Treatment of obliterating endarteritis

Treatment of obliterating endarteritis pursues three main goals: 1) the removal of predisposing factors - organize your work and life, regular meals; 2) exception influences that contribute to arterial spasm,- cooling, local chronic infections (athlete's feet), intoxication, mandatory Smoking cessation; 3) strengthening of arterial blood flow by removing spasm of blood vessels and improve the function of collaterals. This prompted many tools and methods, however, cannot be treated obliterating endarteritis the template to any one method of treatment should be individualized and comprehensive - to combine methods of conservative and surgical. They demand from workers of perseverance and tenacity.
Conservative treatment of the disease is carried out by use of drugs and physiotherapeutic factors. Obligatory condition of conservative treatment is categorical prohibition of Smoking, otherwise any methods of treatment ineffective. In the period of exacerbation and must be treated in hospital subject to the sick in bed. The basic principles of conservative treatment of the disease are the following:
1) prevent obliteration of new sections of the arteries;
2) the use of vasodilators;
3) the use of drugs that reduce the coagulation and blood viscosity;
4) measures aimed at the improvement of trophism of tissues suffering from ischemia;
5) the use of analgesics for the treatment of pain syndrome;
6) local treatment of ulcers and gangrenous plots;
7) the use of antibiotics and sulfonamides to fight with secondary infection.
Of drugs in the treatment of disease are widely used vitamins (B1, B2, B6, C, E, multivitamin); hormonal preparations (diethylstilbestrol, testosterone propionate, methyltestosterone, hydrocortisone, prednisolone); vasodilator drugs (angetroffen, depot Putin, ataman, tifen, redell, pahikarpin, nicotinic acid, no-Spa and other); anticoagulants (heparin, dikumarina, neodikumarin, plantan, fenilin and others).
In the treatment of disease is widely used intra-arterial injection of novocaine for morphine, caffeine and glucose. Apply 0,5-1-2% solution novokaina in the amount of 10-20 ml in one sprite with 1 ml of 1 % solution of morphine or 1-2 ml of 10% solution of caffeine.
In the early stages shows the use of UHF on the lumbar region, currents Bernard, diathermy. Given the presence of ischemia of lower limbs tissues, proposed the introduction of oxygen into the skin of the leg. This method gives a small effect and, in addition, unsafe, especially in the period of exacerbation. One time, widespread treatment by the method of A. Century Vishnevsky, combining perirenal procaine blockade with local administration Vishnevsky ointment in the form of long hot compresses to the entire limb, however, as shown by extensive practical experience, this therapy can be used only in combination with other therapeutic interventions. In some cases, gives a good effect, especially in young patients, the use of steroid hormones hydrocortisone and prednisolone.
If conservative measures fail to reach quickly noticeable remission, should encourage the patient surgical treatment. The same applies to patients with III stage disease.
Surgical treatment. None of surgical treatment of obliterating endarteritis is not ideal, but they allow you to varying degrees to reduce ischemia in cases that do not respond to medical treatment. Operational methods can be divided into two groups: activities aimed at improving the function of collaterals, and operations, reducing main circulation.
The first group are different types of sympathectomy (see). The most effective lumbar sympathectomy, which securely interrupts reflex arch pathological impulses and removes a spasm of peripheral vessels. This operation is the most effective in the early stages of the disease. One important outcome of this activity is the absence of pain or sharp weakening. Swelling legs quickly disappears, the skin takes a normal color. Sores heal quickly, dead areas gradually rejected. Skin temperature increases by an average of 4 - 6 degrees and holds on these figures over the years.
The operation of the second group (restore the patency of the large arteries) - thromboendarterectomy, autoplastika substitution artery, her prosthesis is rational only in patients with obturation of a small area of a large vessel, when his peripheral departments and branches passable, i.e. they are shown mainly in obliterating atherosclerosis.
If you have a limited necrosis fingers do intensive conservative treatment to cause the restriction of necrosis, the emergence of demarcation necrotic areas produce their destruction (necrectomie). Wet gangrene of the foot or lower leg produce amputation of limbs.

Treatment of obliterating endarteritis pursues three main goals: 1) the removal of predisposing factors - organize your work and life, a full-fledged regular meals, fortification; 2) exception influences that contribute to arterial spasm,- cooling, local chronic infections (e.g. fungi), intoxication, especially in the area; 3) strengthening of arterial blood supply by removing spasm of blood vessels and improve the function of collaterals. To solve this last problem is proposed many tools and methods. However, you cannot treat obliterating endarteritis the template in any way; treatment should be individualized and comprehensive - to combine methods of conservative and surgical. It requires the doctor and the patient perseverance and persistence.
Conservative treatment. Conservative methods include medication and physical therapy. There is a widespread intravenous infusion 50-300 ml and 3.5 - 5% solution of sodium chloride. Infusion such hypertonic solutions of sodium chloride or sulphate of magnesia increase the volume of circulating blood, reducing its viscosity and provide extends the operation of vessels; however, the effect of this treatment short.
Along with the use of drugs bromine, iodine has acquired a certain popularity treatment complex vitamins (B1, B12, B6), multivitamins. Also used hormone therapy (diethylstilbestrol, testosterone propionate, or methyltestosterone), mechanism of action which is similar means designed for removing spasm and vasodilatation. This includes drugs such as depo-Putin, angiostatin, ataman, Tiffen, redell, nicotinic acid. The basis of action of these drugs is their ability to reduce the excitability of autonomic ganglia, causing the expansion of peripheral vessels, and this reduces the pain. Recommend use of antikoagulyaim medium - plantana, hirudin, dikumarina, fibrinolizina.
Proposed intra-arterial injection of novocaine morphine, caffeine and glucose (N. N. Elansky, A. A. Begelman). Recommended different concentrations of novocaine - 0.5 to 2% or even 10%. To improve the common currency and increasing blood circulation in the early stages of useful thermal treatments, baths (conifer, radon, sulphur).
In the early stages useful application on the lumbar region UHF, currents Bernard, diathermy, ozokeritovye applications, etc. Taking into account the presence of ischemia of lower limbs tissues, proposed the introduction of oxygen into the skin of the lower legs. This method gives a small effect and, in addition, not secure, especially in the period of exacerbation.
The wide circulation was received treatment by the method of A. Century Vishnevsky, combining procaine blockade with local administration Vishnevsky ointment as long hot compresses to the entire limb. However, as shown by extensive practical experience, this therapy can be used only in conjunction with other therapeutic interventions.
A. N. Shabanov, C. J. Hodynskaya in some cases successfully treated patients with tromboliticescoy form obliterating endarteritis drugs steroid hormones - - cortisone, prednisone, prednisone, and other such methods of treatment not to recognize the specific when endarteritis, this is confirmed by the divergent characteristics of each of the proposed substances and methods. If conservative measures fail to reach quickly noticeable remission should not lose time and to resort to surgical treatment. The same applies to patients with clearly neglected diseases. However, in those and other cases it is necessary to fully use the funds conservative treatment as a complement to operational.


Surgical treatment. None of surgical treatment of obliterating endarteritis is not ideal, but they allow you to varying degrees to resolve ischemia, do not respond to medical treatment. Many surgical techniques can be divided into two groups: activities aimed at improving the function of collaterals, and operations, reducing the main circulation.
The first group consists of different types of sympathectomy (see). The most effective and safe operations at border trunk and sympathetic ganglia. Lumbar ganglionectomy reliably interrupts reflex arch pathological impulses and relieves spasms of peripheral vessels. This operation is shown in the early stages of the disease when expressed spastic phenomena. In the preoperative period for determination of acute pressure, it is recommended conducting functional tests in the form of perirenal and especially paravertebral blockades. The disappearance of pain and improvement of capillary circulation after blockade can count on a positive result of the operation. The least effective periarterial sympathectomy for Leriche. This operation, first very popular, gives only short-term effect, because of its anatomical invalidity; it also describes many of the complications of this operation. Similar in principle resection vascular highway proposed A. N. Dumbadze, even in the complete obliteration of resected plot arteries than once caused a progressive gangrene limbs.
Operative technique of interventions on the edge of the trunk is well developed. Vnebrachnyi access to border ganglia is accompanied by minimal injury. After the operation there is an opening collaterals - those vessels that Leriche (R. Leriche) called vessels of the second and third plan circulation (see Ligation of the blood vessels). Big changes are taking place in the capillaries. When capillaroscopy find out increase blood flow to the capillary network, painting capillaries becomes more vivid, and capillary network thicker, new capillaries. Small arterial branches back to normal, their volume is improving the blood flow becomes homogeneous. In some cases increases the amplitude of oscillations.
One of the most important results of these operations is the disappearance of pain or sharp weakening. Swelling legs quickly disappears, the skin takes a normal color. They heal, dead areas gradually rejected. Skin temperature increases on average by 4-6 degrees and kept at high figures for years. Contraindications to the lumbar ganglionectomy are changing vessels in the brain, heart, severe lung diseases, the rapid course of the process in the limb, rapidly progressive necrosis, especially when susceptible to infections.
The operation of the second group (restore the patency of highways) - thromboendarterectomy, autoplastics substitution artery, its prosthetics alloplastic material, or bypass grafting (see the Blood vessels, the operation) is rational only in patients with Abdulrahman a small area along the highway, when her peripheral departments and branches passable, i.e. mainly in obliterating atherosclerosis. Obliterating endarteritis characteristic common defeat receptacles limbs, the most pronounced in its distal, therefore, the production of such operations cannot be effective, and often even dangerous.
In gangrenous stages of obliterating endarteritis produce amputation. In isolated finger necrosis, when there demarcation, resort to assertequal finger. With extensive, the more progressive gangrene of the feet is the most expedient to do osteoplastic amputation hips Gritti - Shimanovsky. Amputation of the tibia is often insufficient. Border reactive hyperemia skin after removing harness imposed on 1-2 minutes, the root of limbs and even arteriography not always make it possible to accurately determine the necessary level of amputation of the tibia, and the stump of the latter turns out to be unviable. After successful amputation is necessary to continue with conservative treatment, even if the other extremity there are no signs vascular disease, as obliterative endarteritis (as in atherosclerosis) does not exclude the possibility of subsequent defeat surviving limb.