Main clinical features

Modern methods of diagnosis

Modern methods of diagnosing disorders of the peripheral arterial circulation are different latitude range ones used to refine the clinical diagnosis, the nature and extent of vascular lesions, the other to evaluate the effectiveness of the treatment or the dynamic observation of patients. To study the hemodynamics of the lower limbs and topical diagnosis of arterial lesions using the following instrumental methods: Doppler ultrasound sphygmomanometers, treadmill test, ultrasound angioscanning, including duplex, and X-ray aortoarteriografiya. In addition, it is necessary to determine the lipid profile, coagulation and blood rheology.

As the first stage, all patients with suspected occlusive-stenotic lesions of the aorta or lower extremity arteries is performed with Doppler ultrasound measurement of ankle-brachial index.

This index is the ratio of maximum pressure on one of the tibial artery to the pressure on the brachial artery. Decrease of this index less than 0.9 require much more attention to the patient. In this regard, one of the most promising at present is the combined use of Doppler ultrasound and the standard treadmill test [10]. By non-invasive methods of investigation also includes an ultrasound angioscanning, through which you can with a high degree of reliability to determine the degree of stenotic lesion. Recently, duplex brand viagra ultrasound angioscanning in the algorithm of the diagnostic program is one of the leading positions as a result of non-invasive and security, as well as high sensitivity and specificity. According to the duplex scanning is determined not only the structure of atherosclerotic plaques, but also evaluated hemodynamic degree of stenosis, which is crucial. Radiopaque angiography currently remains the main method of diagnosis of obliterating diseases of the vascular bed. With this method it is possible to pinpoint location, extent, degree and nature of the stenosis, a plurality of occlusive lesions of arteries of the lower limbs, assessment of collateral channels, to predict the nature and scope of reconstructive surgery, as well as to monitor the effectiveness of treatment and surgery. In the arsenal of Angiology and Vascular Surgery, there are also such diagnostic techniques as laser Doppler flowmetry, transcutaneous monitoring of O2, photopletismography radioisotope investigations, computer tomography and nuclear magnetic resonance.

Definitions and clinical classification

In clinical practice, to refer to pay attention diseases of the abdominal aorta, leading to its narrowing or occlusion, often use the term Leriche syndrome, which generalizes the pattern of bifurcation lesions of the abdominal aorta and iliac arteries.

The main clinical features of this lesion are highly intermittent claudication (pain in the limbs when walking), bilateral absence of the pulse in the arteries and erectile dysfunction.

Approximately 30% of patients with chronic arterial insufficiency of the lower limb atherosclerotic some convincing test occlusive process localized in the abdominal aorta, 70% of patients in the arteries of the femoro-popliteal segment.

Tactical issues in choosing a method of treatment in atherosclerotic lesions of the aorta and arteries of the limbs are based on the severity of chronic ischemic syndrome, which is classified in four stages of the disease. Prevailing system of evaluation are the classification of R. Fontaine and A. Pokrovsky.

At the 1 st stage of the disease pain in the lower extremities appears only when a large exercise, it is not related to patient distance traversed.

For the 2 nd stage characterized by the appearance of the limiting pain when walking (intermittent claudication limiting). With tactical positions that stage is subdivided into 2A (traversed distance without pain for more than 200 m) and 2B (the appearance of pain when walking at a distance of less than 200 m).

Pain in the limbs at rest characterizes the third stage, the appearance of ulcerative-necrotic changes in 4-th stage of the disease.

Urine tests
hormonal agents
Human genome