Peripheral type

Peripheral type: pain and paresthesia on the foot and fingers, poorly treatable interdigital mycoses, prolonged healing of wounds after finger injuries. Pulsation on the femoral and popliteal arteries is preserved, but there is no foot on the arteries. In diagnostics, rheography, ultrasound dopplerophage, angiography can be used.

For all types of occlusion localization, a differential diagnosis with radicular spinal cord syndrome, osteochondrosis, Raynaud's disease, diabetic angiopathy, etc. should be performed.

Treatment in the initial stage is conservative: elimination of adverse factors (cooling, smoking, drinking alcohol), spasmolytic therapy (no-shpa, halidor, etc.), ganglion blockers (diprofen, dicoline, etc.), painkillers. To improve the metabolic processes in the tissues prescribe vitamins, komplamin, solkoseril. It is advisable to prescribe drugs that normalize blood clotting, which reduce platelet aggregation (rheopolyglucin, trental, quarantil, fresh-frozen plasma). Carry out physiotherapeutic treatment, it is expedient to hyperbaric oxygenation, sanatorium-and-spa treatment.

The purpose of surgical treatment is the restoration of blood flow in the affected limb. Indications for the operation depend on the stage of the disease (they are absolute in the III-IV stages and are relative at the stage), the technical feasibility of the operation (the extent and localization of obstruction), the degree of concomitant pathology (myocardial infarction, diabetes, kidney damage, ).

Variants of interventions in arterial occlusion: with limited stenoses, balloon dilatation can be used, with extended lesions - thrombinectomy. When the artery stenosis is located above the inguinal ligament, a bypass graft is used with a synthetic graft, and with a lower artery obstruction, a graft from an autovenous or heterologous material is used. At the generalized atherosclerotic narrowing of the vessel, a lumbar sympathectomy with removal of 4 ganglia is shown.

Complications: bleeding from the anastomosis area after surgery, early thrombosis of the operated vessel or transplant, infection. Prevention of these complications consists in careful observance of the technique of superposition of the vascular suture, mandatory early heparinization.

Forecast. The best prognosis was obtained with unextended occlusions of large arteries. Five-year monitoring shows a good effect of surgical treatment for aorto-iliac type in 90%, in femoropopliteal - in 60%.