The problem is an urgent vascular disorders in vascular surgery. According to statistics from lower limb ischemia is most often diagnosed in men. The main cause pathological changes in the level of vessels is atherosclerosis Atherosclerosis - a chronic disease of the arteries Among the causes of ischemic disease is up to 90%. First, we should not prevent the development of serious complications and progression of the disease, so the first place there is the question of early diagnosis.

Stages of development of pathological process

Ischemia is characterized by lower extremity vessels obstruction of blood flow due to blockage of the vessel and its occlusion. The appearance of clinical symptoms of the disease occurs in stages that formed the basis for the classification of the pathological condition. Ischemic disorders gradually progress, leading eventually to critical ischemia Ischemia - when the brain fails to work   with various complications. Classification limb ischemia was developed in view of what is detected degree of vascular injury during ischemia.

The initial or first stage is characterized by the development of collateral blood flow, which provides tissue oxygen demand in conditions of impaired blood flow. It is important to pay attention to the appearance of symptoms such as pale skin, feeling of pins and needles or paresthesia, numbness of the lower extremities. Complaints are coming in nature, take place after the termination of walk, when it becomes quiet feet. Later symptoms of lower limb ischemia progresses, causing changes in gait, makes it difficult to move the patient.

Circulatory insufficiency develops when creating functional load on the lower limbs while walking. In humans, there is a characteristic symptom of "intermittent claudication" that may be indicative of the second stage of the disease. At this stage, collateral system is unable to cope with increasing workload, becomes functionally defective. Later joins anatomical insufficiency of collateral blood flow.

The importance of objective symptoms

In a study of patients with vascular disorders attaches great importance to the objective severity of the symptoms. Chronic lower limb ischemia occurs with trophic changes, which appear in the later stages of the disease. Clinical manifestations of venous disorders can be different:

• depigmentation
• ulcers
• necrotic changes
• loss of hair

An objective examination of the lower limbs makes it possible to evaluate the nature of the pulse. On the site, which is located below the blockage is determined by weak asymmetric pulse. In some cases, there may be no pulse, which indirectly indicates the severity of the existing disorders.

Arteries are available imaging through the introduction of the practice of ultrasound. Holding ultrasound of the arteries is the basic method for diagnosing patients who undergo training before invasive treatment. Thanks to the good visualization can monitor the effectiveness of surgical treatment, prostheses and the state created anastomosis.

Conducting research tool provides an opportunity to assess the nature of vascular injury. Special sensors detect the pulse volume of blood in different areas of the lower limbs.

In some cases there are acute cardiovascular disorders that require urgent medical measures. Acute lower limb ischemia often develops on the background of existing vascular disease, when there is a change in the vessel walls. The problem is widespread thrombosis, so it is important early detection of pathological changes. This problem applies not only to medical problems, and is organizational. The severity of the disease determines the prognosis, then, is whether to keep the affected limb, and patient survival.

What should determine the choice of treatment tactics

Vascular changes as chronic arterial insufficiency may be a cause of critical ischemia. Critical limb ischemia is clinically proceeds with the formation of trophic disorders as ulcers or gangrene of the foot. These changes are also developing in acute disease processes in the bloodstream (thrombosis, embolism, or injury). Treatment of lower limb ischemia presented methods of conservative treatment and surgical treatment. The most difficult ones amenable to treatment of pathological conditions that are caused by diabetic lesions. For the reason it attaches great importance to early diagnosis.

The first step is to remove the pain. Analgesics can reduce the severity of the pain, alleviate the condition of the patient, so this group of drugs should be included in the complex therapy. Treatment of critical limb ischemia is aimed at improving the rheological properties of blood, a reduction in viscosity. These therapeutic activities are conducted under the supervision of the state of the coagulation system.

Surgical revascularization is performed in the presence of strict indications in specialized centers or departments of vascular surgery. If the operation was carried out without a comprehensive study and without the availability of evidence, it can cause amputation and death.

Degrees of lower limb ischemia, the patient's general condition and the presence of comorbidities define the indications for surgical treatment. This treatment is aimed at the preservation of the limb, but in some cases there is the need for amputation. Amputation is shown in the case of progressive gangrene, as a last resort. It is necessary to try to make the operation so that in the future could effectively use a prosthesis. Forecast at a critical ischemia of the lower limbs experts associated with prognosis in malignant diseases. In many ways, this is determined by the need for high amputation. One-third of patients there is a need for amputation in the first year of development of vascular disorders.

Marina Solovyov

Signs of ischemia may be different - it all depends on the affected organ. The most sensitive to lack of oxygen brain cells and heart muscle. Ischemia can occur in all organs and tissues, including kidney, liver, lung, lower limbs and so forth.

Symptoms of cerebral ischemia

Ischemia - is poor circulation in the organ or part of the body, which leads to a deficiency of oxygen and nutrients. Cerebral ischemia may develop on the background of atherosclerosis, blood clots or emboli (blood clots break away), a sharp spasm or expansion vessel, and so on.

Acute cerebral ischemia Cerebral ischemia - how to overcome illness   often manifested as transient (transient), cerebrovascular accident. Symptoms of ischemia: headaches, dizziness, short-term impairment of speech, vision, hearing, movement or skin sensitivity. If the cerebral circulation continues for a long time, it is possible necrosis (death of) brain cells (neurons) - ischemic stroke. Depending on the location and size of area of ​​necrosis ischemic stroke may be mild, moderate and severe.

They may be different: one-sided paralysis or paresis (complete or partial violation of movements), visual impairment, hearing loss, skin sensitivity, and so on. Frequently stroke manifested as mild facial asymmetry.

Stroke moderate and severe is accompanied, as a rule, cerebral symptoms, which suggests that the process involved the entire brain. This is a severe headache, dizziness, nausea, vomiting, convulsions, loss of consciousness and coma. Against this background, developing neurological symptoms.

Signs of myocardial ischemia

The myocardium, or heart muscle as well as brain tissue, constantly requires oxygen and nutrients. Characteristic signs of myocardial ischemia - is angina - severe short-term pain in the heart, which are well removed nitroglycerin.

Most often associated with myocardial ischemia, atherosclerosis of the coronary arteries, in which the walls of coronary atherosclerotic plaques are deposited, reducing the vascular lumen. Initially, acute attacks of crushing, the contraction pains in the heart develop only during exercise, when the myocardium requires more than the usual amount of oxygen (angina). The attack takes place at the termination of exercise or taking nitroglycerin. But such attacks are gradually beginning to appear suddenly among complete rest. This condition is called angina rest.

There are so-called Prinzmetal angina - heart attacks of acute pain, barely filmed nitroglycerin. Often, these patients do not have evidence of atherosclerotic lesions of the coronary arteries. Bouts of acute pain in the heart often occur at night, including complete rest and the mechanism of their development is not yet fully understood.

An extreme manifestation of myocardial ischemia Myocardial ischemia - the effect on the functional activity of the heart   It is myocardial infarction, in which the necrosis of some portion of the heart muscle. This is accompanied by severe pain in the heart, which can not be removed nitroglycerin. Such a patient in need of emergency medical care and hospitalization in a specialized department.

Signs of ischemia on ECG

Symptoms of angina ECG is usually not possible to fix. But if the attack begins during the diagnostic studies (such as during exercise stress) ECG seen some signs of ischemia, which run immediately after the end of heart attack pain.

When angina at rest also appear minor changes on an electrocardiogram. In addition, quite often during the attack shows signs of cardiac arrhythmia. All these changes are in most cases also disappearing after attack, but sometimes can be kept for several hours.

Typical ECG changes appear in a fit of angina Prinzmetal Prinzmetal angina - a rare disease with serious consequences . The ECG during the attack and for some time afterwards, you can see the changes characteristic of myocardial infarction. Characterized as cardiac arrhythmias. These changes are then completely disappear, in contrast to the true myocardial infarction, in which signs of ischemic ECG remain for a long time.

Signs of lower limb ischemia

Lower limb ischemia often is chronic, slowly rising character. The reason it may also be atherosclerosis. One of the first signs of limb ischemia Lower limb ischemia - what is the prognosis of the disease   are fatigue when walking, heaviness in the legs when walking, creeping sensation in the leg (paresthesias), cold fingers.

Then, after a while there is intermittent claudication - leg pain while walking that cause the patient to stop and rest. After resting pain persist, the patient can walk normally again for a while, but then everything is repeated. Over time, tissue necrosis may occur that require amputation.

Emerging signs of ischemia indicate poor circulation in this or that body and require long-term care under the supervision of a physician.

Galina Romanenko