Diagnostics endarteritis

For diagnosis of the disease, in addition to the above clinical symptoms, the importance of functional studies: oscillographe (see), rheovasography, capillaroscopy (see), arteriography, the study of skin temperature. X-ray study of the bones of the affected limbs revealed spilled osteoporosis, bone thinning of the cortical layer. Differential diagnosis is conducted primarily with atherosclerosis of peripheral vessels. For the last characteristic age of patients (over age 50), a slow increase of the symptoms - the change of color of foot skin, dry skin, trophic changes. Atherosclerosis of peripheral vessels often affected both limbs, no migrating thrombophlebitis, disease in most patients is growing slowly, with a long remissions. However, atherosclerosis is often accompanied by thrombosis and deepthat cause acute obstruction of the large arteries and rapid ischemic disorders on a large plot of the leg. Obliterative endarteritis, the disease is usually more severe, trophic disorders usually occur more rapidly, the younger the patient, especially malignant flows juvenile form of the disease that occurs at the age of 20-25 years. It is much easier to distinguish the disease from other diseases, accompanied by pain in the lower extremities. In case of chronic venous insufficiency of lower extremities (varicose veins) complaints of patients in pain in the legs due to venous blood congestion, and so the pain intensifies in standing position. In some cases it is necessary to differentiate endarteritis with pain in the legs, caused by arthritis and arthrosis, myositis, fasciculata, radiculitis, platypodia, residual effects of the injury. In all these conditions, there are no signs of violation of main blood vessels good pulse, oscillogram normal.

The diagnosis. When examining patients with obliterating endarteritis of important arterial oscillometry. In the normal state of the arteries oscillometric curve usually has a sharp peak (Fig. 1), i.e. the maximum oscillation matches any one digit of maximum pressure in the cuff. Pathological state of the arterial system limbs character oscillometric curve changes (Fig. 2). When complete obliteration of the arteries oscillation completely determined (Fig. 3).
Of great importance capillaroscopy (see) and plethysmography (see). To detect vascular spasm is used functional tests - perirenal procaine blockade or paravertebral blockades lumbar ganglia.
Before the blockade produce capillaroscopy, and the study of skin temperature, and then these measurements are repeated in 30 minutes after the blockade. At a spasm of blood vessels blockade usually changes the state of capillaries, it is possible to see more of them, skin temperature increases by 2-4 degrees. No such effect speaks against spastic origin ischemia.
Chest x-ray shows trophic changes of the bones of the affected limbs - spilled osteoporosis, thinning of the cortical layer.
Arteriography allows to judge about the state of the arterial and venous blood Circulation, but vazografina research should be conducted only when the absolute necessity, for they vessels already changed, not indifferent.

Fig. 1. Normal oscilloscope.
Fig. 2. Waveform at a spasm of the vessels of the lower limbs (decrease oscillations in the foot).
Fig. 3. Oscillogram with the obliteration of the arteries of the lower limbs (oscillation in the foot is not).

Differential diagnosis is conducted primarily with atherosclerosis of peripheral vessels. For the last characterized by the development in the age of 50, a slow increase of symptom - to change the colour of the skin of the feet, dry skin, trophic changes. Atherosclerosis of peripheral vessels of the limb affected symmetrically, no thrombophlebitis, especially migratory, collaterals long retain its function, circulatory disorders in the majority of patients developing slowly, with a long remissions. However, atherosclerosis is often accompanied by thrombosis and embolism, which cause acute occlusion of a major highway and rapid ischemic disorders on a large plot of the leg. Obliterating endarteritis flows, as a rule, much more acute disorders usually occur more rapidly, the younger the patient; especially adverse juvenile form of the disease that occurs at the age of 20-25 years.
Not always (especially in the elderly) is possible with confidence to differentiate these two diseases; it is much easier to distinguish the disease from other forms of diseases accompanied by pain in the lower extremities.
Chronic insufficiency of the lower extremities veins (varicose) complaints of patients in pain in the legs are associated with venous blood congestion, and pain worsens in standing position. In some cases it is necessary to differentiate endarteritis with pain syndromes, caused by rheumatic phenomena, myositis, fasciculata, radiculoneuritis (for example, in osteochondrosis of the lumbar vertebrae), the deformation of the foot, residual injury, etc. In all these conditions, there are no signs of violation of main blood vessels good pulse, oscillogram normal. It is more difficult to differentiate between disease of the upper extremities from other forms belonging to the group painful neck-shoulder syndrome (see).