Патологии системы кровообращения лидируют во всей структуре заболеваний, среди главных причин инвалидности и смертности населения. Этому способствует распространенность и устойчивость факторов риска. Болезни не всегда поражают сердце и сосуды одновременно, часть из них развивается в венах и артериях. Их достаточно много, но окклюзия артерий нижних конечностей — наиболее опасна.
Понятие окклюзии (закупорки) сосудов ног
Закупорка артерий нижних конечностей приводит к прекращению поступления кислорода и питательных веществ к органам и тканям, которые они снабжают. Чаще поражаются подколенные и бедренные артерии. Заболевание развивается резко и неожиданно.
Просвет сосуда может быть перекрыт тромбами или эмболами различного происхождения. От их размеров зависит диаметр артерии, которая становится непроходимой.
При этом быстро развивается некроз тканей на участке ниже закупорки артерии.
Выраженность признаков патологии зависит от места расположения окклюзии и функционирования бокового — коллатерального кровотока по здоровым сосудам, проходящим параллельно пораженным. Они доставляют питательные вещества и кислород к ишемизированным тканям.
Закупорка артерий нередко осложняется гангреной, инсультом, инфарктом, которые приводят больного к инвалидности или смерти.
Невозможно понять, что такое окклюзия сосудов ног, осознать тяжесть этого заболевания, не зная его этиологии, клинических проявлений, методов лечения. Надо также учесть значимость профилактики этой патологии.
Более 90% случаев закупорки артерий ног имеют две основные причины:
- Тромбоэмболия — сгустки крови формируются в магистральных сосудах, током крови доставляются в артерии нижних конечностей и перекрывают их.
- Тромбоз — тромб в результате атеросклероза появляется в артерии, разрастается и закрывает ее просвет.
Этиология
Этиология остальных случаев следующая:
- накопление холестериновых бляшек на стенках сосудов при атеросклерозе до его закупорки;
- эмболия частичками жира или инородного тела, пузырьками воздуха, инъекционной жидкостью;
- аневризма артерий — их растяжение и выпячивания, в которых быстро накапливаются тромбы и эмболы;
- механические травмы сосудов, сдавливание, перекрывающие кровоток;
- воспалительные заболевания артерий, которые сопровождаются отечностью и накоплением экссудата;
- ишемия сердца, гипертония, порок сердца, инфаркт миокарда, сахарный диабет способствуют развитию окклюзии;
- лейкоз — просвет артерии закупоривают разрастающиеся злокачественные клетки.
Факторы риска
Окклюзия сосудов — это заболевание, для развития которого особенно важно наличие факторов риска. Их минимизация снижает возможность возникновения непроходимости. Они такие:
- алкоголизм, наркомания, курение;
- наследственность;
- хирургическая операция на сосудах ног;
- несбалансированный рацион питания;
- беременность, роды;
- лишний вес;
- малоподвижный образ жизни;
- половая принадлежность — чаще болеют мужчины, возраст — более 50 лет.
Воздействие основных причин и факторов риска чаще всего накапливается долго.
Важно! Специалисты отмечают распространение окклюзии сосудов ног среди молодых людей, многие из которых просиживают перед компьютерами и мониторами гаджетов. Поэтому при возникновении первых признаков окклюзии, не зависимо от возрастной категории, необходимо незамедлительно обратится к врачу.
Виды и признаки болезни
Закупорка артерий может произойти на любом участке нижней конечности, перекрываются различные диаметры сосудов. В соответствии с этим различают разновидности окклюзий:
- Непроходимость крупных и средних артерий. Нарушается кровоснабжение бедренных и прилегающих к ним участков.
- Закупорка мелких сосудов, снабжающих кровью голени и стопы.
- Смешанная непроходимость — крупных и мелких артерий одновременно.
По этиологическим факторам, спровоцировавшим появление и развитие болезни, окклюзии разделяют на такие виды:
- воздушная — закупорка сосуда пузырьками воздуха;
- артериальная — непроходимость создают тромбы;
- жировая — закупорка артерии частичками жира.
Непроходимость сосудов ног протекает в двух формах:
Острая окклюзия возникает при закупорке артерии тромбом. Развивается внезапно и быстро. Хроническое заболевание протекает медленно, проявления зависят от накопления холестериновых бляшек на стенке сосуда и уменьшения его просвета.
Симптоматика
Первым признаком непроходимости артерий ног является симптом перемежающейся хромоты. Интенсивная ходьба начинает вызывать боль в конечности, человек, щадя ногу, прихрамывает. После короткого отдыха болезненные ощущения исчезают. Но с развитием патологии боль появляется от незначительных нагрузок на конечность, хромота усиливается, необходим продолжительный отдых.
Со временем появляются 5 главных симптомов:
- Постоянная боль, усиливающаяся даже от незначительного увеличения нагрузок на ногу.
- Бледная и холодная на ощупь кожа на участке поражения, у которой со временем проявляется синюшный оттенок.
- Пульсация сосудов на участке закупорки не прощупывается.
- Снижение чувствительности ноги, ощущение бегающих мурашек, которое постепенно исчезает, остается онемение.
- Наступление паралича конечности.
Важно знать, что через несколько часов после появления характерных признаков закупорки начинается некротизация тканей на участке окклюзии сосуда, возможно развитие гангрены.
Эти процессы необратимы, поэтому несвоевременное лечение приведет к ампутации конечности и инвалидности больного.
Если появляются признаки перемежающейся хромоты или хотя бы один основной окклюзивный симптом — это повод срочного обращения к врачу.
Методы лечения
Флеболог проводит необходимые исследования, подтверждающие диагноз. После этого назначает лечение. На начальных стадиях развития болезни оно консервативное и проводится в домашних условиях. Применяют лекарственную терапию:
- антикоагулянты, разжижающие кровь и понижающие ее вязкость (Кардиомагнил, Плавикс, Аспирин Кардио);
- спазмолитики, снимающие спазмы сосудов (Но-Шпа, Спазмол, Папаверин);
- тромболитики (фибринолитики), разрушающие тромбы (Проурокиназа, Актилаза);
- обезболивающие, снимающие приступы боли (Кетанол, Баралгин, Кеталгин);
- сердечные гликозиды, улучшающие работу сердца (Коргликона, Дигоксин, Строфантина);
- противоаритмические препараты, нормализующие сердечные ритмы (Новокаинамид, Прокаинамид).
Антикоагулянтное действие Гепариновой мази используют для местного лечения окклюзии. Назначают комплексы витаминов. Используют физиопроцедуры.
Электрофорез ускоряет и обеспечивает максимальное проникновение лекарств к месту поражения артерии.
Магнитотерапия снимает боль, улучшает кровообращение, повышает насыщаемость крови кислородом.
В случае тяжелого развития окклюзии и неэффективной медикаментозной терапии, применяют оперативное лечение:
- Тромбэктомия — удаление тромбов из просвета сосуда.
- Стентирование — введением специального баллончика открывается просвет артерии и устанавливается стент, предотвращающий его сужение.
- Шунтирование — создание обходной артерии взамен пораженного участка. Для этого может быть использован имплантат или здоровый сосуд конечности.
При развитии гангрены проводят частичную или полную ампутацию конечности.
Профилактика
Выполнение несложных правил профилактики существенно снижают риск развития заболевания:
- Вести активный образ жизни, применять умеренные физические нагрузки.
- Посещать катки, бассейны, тренажерные залы.
- Отказаться от курения и алкоголя или сократить употребление крепких напитков до минимума.
- Употреблять правильную пищу, которая содержит достаточное количество витаминов и микроэлементов. Исключить продукты, повышающие холестерин в крови, ее вязкость, артериальное давление, содержащие большое количество жира.
- Не допускать значительного повышения массы тела, поддерживать ее в норме.
- Избегать стрессов, научиться избавляться от них.
- Контролировать течение и лечение хронических заболеваний, которые могут вызвать непроходимость сосудов ног.
Заключение
Закупорка артерий нижних конечностей в большинстве случаев развивается длительно, поэтому ранние симптомы появляются на начальных стадиях заболевания. Они сигнализируют о проблемах с сосудами. Надо не упустить этот момент и посетить специалиста. Только так можно правильно определить причину окклюзии сосудов, устранить ее, остановить развитие патологии, иметь благоприятный прогноз на выздоровление.
Окклюзией артерии называется закупорка просвета с развитием ишемии тканей. Непроходимость сосуда может быть связана с тромбоэмболией или спазмом. Если кровоток не возобновился, то в зоне, которую питает бедренная артерия, нарастают признаки омертвения. В случае угрозы гангрены проводится ампутация.
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Причины окклюзии бедренной артерии
К основным факторам, которые могут привести к препятствию прохождения крови по бедренной артерии, относятся тромбоз, эмболия, пересечение сосуда при травме или операции, а также длительный спазм.
Окклюзия бедренной артерии (сужение просвета сосуда)
Тромбоэмболия возникает при следующих состояниях:
- попадание в артерию инородных тел, кусочков тканей, костей при переломах и тяжелых травмах;
- после операций на открытом сердце, ранений или инъекций происходит закупорка пузырьком воздуха;
- инфекционные болезни, развивается окклюзия при скоплениях микробов, гноя;
- тромб (или его часть) с током крови продвигается из разрастаний на клапанах и стенках сердца (эндокардит, пороки, аневризма);
- случайное попадание в артериальную сеть капель масла при введении препаратов на масляной основе;
- распространение по кровеносным сосудам фрагментов новообразования.
Нижние конечности поражаются при ишемии и инфарктах миокарда, нарушении ритма сокращений, артериальной гипертонии, атеросклеротических изменениях или аневризме аорты (ветвей), кардиомиопатии с расширением полостей сердца.
К окклюзии приводят:
- оперативные вмешательства;
- обморожение;
- повреждение электрическим током;
- болезни крови с избыточным размножением клеток (лейкоз, полицитемия);
- сдавление артерии извне или спазм;
- заболевания сосудов ног (атеросклероз, эндартериит, синдром Такаясу, периартериит).
Спровоцировать распад и передвижение тромба или эмбола может аритмия, снижение силы сокращений сердца, скачок давления, умственное, эмоциональное или физическое перенапряжение.
Рекомендуем прочитать статью о причинах, симптомах и лечении закупорки сосудов ног. Из нее вы узнаете об основной причине закупорки — образовании сгустков крови, окклюзии артерий, а также о лечении патологии сосудов ног и закупорке тромбом вен нижних конечностей.
А здесь подробнее о шунтировании сосудов нижних конечностей.
Процесс возникновения
Помимо чисто механической преграды для кровотока, при окклюзии возникает артериальный спазм той зоны, куда попал тромб или эмбол. На этом месте в самые краткие сроки образуется местный кровяной сгусток, который увеличивает протяженность закупорки в обоих направлениях. При этом перекрывается не только основной сосуд, но и обходные пути – коллатерали.
Продолжительность и интенсивность этого процесса зависит от скорости движения крови, ее густоты и наличия повреждений артериальной стенки (воспаление, атеросклероз, молекулы глюкозы при диабете). Нарушения питания тканей проявляются в виде изменения обменных реакций, накопления кислоты, продуктов метаболизма. Это приводит к разрушению клеточных структур, развитию отечности, усилению ишемии.
Проявления заболеваний периферических артерий в результате атеросклеротической окклюзии крупных артерий нижних конечно
Клинические проявления в первую очередь связаны с калибром перекрытого сосуда – чем он крупнее, тем тяжелее протекает заболевание.
Окклюзия поверхностной сети
Закупорка происходит на уровне мелких артериальных сосудов голени и стопы. Является наиболее частым вариантом поражения нижних конечностей.
Подколенной артерии
Бедренно-подколенный сегмент относится к сосудам среднего диаметра, при их перекрывании нарушается питание бедра, голени и стопы.
Не всегда картина болезни определяется только одним местом окклюзии, на практике встречаются случаи перекрывания просвета на разных уровнях в одной артерии, на различных анатомических областях обеих конечностей (например, бедренная на одной ноге и подколенная на другой), сочетание тромбоза нижних конечностей и окклюзии сосудов головного мозга или внутренних органов.
С обеих сторон
Если симптоматика возникает одновременно в правой и левой нижней конечности, то это означает, что окклюзия произошла на уровне раздвоения (бифуркации) аорты. Она может быть связана с передвижением крупного тромба, который сформировался в полости сердца при мерцательной аритмии, в месте аневризмы или инфаркта сердечной мышцы.
Симптомы по стадиям
Начальные проявления недостаточного питания тканей конечности возникают только при нагрузке, а в состоянии покоя прекращаются. Затем боль ниже места закупорки становится разлитой, усиливается и не проходит при изменении положения.
Снижение пульсации артерий сопровождается бледностью, в дальнейшем возникает цианоз, похолодание, сухость кожных покровов. Страдает чувствительность, возникает онемение, покалывание, невосприимчивость поверхности при ходьбе.
Движения постепенно снижаются из-за слабости мышц, затем становятся возможными только пассивные (паралич). Полная обездвиженность ноги является признаком глубоких ишемических нарушений и предшествует гангрене.
Закупорка мелких артериальных сосудов стопы
Все эти признаки имеют стадии прогрессирования. Их выделение помогает при выборе метода лечения окклюзии артерии бедра:
- 1А – холодная кожа, покалывание, жжение или онемение, ползание «мурашек»;
- 1Б – боли в стопе в состоянии покоя при сохранении чувствительной и двигательной функции;
- 2А – мышечная слабость и пониженный объем самостоятельных движений;
- 2Б – возможны только пассивные сгибания и разгибания ноги (паралич);
- 3А – начальные проявления некроза, отек под фасциальной оболочкой мышц;
- 3Б – частичная, а 3В – полная контрактура (невозможно ногу согнуть или разогнуть с посторонней помощью).
Методы диагностики
При осмотре врач обнаруживает холодную бледную кожу на ногах, последовательное определение пульсации артерий (стопа, под коленом, бедренные) может помочь с выявлением места окклюзии, так как под ним пульс не определяется, а выше – сохранен. Если закинуть ногу на ногу, то верхняя нога бледнеет, немеет и начинает болеть.
Для постановки диагноза проводится обследование:
-
анализ крови – повышен протромбиновый индекс и содержание фибриногена, время
УЗИ с дуплексным сканированиемкровотечения меньше, чем в норме;
Лечение окклюзии
Медикаменты используют для лечения только ишемии напряжения (при физической нагрузке) или на 1А стадии. Во всех остальных случаях лекарственная терапия является этапом предоперационной подготовки. Используются следующие фармакологические препараты:
- для растворения тромбов – Гепарин внутривенно или Фраксипарин, Клексан;
- для активации фибринолиза (растворения нитей фибрина) – Фибринолизин, Стрептокиназа, Альтеплаза;
- дезагреганты (предотвращают склеивание тромбоцитов) – Иломедин, Алпростан, Клопидогрель;
- спазмолитики – Но-шпа, Ксантинола никотинат.
Показаны методы экстракорпоральной очистки крови (плазмаферез) и облучение крови лазером. В некоторых случаях используют физиотерапию – помещение конечности в магнитное поле, гипербарическую камеру, диадинамические токи. Если за сутки нет положительных сдвигов в состоянии пациента, то назначается удаление тромба или эмбола эндоскопическим методом.
Процедура плазмафереза
На 1Б, 2Б стадии проводится операция по экстренным показаниям – извлекается из артерии закупоривающий сгусток, при коротких окклюзиях ставится стент или прокладываются обходные пути кровотока (шунтирование). Если определена ишемия 3А или 3Б степени, то в дополнение к предыдущим действиям хирург рассекает оболочку мышцы (фасциотомия) для уменьшения отека и давления на сосуды.
После наступления полной мышечной контрактуры все сосудистые вмешательства противопоказаны, так как это приведет к поступлению токсических соединений из разрушенных тканей в кровь. Такие состояния считаются смертельными. Поэтому при 3В стадии спасти жизнь может только ампутация.
Смотрите на видео об окклюзии артерий голени и стопы при синдроме диабетической стопы, восстановлении кровотока:
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Предотвращение закупорки бедренной артерии возможно при воздействии на основные факторы:
- прекращение курения;
- своевременное обращение к врачу при заболеваниях сердца;
- прохождение анализов крови на уровень сахара, холестерина, коагулограммы;
- достаточный питьевой режим;
- снижение избыточного веса тела;
- дозированная физическая активность;
- прием антикоагулянтов при угрозе образования тромбов.
Рекомендуем прочитать статью об атеросклероз сосудов нижних конечностей. Из нее вы узнаете, что представляет собой атеросклероз, как развивается, кто находится в группе риска данного заболевания, а также о симптомах, стадиях, диагностике и лечении облитерирующего атеросклероза.
А здесь подробнее о том, чем опасен облитерирующий эндартерит.
Окклюзия бедренной артерии возникает при попадании в нее тромба или эмбола с током крови, а также при спазме сосуда. Клиническими проявлениями являются боль, нарушение чувствительности кожи, ее бледность и похолодание. При исследовании пульсации она оказывается сниженной ниже места закупорки.
Для того чтобы определить тактику лечения, нужно понимать, на какой стадии у пациента находится ишемическое повреждение тканей. При легких нарушениях могут быть назначены медикаменты, при угрозе гангрены проводится ампутация. При всех остальных степенях снижения кровотока показана реваскуляризация с обязательным удаление тромбов.
Проводится операция на бедренной артерии при угрозе жизни из-за тромба, эмбола, бляшки. Процедура профундопластика может быть проведена разными способами. После вмешательства человек остается в стационаре.
Закупорка сосудов на ногах возникает из-за образования сгустка или тромба. Лечение будет назначено в зависимости от того, где произошло сужение просвета.
В некоторых ситуациях протезирование артерий может спасти жизнь, а их пластика — предотвратить тяжелые осложнения многих заболеваний. Может быть выполнено протезирование сонной, бедренной артерии.
После 65 лет нестенозирующий атеросклероз брюшного отдела аорты и подвздошных вен встречается у 1 из 20 человек. Какое лечение допустимо в этом случае?
Проводится МСКТ артерий нижних конечностей при подозрении на их изменения, после операции. Может быть выполнена совместно с ангиографией с контрастированием для сосудов ног, брюшной аорты.
Возникает аневризма бедренной артерии из-за множества факторов. Симптомы могут остаться незамеченными, есть ложная аневризма. Если случился разрыв, то необходима срочная госпитализация и операция.
В целом склероз Менкеберга похож с обычным атеросклерозом по симптомам. Однако болезнь проявляется кальцинозом стенок, а не отложением холестерина. Как лечить артериосклероз Менкеберга?
Врожденная гипоплазия сонной артерии может привести к инсульту даже у детей. Это сужение внутренней, левой, правой или общей артерии. Диаметр — до 4 мм и менее. Требуется хирургическое вмешательство.
При закупорке венечных артерий возникает коронарная окклюзия. Бывает частичная, хроническая. Лечение артерий подразумевает лекарственную терапию, а также ангиопластику сосудов.
Сердечно-сосудистая система организма человека является наиболее уязвимой, поэтому число больных с патологиями, поражающих ее, неуклонно растет. Также увеличивается и количество известных миру заболеваний. Ежегодно, специалисты обнаруживают новые формы нарушений, которые возникают на фоне протекания более распространенных недугов. Все они представляют угрозу для здоровья и жизни людей, и требуют обязательного лечения, а также тщательного изучения. Ведь чтобы подобрать эффективные методы терапии, следует первоначально выяснить происхождение патологии и найти факторы, спровоцировавшие ее развитие.
Окклюзия — характеристика
Окклюзия артерий нижних конечностей представляет собой очень серьезное заболевание, связанное со снижением проводящей способности крупных сосудов кровеносной системы. То есть, это своего рода сосудистая недостаточность, приводящая к парализации функционирования многих систем организма. Окклюзия — это внезапно появляющаяся непроходимость артерий, спровоцированная патологическими процессами, травмированием структур или закупоркой тромбом. Очень важно владеть знаниями о причинах, которые могут вызвать данный недуг, так как в случаях резкого перекрытия кровяного потока, время для принятия мер будет крайне ограничено. По мимо артерий нижних конечностей окклюзия может поразить также магистральные сосуды, питающие другие органы и системы. Все виды недуга развиваются в следствии нескольких неблагоприятных факторов.
Причины окклюзии
Причины окклюзии- Эмболия . Возникает в результате закупорки артерий плотными образованиями, попавшими в русло кровотока. Это нарушение может быть спровоцировано инфекционными процессами, при которых в сосуде скапливаются болезнетворные организмы или формируются гнойные воспалительные тромбы. Различают несколько видов эмболии, которые приводят к окклюзии: а) Воздушная — следствие проникания в сосуд воздушного пузырька. Произойти подобное может при сложном травмировании легких и других органов дыхания, а также в случаях неправильно выполненной внутривенной инъекции. б) Жировая — появляется в результате травмирования и острых нарушений обменных процессов в организме. При этом, в артериях находятся мелкие частички жира, которые соединяясь в одно целое, закупоривают собой канал, что вызывает окклюзию. в) Артериальная — факторами-провокаторами в данной ситуации являются активные тромбы. Эти подвижные образования локализуются преимущественно в клапанном сердечном аппарате. Тромбы — сопутствующие признаки целого ряда патологий сердца. Именно артериальная эмболия чаще всего становится предшественником окклюзии. Эмболы образуют закупорку в основном в местах сужения, а также разветвления артерий.
- Тромбоз . Просветы крупных кровеносных сосудов часто закупориваются постепенно. Это обусловлено накоплением и разрастанием тромбов на их внутренних стенках. Тромбоз развивается на фоне атеросклероза, травмирования, инфекции. Тромбоз является предпосылкой для тромбоэмболии, так как в зонах его локализации артерии становятся очень уязвимыми и легко закупориваются. Как итог — окклюзия артерий нижних конечностей и других органов.
- Аневризма. Не менее распространенный фактор риска возникновения окклюзии — это аневризма. Ослабление сосудов, их патологическое расширение и выпячивание, становятся поводом для формирования в пораженных участках тромбов (эмболия, тромбоз). Поэтому врожденные или приобретенные аномалии тканей артерий относятся к причинам появления рассматриваемой болезни.
- Повреждения . При травмах, когда сосуд сдавливается костными или мышечными тканями, естественный кровоток нарушается и в участке сжатия крупных артерий начинаются процессы тромбоза.
Поражение ног, особенности
Окклюзия артерий нижних конечностей случается чаще всего. В половине процентов случаев у пациентов обнаруживают именно поражение бедренного и подколенного большого сосуда. Признаки подобного нарушения установлены и изучены. К ним относятся:
- Болевые ощущения, которые распространяются на всю область ног и не утихают даже при смене положения конечностей.
- Отсутствие пульса на участках артерий, близко расположенных к зоне локализации окклюзии (по этому симптому специалистам удается определить точное место, где произошла закупорка).
- Бледность кожного покрова пораженной конечности с последующим появлением следов цианоза.
- Снижение температуры тела в области сосредоточенности окклюзии.
- Парестезия, то есть онемение, которое четко ощущается больным. Вначале появляются покалывания и «мурашки», а после нога может вообще утратить чувствительность.
- Полный паралич, возникновение обширной ишемии — нарушение двигательных функций конечности.
Если у человека наблюдаются описанные выше симптомы, то это свидетельствует о том, что у него окклюзия артерий нижних конечностей и следует безотлагательно принимать меры по оказанию медицинской помощи. Если лечение не было начато в течении 4-5 часов, то возникает угроза необратимых процессов некроза (отмирания) тканей сосудов и развития гангрены. Такое опасное заболевание, в случаях несвоевременно проведенного лечения, становится причиной ампутации ног и инвалидности. Подвергаются данному недугу преимущественно мужчины пожилого возраста.
Профилактика патологии
Окклюзия артерий нижних конечностей образуется в следствии довольно распространенных заболеваний, поэтому в зоне риска находится каждый человек, имеющий проблемы с сердечно-сосудистой системой. Чтобы уберечь себя от столь опасной болезни, необходимо принимать профилактические меры, которые включают:
- Поддерживать нормальный уровень артериального давления, не злоупотреблять кофе, алкоголем, соленой и острой пищей.
- Правильно и сбалансировано питаться, ограничить потребление жирных блюд, источников холестерина.
- Насыщать организм витаминами.
- Следить за массой тела.
- Отказаться от курения и спиртного.
- Вести активную жизнь (заниматься спортом).
- Избегать стрессов и эмоциональных всплесков.
Окклюзия артерий нижних конечностей излечивается в большинстве случаев только путем хирургического вмешательства. Следя за своим здоровьем и поддерживая функционирование сердечно-сосудистой системы в норме, можно избежать необходимости проведения операции.
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