Obliterating endarteritis

Endarteriit (synonym: obliterating endarteritis; spontaneous gangrene, spontaneous gangrene, peremejatayasa limp, disease Friedlander, a disease of Winiwarter, Buerger's disease, and others) is a disease of the peripheral blood vessels, leading to their obliteration and violation of peripheral blood circulation up to gangrene of the extremities.
Obliterating endarteritis sometimes incorrectly identified with obliterating atherosclerosis of peripheral arteries. The distinction between these two different diseases is of considerable practical importance. Occlusive disease - a disease of the young and middle age. The greatest changes when it occurs in small blood vessels. Most often affects the arteries of distal sections of the extremities, often the feet and lower legs. Atherosclerosis (see) is a disease of the elderly, where the defeat of vessels is more common that the greatest changes occur in large blood vessels.
Etiology. The reasons contributing to the development of obliterating endarteritis, diverse. First of all this factors causing long spastic condition of peripheral vessels - Smoking (due to the vasoconstrictive action of nicotine), some chronic intoxication (e.g. lead); re-long cooling (osnaline) of the limbs; previous frostbite; disorders of innervation (chronic neuritis of the sciatic nerve, the wounds of the extremities). Some infections such as typhoid fever, syphilis, and according to some authors, and athlete's feet, also contribute to the development of the disease. Unquestionable importance in the development of the disease is chronic overstrain of the nervous system and first of all its Central departments, emotional factors that can cause long-vascular spasms. Is developing at that dysfunction of the autonomic nervous system and consequently the disruption of the endocrine activity, in particular the violation of hormonal function of sex glands and the adrenal gland. The increased frequency of diseases were registered during the first and second world wars and in the first postwar years, testifies in favor of neuro-psychological factor in the development of the disease. The origin of the disease is a congenital lability vessels with a predominance of spastic reactions.
The pathogenesis of obliterating endarteritis very difficult. Schematically it can be represented as follows: first prevails spasm of the vessels, i.e., functional disorder that causes prolonged its existence to organic changes of the vascular wall with a thickening of the inner lining of the vessel and the formation of a wall of blood clots. The blood supply of the vascular wall suffers due to compression vasa vasorum spazmirovannah muscles of the vessel. Due to spasm of ischemia causes powerful pain impulsaciu, in response to which the changes occur vasomotor and trophic innervation. They lead to the strengthening and spread of spasm of the vessels, to the disturbance of trophism of the vascular wall and development in it degenerative changes. There is a destruction of the endothelium, and deprived of endothelium parts of the vessel produce blood clots. Intense pain stimulation causes a number of humoral shifts promoting blood clots, - increase in blood clotting, hyperadrenalism. Organic changes of a vascular wall lead to a decrease of the lumen and create the possibility of its complete obliteration. Pathological process is not limited to major vessels, similar changes are taking place in collateral network, in some cases, their defeat coming at the same time, in others later. First of collateral circulation is insufficient only under functional load legs while walking (relative failure); later develops absolute lack of collateral circulation, as evidenced by the emergence of severe pain not only while walking (intermittent claudication), but in the rest, particularly in a horizontal position.

Obliterating endarteritis (endarteritis obliterans; synonym: spontaneous gangrene, spontaneous gangrene, peremejatayasa limp, disease Friedlander, a disease of Winiwarter, Buerger's disease, hip tonsillitis and others) - a disease of the peripheral blood vessels, leading to their obliteration and violation of peripheral blood circulation until ischemic necrosis distal extremities (mainly lower).
Obliterating endarteritis sometimes incorrectly identified with obliterating atherosclerosis of peripheral arteries. Therefore, made on 27 all-Union Congress of surgeons (1960) the distinction between these two diseases is significant not only theoretical but also practical value. Occlusive disease - a disease of the young and middle aged. The greatest changes when it occurs in peripheral arterial highways. The vessels are affected is not the same all over, but segmental and most distal areas on the foot and lower leg. Atherosclerosis (see) is a disease of old age at which changes are more General in nature and occur mainly in the major arteries.
Offered many options classification obliterating endarteritis, but they are not widely spread. Often there are two forms of arterial and arteriovenous. The latter was described by Burger (L. Buerger) called "migrating thrombophlebitis". But later it turned out that this disease is just a variation of obliterating endarteritis, during which the process starts affecting the small peripheral veins of the extremities, or peripheral arteries with the move to Vienna. This interpretation has received General recognition, and this form is called "thromboangiitis obliterans".
Etiology. Obliterating endarteritis - polietiologic disease. The underlying reasons are quite diverse. These include: 1) some of infection - fever, syphilis, dermatophytosis; 2) factors causing long spastic condition of peripheral vessels,chronic intoxication (lead, nicotine); re-long cooling, especially cause frostbite; disorders of innervation (chronic sciatic nerve neuritis); emotional factors that serve the cause vascular spasm, congenital or acquired lability vessels with a predominance vasoconstrictor reactions; 3) chronic overstrain of the nervous system and first of all its Central departments; the most important is the dysfunction of the autonomic nervous system and consequently the disruption of the endocrine activity, in particular violation of hormonal function of sex glands and the adrenal gland.