3. Atherosclerosis (obliterative
atheromatous disease) of the
lower extremities
Chronic disease with occlusive or
stenotic damages of main and
middle size peripheral arteries,
which is as the result of lipid
deposition in their walls. This
pathology is evident with
insufficiency of arterial blood
circulation in lower limbs. It can
be of different degree (rate) of
manifestation.
4. Prevalence of obliterating
atherosclerosis
More than 20 % in all cardio-vascular
pathology;
in 1000 men women
45 - 54 years – 1,8 0,6
55 - 64 years – 5,1 1,9
64 - 74 years – 6,3 3,8
5 – 7 % of population in the age of 60 – 70
years;
180 – 250 amputations on 1 million of
population in Europe;
1500 amputations on 1 million of population
in Russia.
5. Theories of atherosclerotic
pathogenesis
1. Cholesterol theory (Halatov S.S.,
1911).
2. Combinative theory (Anichkov
N.N., 20-th years of the XX
century).
┬
Realising factor Conditions of
(dyslipidemia) development
6. Etiology and pathogenesis of
obliterating atherosclerosis
1. Disorders of the vessel wall.
2. Functional changes of cell-
receptor apparatus.
3. Decreasing of immunity.
4. Homocysteinemia .
5. Genetic (inherited) factor.
7. Dyslipidemia
There are five main classes of
lipoproteins:
- chylomicrons ,
- very low density lipoproteins
(VLDL),
- low density lipoproteins (LDL),
- high density lipoproteins (HDL),
- lipoproteins «a» (LP a).
8. Clinical manifestations of the
peripherial lower limb ischaemia
The cardinal features of periferial lower limb
ischaemia include:
1. Pain in the limbs. It is the main symptom
lower limb ischaemia. Appearance of it is due
to ischaemia of the muscles, caused by
inadequate oxygenation of tissues.
The patient with chronic ischaemia of legs may
have 2 types of pain.
The first type is when pain is initiated by
walking and relieved at rest. The second
type is a rest pain.
9. Clinical manifestations of the
peripherial lower limb ischaemia
2. Coldness, numbness, paraesthesia;
3.Weakness in muscles of the legs;
4. Brittle, flatand ridged nail, and shiny
skin;
5. Diminished hair and nail growth on
affected limb and digits;
6. Colour changes (blueness or
paleness);
7. Atrophy of muscles;
8. Loss of subcutaneous fat;
10. Clinical classifications of
obliterating atherosclerosis of
the lower limbs
Stages of chronic arterial insufficiency
of the lower limbs according to Rene Fontaine
I stage(initial manifestations of the
occlusions)- mild pain on walking (“claudication”).
II stage (circulative insufficiency in
functional load)- severe pain on walking relatively
short distances (intermittent “claudication”).
III stage (circulative insufficiency at rest
conditions)- pain at rest (“night pain”).
IV stage (ulcerative necrotic changes of the
distal parts of the legs)- tissue loss (gangrene).
11. Palpation of the
lower limb arteries
Common femoral artery (under
inguinal ligament; between
inner and middle it’s third)
Popliteal artery (the middle of
the popliteal fossa)
Dorsal pedis artery (on cuneiform
bones; continuation of the 1st
interfinger interval)
Back tibial artery (fossa
behind the medial ankle)
