
5. Thermometry, thermography - reducing tissue temperature and the level of IR radiation.
6. US leg vessels (Doppler) constitutes a violation of the blood supply to peripheral parts.
7. Arteriography (research with the introduction of leg artery contrast agent) indicates the area of ​​narrowing of the arteries limbs.
8. Samples with functional load - reduced exercise tolerance, rapid fatigue and the appearance (or gain) of ischemic pain.

Treatment of atherosclerosis obliterans

Conservative treatment of patients with atherosclerosis obliterans of lower limb arteries is performed in the case of:

• at the stage of chronic arterial insufficiency of blood circulation in the limbs on the classification of AT. Pokrovsky - Fontane;
• with severe concomitant diseases: coronary artery disease, cerebral vascular injury, chronic lung diseases, liver, kidney, diabetes;
• multiple (multi-storey) occlusion and stenosis of major arteries;
• lesions of the distal vascular bed.

It involves:

• sedative therapy (seduksen, elenium);
• desensitizing therapy (diphenhydramine, Pipolphenum);
• pain relief (analgesic, intra-arterial means, blockade 1% novocaine solution, paravertebral blockade at A2 - A3, epigastric blockade);
• the exclusion of action of vascular risk factors (smoking, alcohol, excessive cooling, nervous stress, physical inactivity, diabetes);
• improving blood rheology, ie. e. reduction of its viscosity (plasma substitutes - dextran, defibrinogeniziruyuschie enzymes - akrod, pentoksifilin, Trental, flowerpots, agapurii);
• elimination of vasospasm (antispasmodics - no-spa, Halidorum, ksantinola nicotinate; gangioblokatory - hexon, dicain);
• normalization of blood coagulation (anticoagulants);
• inhibition adhesive-platelet aggregation activity (acetylsalicylic acid, tiklid);
• restore oxidant-antioxidant balance - protection of cell membranes (antioxidants - vitamins A, E, C, probucol);
• activation of metabolic processes in the tissues (vitamins, nicotinic acid, komplamin, solkoseril inhibitors bradykinins - prodektina, parmidin);
• elimination of immune disorders (immunomodulation, immunoadsorption, blood UVR);
• normalization of the lipid metabolism. It includes diet therapy, the purpose of lipid-lowering drugs, the use of extracorporeal correction methods composition and properties of the circulating blood, partial eyunoileoshuntirovanne holding gene therapy.

Diet therapy in obliterating atherosclerosis based on limiting energy value food intake to 2,000 calories a day, with a decrease in the proportion of fat in it (up to 30% or less) and cholesterol (300 mg). Justified assignment patients antiatherogenic nutritional supplements such as fatty acids, fish oil, Eiconol (is a food additive derived from some species of fish).

In the absence of normalization of the lipid metabolism in the background diet, not stopping it, spend medication. At present, for the treatment and prevention of atherosclerosis used five groups of lipid-lowering drugs:

• chelators - cholestyramine which are bile acid sequestrants;
• statins - lovastatin (Mevacor), simvastatin (Zocor), privastatin (lipostat), fluvastatin (Lescol)
• fibrates - mofibrat, otofibrat;

The effectiveness of conservative therapy is evaluated by applicants of lipid metabolism, especially on the level of total cholesterol and LDL cholesterol.

Normal triglycerides - 150 mg / dl. Extracorporeal techniques correction composition and properties of circulating blood: plasmapheresis; selective immunoadsorption, including sorbents with monoclonal antibodies to LDL (especially effective in treating patients with severe hypercholesterolemia hetero- and homozygous); hemosorbtion. These methods allow to obtain stable hypolipidemic effect, which consists in reducing the level of LDL in the blood and increase HDL, decrease atherogenic factor. It slows the progression of atherosclerotic arterial occlusion. However, when failure of conservative correction hyperlipidemias, trends to the progression of the process, especially during the early atherosclerosis, significant clinical manifestations of atherosclerosis in patients with generalized form it is commonly seen in people with a family hypercholesterolemia when cholesterol level than 7.5 mmol / l, expressed xanthomatosis partial operation can be carried out eyunoileoshuntirovaniya (Buchwald operation).

The essence of this surgery is turned off from the digestion of the distal third of the small intestine and the proximal anastomosis of the small intestine 2/3 dome blind. Pushing intestine has the ability to synthesize and release several types of PL and their apoproteins affect hepatic lipid synthesis and secretion by absorption and enteropechenochnoy circulation of bile acids (BA), and cholesterol, reduce the length of the small intestine functioning card leads to disruption absorption LCD and accelerate their excretion, improve synthesis of fatty acids in the liver, enhancing the oxidation of cholesterol, decrease intestinal cholesterol synthesis, chylomicrons, VLDL, lipid absorption and the fall inhibition followed by synthesis in the liver atherogenic lipoproteins. A side effect of the operation Buchwald is the frequent development of diarrhea, malabsorption of vitamin B12 and folic acid.

Two main methods of gene therapy of atherosclerotic lesions developed. SUMMARY first of them consists in introducing a gene encoding the normal protein - receptor to LDL via retrovirus into cell-culture hepatocytes of the patient, and then through a catheter inserted in the portal vein, delivery of a slurry of such cells to the liver patient. After their normal receptors donor engraftment begin to function. The disadvantage is the necessity of patients receiving large doses of statins and gradual decrease in the function of the introduced genes.

The second (direct) method is performed on a patient without prior manipulation of target cells, wherein the gene is complexed with a carrier (vector) and directly administered to a patient, but locally - in the cardiovascular system to prevent dissemination of the gene in body. Direct administration is via viral infection, chemical or physical method,

The complex of conservative treatment of patients with atherosclerosis, especially with III - IV chronic stages limb arterial insufficiency, it is advisable to include products that have a complex mechanism actions; 1) tanakan - stimulates the production of vascular endothelium relaxation factor. The drug has a vasodilatory effect on the small arterioles, capillaries reduces the permeability decreases platelet aggregation and erythrocytes, protects the cell membranes, inhibiting the reaction of lipid peroxidation, improve the absorption of glucose and oxygen fabrics; 2) prostaglandins and their synthetic derivatives (vazoprostan). They affect all parts of the ischemic limb syndrome, have a vasodilator action, inhibit platelet aggregation, improve microcirculation, normalize metabolic processes in the ischemic tissues.

Patients with lower extremities atherosclerosis obliterans appointed physiotherapy, thermal bath and spa treatment (magnetotherapy Continuous and pulse currents to the impact on the lumbar sympathetic ganglia and lower limbs, interference currents on the lower limbs and lumbar spine, massage of the lower extremities, reflex - segmental spinal massage, radon, hydrogen sulfide baths, acupuncture, giperbaroterapiya).

One of the most modern methods of physiotherapy treatment of patients with lower extremities atherosclerosis obliterans is the electrical stimulation of the spinal cord. It is produced in case of impossibility of performing reconstructive procedures on the arteries due to the prevalence of occlusal lesions with systolic blood pressure at the ankle of less than 50 mm Hg. Art. The essence of the method consists in transdermal kvadripolyarnogo electrode in the epidural space lumbar spine with holding it up to the top level of T12 and the location of the middle line. During the first week of the spinal cord electrical stimulation is carried out with a pulse frequency of 70 - 120 Hz from an external source. When receiving a positive clinical outcome generator is implanted in the subcutaneous tissue of the anterior abdominal wall and is programmed for permanent or interleave mode. Electrical stimulation is carried out for a long time (months).

In obliterating atherosclerosis of the lower extremities and used walking training (kinesitherapy, muscle training, walking through walking throuth). Kinesitherapy aims to increase pain-free walking distance. The essence of the method is as follows: in the case of hypoxic pain in the calf muscles when overcoming a certain distance by the patient temporarily lowers the pitch. A few minutes after that, the patient is again able to perform movements without pain. The mechanism of the beneficial effects of training at a distance of occlusive and stenotic lesions of arteries due to improved oxygen utilization myocytes, increase activity of mitochondrial enzymes and anaerobic energy production, transformation white muscle fibers in red, stimulation of collateral krovobrascheniya, raising ischemic pain threshold.

For the surgical treatment of atherosclerotic lesions of the main arteries of the lower extremities are used arterial reconstructive and palliative operations. For reconstructive techniques restore arterial blood flow include endarterectomy, bypass surgery, prosthetics, endovascular reconstruction (see. "Treatment of Leriche syndrome"). Sine qua non of their performance is good patency of the distal vascular bed.

Endarterectomy (trombendarterektomiya) is generally used in patients with unextended (segmental) single trunk occlusions .artery length 7-10 cm. SUMMARY operation consists in removing atheromatous intima-modified with juxtaposed with it thrombi. Endarterectomy is - open, semi-closed, closed, eversion, and with the help of mechanical and physical methods.

When you open an artery endarterectomy allocated longitudinally dissected over the site of the plaque localization. Then, under the control of changing the sex to be peeled from the wall layers to the level of the transition to visually affected areas and cut off. The edges of the intima adjacent to the area of ​​manipulation, fixed to the wall of the artery atraumatic sutures, it is a reliable way to prevent her wrap and overlap the arteries. In order to prevent narrowing endarterektomirovannoy artery incision is sutured autovenous patch.

semiclosed endarterectomy method involves: 1) exposure of the affected segment of the arteries all over; 2) arterial dissection (lengthwise, transverse) in the projection of the distal end of the occlusion; 3) a circular separation at this point of atheromatous intima-modified from the tunica muscularis; 4) cross the intersection of the selected segment and carrying on it in the proximal direction special tool - dezobliteratora mainly rings (ringstrippera) peelably ingimu altered; 5) opening the artery lumen proximal end portion of the occlusion and removing therethrough exfoliated cylinder diseased intima; 6) ligating the artery wall, optionally with a patch autovenous.

Endarterectomy closed method is the same as the semi-open, but without isolation of the arteries all over.

When using the method eversion endarterectomy artery is cut transversely below the site of the plaque localization. Next, a layer of its wall composed of the adventitia and the tunica muscularis, peeled from diseased intima and contractible (everts) in the proximal direction at the upper end plaques. At this level, the resulting modified intimal cylinder is cut off. Inverted muscular layer and adventitia are reset. Patency of the vessel is restored imposition of a circular weld. The reverse execution eversion trombendarterektomii.

Bypass surgery in obliterating atherosclerosis are produced at a stretch, as well as multi-storey occlusive-stenotic lesions of the main arteries of the lower extremities. As the great saphenous vein graft segment increasingly used isolated from its box, reverse, and anastomosed to the artery above and below the obstacle. Less commonly used human umbilical cord Vienna, gomoarterialnye grafts, synthetic prostheses of polytetrafluoroethylene, the greater saphenous Vienna without isolating it from the bed. The essence of this method lies in the fact that Vienna is not released from the subcutaneous tissue and is not reversed, and crosses above and below the site of occlusion. Before the formation of arteriovenous anastomosis venous valves are destroyed using valvulotomy of various designs. The presence of venous tributaries that can fulfill the role of arteriovenous fistula after start-up of arterial blood flow it is set on the basis of angiography data, Doppler ultrasound, palpation, and so on. D. their subsequent ligation.

The success of bypass operation state determined by addition of the peripheral channel and the diameter of a shunt used, which should exceed 4-5 mm.

In marked lesion leg arteries, obstruction of the plantar arch, in addition to conventional femoro-popliteal (tibial) autovenous shunting additionally. listalnogo anastomosis formed arteriovenous fistula, which leads to a discharge portion of the blood directly into a vein, it increases the rate of blood flow to the fool, and thereby reduces the likelihood of it thrombosis. During surgery, first applied to the receiving artery anastomosis in an "side to side" then fistula is created by anastomosing the distal end of the shunt with a series situated popliteal or tibial vein. The diameter should be 2-4 mm, m. F. 40 - 60% of the diameter of the shunt.

Prosthetics of the main arteries of the lower limbs in atherosclerosis is rarely used.

If you restore the blood flow in the arteries of the trunk is not possible, mainly because of the occlusion of the distal vascular bed, made of plastic deep femoral artery. However, frequent enough damage as the deep femoral artery and the popliteal artery and shin, poor development between collaterals lead to unsatisfactory results operations.

Occlusion of the distal vascular bed, the bad state of the deep femoral artery performed palliative surgical intervention, aimed at strengthening the collateral circulation in limbs. These include lumbar sympathectomy, revascularizing osteotrepanation methods P. F. Bytkov, G. BUT. Ilizarov, microsurgical transplantation of greater omentum in the ischemic limb tissue.

Lumbar sympathectomy with obliterating atherosclerosis involves extra-, transperitoneal deletion II - III lumbar sympathetic ganglion ipsilateral (Diez operation). The main mechanism of action of the operation is to eliminate the influence of the sympathetic nervous system.

When using revascularizing osteotrephination with obliterating atherosclerosis on the medial surface of the tibia to a biologically active points (as in acupuncture) in the zone of a well developed subcutaneous network collaterals performed 6-9 burr holes 4-6 mm in diameter without damaging the bone brain. Postoperatively caused by trepanation subthreshold stimulation in biologically active points stimulates disclosure backup collaterals. Simultaneously, through a burr hole formed unconventional interoccular communications between arteries muscular tissue and bone marrow. Furthermore, in the general circulation increases the content of bone marrow mediators - mielopeptidov possessing analgesic, trophic and angioprotektornoy properties (G. BUT. Ilizarov, F. N. Zusmanovich, 1983).

The essence of the method of P. F. Bytkov is to introduce at certain points on the foot and lower leg in their soft tissue autologous blood (Fig. 42). Treatment is carried out within 30 days. Fabric infiltrated twice - in the leg in the 1 st and 14 th days, on the foot on the 7 th and 21 th days. At one session consumes 60 - 80 mL blood to the foot, 150 - 180 ml - for the leg. The clinical effect of the operation becomes noticeable after 2-3 months. after completion of treatment and is associated with the formation of the zone extravasates well vascularized connective tissue.

G. method BUT. Illizarova (longitudinal kompaktektomiya of G. BUT. Illizarovu) involves the formation of bone flake longitudinal length of 10-16 cm from the anterior-surface of the tibia. Through him, held 2-3 distraction spokes attach to the machine Illizarova imposed on the bone. From 8 - 9 th postoperative day daily bone flake is removed from the tibia 0.5 mm. The procedure is performed 31-36 days until the gap between the tibia and its fragments will not be equal to 15-20 mm. Thereafter, for 45 - 60 days, depending on the degree of maturity of the connective tissue, the fixation proceeds flake. According to the opinion of G. BUT. Illizarova, when the distraction takes place flake regional stimulation of the vasculature under the influence of tensile stress. In this case, the main vessels dilate, increasing the number and caliber of the small muscles of vessels, fascia and bone; at the site of hematoma develops well supplying the connective tissue; by increasing the blood supply to activate regenerative processes in the limbs.

When microsurgical transplantation of greater omentum in the limb ischemic tissue caul Subfascial fit on the thigh with the transition to the popliteal region and the lower leg. The supply of the graft vessel, often right digestive gland artery is implanted into the common femoral artery and Vienna - in the femoral vein.

A disadvantage of the above methods for surgical treatments of atherosclerosis obliterans flowing just distal occlusion vascular lower limbs, is a large amount of time necessary for the development of collateral circulation - from 1 to 3 months. This limits the use of such operations in the treatment of patients with critical limb ischemia III - IV steps requiring rapid increase in blood circulation in the limb. In such cases, made arterilizatsiya venous system of the foot: arterilizatsiya superficial venous network with a preliminary destruction of its valves - arterilizatsiya origins in the great saphenous vein and the occlusion surface veins - in deep venous system. Arterilizatsiya origins in the great saphenous vein in the stack includes a number of shunt (reversed autovein, vein in situ, a prosthesis) traversable between popliteal segment or distal segment of the artery of the superficial femoral artery and origins of the great saphenous vein in foot. The basis arterilizatsii deep venous network is included in the bloodstream posterior tibial veins analogously.

In case of failure to perform reconstructive surgery patients with thrombotic occlusions of arteries of the lower extremities, abdominal aorta systemic or local thrombolysis generally known thrombolytic agents (streptokinase can be used due to atherosclerosis. Élie, duc Decazes).

The greatest effect is attained by its use: 1) when the timing of the occlusion not exceeding 12 months. in patients with lesions of the abdominal aorta and iliac arteries, 6 months. - with the advent of the femoral and popliteal arteries, 1 month. - Berdova arteries; 2) when the length of the occlusion and 13 cm 3) under satisfactory distal vascular (artery passable tibia).

System lysis is carried out according to the traditional scheme involves the introduction of local thrombolytic at a lower dosage through the catheter directly a body thrombus antegrade or retrograde, is accompanied by activation as opposed to a systemic plasminogen lysis entering the structure thrombus.

There are several techniques local thrombolysis: 1) continuous infusion administration of a large initial dose, followed by maintenance; 2) introducing a thrombolytic agent through the catheter with multiple holes throughout the occluding thrombus (appliances "pulsating spray"); 3) introducing a high dose thrombolytic agent during catheter pull-in length of the thrombus. The maximum duration of thrombolytic therapy does not exceed 48 hours. Its effectiveness is monitored by angiography or by using ultrasound.

Postoperatively, patients continue to complete the conservative treatment directed to prevention of thrombotic complications of septic and operation. Subsequently, they have to undergo an annual 1 - 2 courses of inpatient treatment of the disease, and being on outpatient treatment, constantly taking dezagregakty, oral anticoagulants and other pathogenetic reasonable preparations.

prevention

Lost health in atherosclerosis is a result of your relationship to yourself to chance, therefore, already having this disease, you should at least now be in a more careful and be sure to spend prevention. When OASNK necessary to choose a spacious comfortable shoes in order to avoid calluses, bruises, to avoid any injuries legs, with the seat does not throw his legs against each other, as thus broken are pressed vessels and blood flow in the patient leg. It is necessary to make walking every day, it is very useful for the feet. It also includes the right food with the exception of animal fats, salt, smoked, fried, red meat, whole milk, cream.

Requires normalization of weight, blood pressure control - the figures should not exceed 140/85. Lowering blood lipids protect you from myocardial infarction, with the exception of the inactivity of his regime and the introduction of the day of moderate physical activity will also be superfluous. Smoking cessation is required (only one is reduced mortality from 54% to 18%). Alcohol should be abandoned at any dose.

Need time to cure any chronic disease, control blood sugar, avoid stress, see your doctor regularly for check-ups, systematically conservative courses treatment. Prognosis is determined by the presence in the vicinity of other forms of atherosclerosis: cerebral, coronary - which, of course, do not add health.