Endarteritis clinical course and symptoms

Obliterating endarteritis are mostly men aged 20-50 years. Women occlusive disease occurs more often by type of disease Reynaud (see Reynaud disease). The disease usually occurs first on one foot and can be unilateral or subsequently affects the other leg. Occlusive disease - a chronic disease, often it develops slowly, proceeds with remissions, rarely, the fast-flowing form. The clinical course of the disease is most conveniently be divided into three stages: I - intermittent spasm of the vessels, II - progressive trophic disorders, III - gangrene of the extremities.
Stage intermittent acute pressure. The first clinical sign of disease are pain in the limbs. At first the pain occur only during the walk, forcing patients often stop (intermittent claudication). Then there numbness of the fingers, paresthesia, confusion, twitching of the muscles of the leg and foot. An important early symptom is an increased sensitivity to cold feet. Further, in the II and III stages, appear and persistent pain. Strong night pain cause patients to sleep with lowered his foot, which is slightly; pain relief, and then actually deprive patients of sleep. At survey of the affected limb may be noted changes the color of skin, pallor or cyanosis, appear purple spots, skin of the feet and lower legs becomes dry and shiny hair on it disappear. It is often stated symptom of Oppel: when lifting the legs appears pale fingers, and when lowering it changes slowly coming, irregular spotting - "marbling", hyperemia. A number of patients occlusive disease begins phenomena migrating thrombophlebitis with the formation of blood clots in the subcutaneous veins of the foot and lower leg. Vasomotor disorders, in addition to the colour changes can be expressed well as swelling of the skin (Fig. 3), diffuse weight loss of muscles of the foot and lower leg. When the disease is detected, the disappearance of arterial pulse in different parts of the limbs, typically the first thing on the back of the arteries of the foot and the posterior tibial artery. Feeling the pulse is better to start with arteries stop further inquire to the femoral artery. This sequence allows you to better navigate in the state of main circulation of the limbs.

endarteritis
Endarteritis. Fig. 3. Cyanosis and swelling of the foot. Fig. 4. Focal necrosis of the fingers.

Under the influence of spasm of peripheral arteries already in the initial stages of the disease there will be a noticeable decrease of the temperature at the foot of sick extremity compared with healthy that is easily identified by touch, and more accurate skin thermometer.
Stage progressing trophic disorders. Trophic changes, characteristic of the second stage of the disease, can sometimes occur very early. On the ill stop the skin becomes thin, shiny, dry, peel, nails lose their natural Shine, thicken, take an ugly look, easily crumble. The skin is vulnerable, it influenced the most insignificant impacts cracks, abrasions that are difficult to heal. For no apparent reason or under the influence of minor injuries are formed small sores. Sometimes these sores are cleared, pogibayut, but then at the same place or nearby arise again (Fig. 4).
Stage necrosis and gangrene. Gangrene of fingers or feet develops in the third and final, stage of the disease. Sometimes necrosis occurs spontaneously, but in half of the cases the beginning of gangrene due to the influence of external mechanical, thermal, and other factors. Often the starting point of gangrene is available ulcer, in some cases, gangrene occurs around the nail bed. The death of the exposed toes and foot, less often it is distributed in the Shin. In the acceding infection often develops wet gangrene with significant swelling of the foot (Fig. 5).

Clinical course and symptoms. Obliterating endarteritis are mostly men aged 20 to 50 years. Women occlusive disease occurs more often by type of disease Reynaud (see Reynaud disease). The disease usually occurs on one leg and can be unilateral or later strikes and other leg. Defeat both legs at the same time is relatively rare. Occlusive disease - a chronic disease that develops slowly, proceeds with the remissions. The clinical course of the disease is most conveniently be divided into three stages: intermittent spasm of the vessels, progressing trophic disorders (cracks, sores, dry nails and skin); necrosis and gangrene of the limbs (printing. table).

obliterating endarteritis
Fig. 1. Spastic form of obliterating endarteritis; stage ischemia. Fig. 2. Stage of trophic disorders. Fig. 3. Necrotic stage. Fig. 4. Wet gangrene of the feet.


Many complex classification does not reflect all forms and phases of obliterating endarteritis, since it is distinguished by a variety of symptoms and a large variability in the course of the disease.
Stage intermittent acute pressure. The first clinical signs of the disease are pain in the limbs. Pain worse with movement, causing alternating lameness, forcing patients while walking often stop. Appear numbness, paresthesia, confusion, muscle car. Further pain at night to sleep only with lowered his foot, and then actually deprive patients of sleep.
An important early symptom is an increased sensitivity to cold. Legs begin to "sabot", they have to wrap sometimes even in the warmer months.
At survey of the affected limb is possible to note the change in the color of skin, pallor or cyanosis, the appearance of red spots; the skin becomes dry and shiny, hair disappear; in cases of bilateral lesions of the change on one of the limbs is usually more pronounced. It is often stated symptom of Oppel: when lifting the legs appears pale fingers, and when lowering legs she slowly replaced the coming irregular spotting, "marble" hyperemia. Similar samples for verification of the functional state of the vessels offered a lot. A variety of symptoms in some patients who are not equally intensely.
A number of patients developing obliterating endarteritis begins phenomena migrating thrombophlebitis. On the periphery of the extremities, in the foot and lower leg in the subcutaneous veins formed a more or less noticeable blood clots. Disorders vasomotor nature, except the colour changes can be expressed well as swelling of the skin, diffuse weight loss of muscles.
The main symptoms include the disappearance of arterial pulse in different parts of the limbs, typically the first thing on the back of the arteries of the foot and on the back tibial artery. Feeling the pulse is better to start from the top with femoral artery progressing to investigate pulse in the hollow of the knee, on the shins and feet. This sequence allows the physician to better navigate in the state of main circulation on the periphery of the leg.
Under the influence of spasm of peripheral arteries already in the initial stages of the disease there will be a noticeable decrease of the temperature at the foot of sick extremity compared with healthy defined to the touch, and more accurate skin thermometer (thermocouple).
Stage progressing trophic disorders. Trophic changes, characteristic of the second stage of the disease, can sometimes occur very early. On the ill stop the skin becomes thin, shiny or dry, coarsens, flakes; the nails lose their natural look, thicken, take an ugly form, easily crumble, made Matt. Then the skin is vulnerable, it influenced the most insignificant impacts cracks, abrasions that are difficult to heal. For no apparent reason or under the influence insignificant traumas are formed small sores. Sometimes these sores are cleared, even pogibayut, but then at the same place or nearby reappear.
Stage necrosis and gangrene. Gangrene of fingers and feet develops in the most recent stage of the disease. Sometimes necrosis occurs "spontaneously", but in half of the cases the beginning of gangrene due to the influence of external mechanical, thermal, and other factors. The starting point of gangrene is an existing ulcer. Sores around there is swelling, skin becomes cyanotic and omertvenie, in some cases, gangrene occurs around the nail bed. The death of the exposed toes and foot, less often it is distributed in the Shin. In the acceding infection often develops wet gangrene with significant swelling of the foot.
In other cases necrotic tissue modifitsiruyutsya.