Leriche syndrome - it is a common disease of the circulatory system, which is expressed in clogged arteries aorto-iliac department.The disease is described in detail and the surgeon Rene Leriche scientific figure in the early twentieth century, since already at that time this pathology has been very common.
Leriche syndrome most often occurs in people after forty years, in most cases of this disease suffer from the stronger sex.Specific data on how frequently found in the population, this pathology, no, but that the disease is spread, can be judged by the vast number of restorative operations carried out in the abdominal aorta.Only in America each year these surgical procedures performed over thirty seven thousand.
Leriche syndrome causes
Leriche syndrome is inherently polyetiological state.Trigger the development of this disease can be diseases such as atherosclerotic changes in vessels, nonspecific aortoarteriit, blockage of a blood vessel embolism, thrombosis due to
Most reported cases of Leriche syndrome is caused by abnormal blood vessel defects associated with atherosclerotic changes.This etiological factor ranks first for the reason that the incidence of new cases of atherosclerosis in recent decades has increased very rapidly.The reason is simple and easy: the wrong schedule with a large deficit of sleep, eating disorders (eating foods from fast-food chain, in which a lot of cholesterol and other substances harmful to vessels, a lot of fatty foods in the diet).Especially harmful fats such people mature and old age, as the metabolism slows down significantly from them and disposed of the body is not harmful fats found in such foods, be sure to settle on vessel walls, and later lead to atherosclerosis.
impaired people exchange processes and endocrine diseases should also be wary of the development of atherosclerosis, as the risk of the disease have increased several times.Nespetsiichesky aortoarteriit (second name - Takayasu's arteritis) is in second place among the etiological causes of Leriche syndrome.The etiology of this disease is still not fully established.By their nature, Takayasu is inflammatory in nature.The inflammatory process involved in this pathology medium and large vessels.Untreated disease in most cases leads to stenosis of the affected vessels.In all other causes, can cause the development of Leriche syndrome, assigned to only one percent.
degree of hemodynamic instability in the affected artery Leriche syndrome is defined by the length of the occluded portion of the vessel, which significantly reduces the amount of blood flow to the organs located in the pelvis and the legs.It is for this reason that at the beginning of Leriche syndrome ischemia phenomena appear only during exercise, but as the disease progresses more and more are beginning to disturb the patient in a calm state.
main manifestation of Leriche syndrome - rapid reduction in pressure in the distal receptacles and a gross violation of microcirculation, and then deterioration of the metabolic processes in the tissues, which supply blood to the diseased artery.
Leriche syndrome symptoms
If Leriche syndrome is caused by atherosclerosis, the main changes start to occur at the site of the bifurcation of the abdominal aorta, and where the internal iliac artery branches off from it.The vascular changes in the Leriche syndrome is commonly found calcifications and mural thrombus.
If the cause of the disease Takayasu served, the wall of the aorta in the study will be significantly thickened due to the fact that the inflammation extends to all three vessel shell.In most cases, and also detected the presence of calcification.
Leriche syndrome Clinical manifestations are directly proportional to the length of the damaged portion of the artery.Severity of symptoms depends on how well developed collaterals in defeat.
very first sign of Leriche syndrome, which is important to pay attention to is the tenderness of the calf muscles during movement.Sometimes the pain becomes so intense that a person begins to involuntarily limp on the affected limb.In nine out of ten cases Leriche syndrome, patients go to the doctor because of intermittent claudication.The higher the pathological focus in relation to the lower extremities (eg, in the arteries of the mesentery), the smaller the changes undergone distal blood flow, the better and more intensive work compensatory mechanisms.When occlusion occurred at medium or high levels, pain will be localized in the gluteal muscles in the lumbar region and outer thighs.This phenomenon is called "high intermittent claudication."
Also unpleasant pain people with Leriche syndrome will complain that the feet are constantly cold, often numb.Almost half of male patients as the disease progresses will suffer from erectile dysfunction, and later - impotence.
flow Leriche syndrome tends to a constant and steady progression.This disease has an interesting feature: in men aged forty or fifty years, it has developed much faster than that of males, after sixty years.
With careful inspection, auscultation, palpation and instumentalnyh conduct diagnostic tests, can detect a variety of characteristic exclusively for Leriche syndrome of symptoms and signs.Upon inspection it can be seen that dyeing damaged legs considerably different from the color of healthy skin, markedly decreased muscle mass, patient limb temperature substantially below body temperature.
If the disease was initially launched and verified already at the last stage, the skin will be visible ulcers and necrotic areas, especially in the fingers, feet.When the feeling you'll find that the femoral artery did not pulsate.If the occlusion site underwent abdominal aortic pulse tremors in the umbilical region will be absent.When listening stethoscope of the femoral artery in the groin area will be clearly audible noise systole.From all of the above it can be concluded that the main features of the syndrome Leriche patognomonicheskimi are no pulse shocks and noise when listening.
In order to confirm this diagnosis, it is necessary to make research tools: rheovasography, sphygmography, flowmetry ultrasound and plethysmography.Using these methods, diagnostic will assess the level of pathological changes in the main circulation.
Determination of blood flow via the clearance 133He gives information about its significant reduction, especially if the patient before the test was given to physical activity.Ultrasound examination using Doppler will provide an opportunity to consider in detail and assess circulatory disorders in the arteries of the legs.A very important point in the diagnosis of "Leriche syndrome" is the definition of a special parameter, which is called the "ankle index."It is determined by measuring the pressure in the arteries of the feet and the radial artery.The ratio of these indicators should be about 1.1-1.2.If this index is 0.8, a patient having the first symptoms of lameness, and if the option is 0.3 or less - are beginning to form a variety of ulcerative necrotic lesions on the skin.For more topical picture can be obtained by angiography.This method is quite informative when Leriche syndrome.If the doctor needs to find the exact location and extent of the defeat of the damaged artery, used aortography.
Differential diagnosis is necessary to Leriche syndrome with radiculitis lumbosacral area, as well as obliterating endarteritis.An important sign that this pathology - not Leriche syndrome, and occlusive disease is the presence of shocks on the pulse of the femoral artery and a complete lack of noise while listening.Another feature - the age: endarteritis predominantly affects young people (about thirty), and Leriche syndrome - after forty.Sciatica lumbosacral area also has some important differences from Leriche syndrome: the pain at the same time sciatica have no relation to walking - they are permanent.It is also important to know that in this pathology surge vessels is maintained and the noise completely absent.
Leriche syndrome treatment
Leriche syndrome Drug therapy is only possible if a small degree of ischemia.When degrees of ischemia 1 and 2A, the patient is prescribed ganglioplegic, sosudorasshiryayushie drugs and anticholinergics.
Among ganglioblokatorov that are used in the treatment of Leriche syndrome, worked well and gave satisfactory results Vaskulat, Mydocalm and Bulatol.Vaskulat consumed orally one tablet every four to six hours (the exact purpose of making the doctor).Perhaps the use of drops Vaskulat.Their drink twenty to thirty per intake, frequency of use in the same day as tablets.
At more advanced variants of Leriche syndrome drug kolyat in the buttock one die five percent of the drug once or twice a day.Good to know: this drug should not be prescribed to patients with diabetes.Mydocalm daily dosage ranges from 150 to 450 milligrams.It depends on the severity of the syndrome Leriche.Usually the drug is beginning to show with fifty milligrams per intramuscular or intravenous administration.The number of injections per day - three.If the effect is insufficient - the dose is increased.This should be done gradually.Normally, the maximum dose to be administered in the gluteal muscle is one hundred milligrams, the multiplicity of injections per day - two.Mydocalm intravenously administered once daily at a dose of one hundred milligrams.In the vein of the drug must be administered very slowly and monitor the health of patients.Treatment Mydocalm inadmissible in the event that a person has an allergy to lidocaine or a history of myasthenia gravis.
Among the enhancements from the vessels used in the syndrome Leriche Nospanum and papaverine.Nospanum in this disease is used as an orally or intravenously and intraarterially.The tablets are in an amount of one to two per intake, the number of receptions per day - two or three.In the vein type two percent to four milliliters of solution.The introduction of the drug into a vein or artery is slow.The drug is not used in such comorbidity as glaucoma and prostate hypertrophy.Papaverine take per os forty-eighty milligrams every eight to twelve hours.A two percent solution for injection may be administered under the skin or into a muscle.The amount of drug per administration - one or two milliliters.For an introduction to the vein should be diluted papaverine ten cubes of isotonic sodium chloride solution.If the patient has a cardiac arrhythmia, you must notify your doctor, as use of papaverine at disturbances in the heart conduction is undesirable.
Among holinolitikov widely used in Leriche syndrome received the following drugs: Depo-Padutin, andekalin.Depo-Padutin appoint forty-action units per injection.The drug is administered intramuscularly, or daily, or every other day.In the course of treatment Leriche syndrome, which lasts five to seven weeks, appoint fifteen or twenty injection.If the disease is serious, duration of therapy Depo-Padutinom can make three or four months.Depending on the severity of the syndrome Leriche andekalin introduced ten to forty units of action.The duration of therapy means - two to four weeks.Every three months, the treatment should be carried out again.Tablets andekalin use two pieces before eating every eight hours.Gradually, the number of tablets per day may be increased to twelve, but only if the initial dose did not produce the desired result.Take the drug for four weeks, after a break of two months, repeat the course.
If ischemia has already passed the stage 3B and 4, must be treated surgically.Operations at Leriche syndrome do in two ways: the removal section of the vessel and replacing it with a prosthesis or bypass surgery.Resection of the section of the vessel to operate if verified occlusion and stenosis.Operation via bypass surgery is performed in cases where an artery patency (even if minimal) is stored.