Occlusion of the right femoral artery. Clinic of occlusion of the femoral and popliteal arteries

Patient N 57162 age 66 enrolled in the NPTsIK in a planned manner with a diagnosis: Multifocal atherosclerosis. ischemic heart disease. Angina pectoris 2 f.cl. Status after CABG 2016 BCA atherosclerosis. Occlusion of the CCA on the right. Condition after TIA from 2016

State after EAE on the right from 2016. Condition after stenting of CABG-RCA dated 28.03.19. Atherosclerosis of the lower extremities, hemodynamically insignificant and atheromatosis of the infrarenal aorta. Stenosis of the left renal artery by 75%. Hypertonic disease 3 tbsp, 2 tbsp, risk 4.

From history: For a long time notes an increase in blood pressure, max. 190\90 mm Hg, BP adapted to 120\80 mm Hg. Constantly took antihypertensive therapy. In 2016, he underwent TIA, followed by EAE on the right. After an additional examination, a multiple lesion of the coronary bed was also revealed and CABG was performed in 2016. Deterioration in 2019, when the patient turned to the NPCIC polyclinic with an increase in angina attacks, as well as resistance to antihypertensive drugs (max. up to BP 180/100 mm Hg). He was hospitalized in the cardiology department of the NPTsIK. After coronary angiography and shuntography, EVP was simultaneously performed on CABG-RCA.

For determining causes of resistant hypertension, an ultrasound scan of the renal arteries was performed, which visualized the narrowing of the lumen of the right renal artery up to 70%, then, for clarification, selective angiography of the right and left renal arteries was performed.

The right renal artery is narrowed by 90% with signs of a parietal contrast defect. The left renal artery is stenotic up to 50%.

Done: PTCA and stenting of the right renal artery Herculink Elite RX 6.5 x 15 mm.

Eccentric stenosis from the mouth of the left renal artery by 90%.

Angiogram of the right renal artery (original).

Angiogram of the right renal artery after predilation. A satisfactory result was achieved, stenosis persisted after PTCA.

Stent implantation into the right renal artery from the mouth. Implantation of the Herculink Elite RX 6.5 x 15 mm stent at 10 atm.

Satisfactory result of stenting. The stent is passable, the residual is simple satisfactory.

The patient was transferred to the intensive care unit under medical supervision in a stable condition. However, 30 minutes after EVP, there was pain and numbness in the right lower limb. The pulsation in the area of ​​the popliteal artery is weakened, and there is no pulsation on the ZBBA and PBBA. A color duplex scan of the arteries of the right lower limb was performed: the superficial femoral artery was occluded in the upper third, the lumen was filled with heterogeneous thrombotic masses; deep femoral artery - blood flow is not recorded; popliteal artery - the lumen is stenotic by 50 - 55%, weakened collateral blood flow; anterior and posterior tibial arteries - blood flow is not recorded. The patient was rushed to the operating room.

Abdominal aortography and angiography of the lower extremities. With tight contrasting of the abdominal aorta: the terminal section with signs of severe calcification, with uneven contours with multiple areas of parietal contrast defect. Right OP, LPA and RPA, BOTH with signs of parietal calcification, with uneven contours without significant stenosis. The right RAA and HBA are occluded. The left LAA is narrowed by 80%, with signs of a parietal contrast defect. Right LIA and RCA, BOTH with uneven contours without significant stenosis.

Angiography of the right iliac-femoral segment. Occlusion of the right SBA and SBA.

Angiogram after mechanical recanalization and angioplasty of the right PBA and GBA. A weak antegrade blood flow was achieved.

Positioning of stents in the right SBA and SBA. At the same time, balloon-expandable stents were inserted and positioned in the OBA-PBA and OBA-GBA.

Implantation of balloon-expandable stents in PBA and GBA (kissing stenting).

Angiogram with the result of stenting. Achieved main antegrade blood flow.

Angiography of the left iliac-femoral segment. The left LAA is narrowed by 80%, with signs of a parietal contrast defect.

Implantation of a balloon-expandable stent in the RA on the left.

Angiogram with the result of stenting. Satisfactory result of stenting. In control AH, stent deployment is complete, positioning is adequate, there are no dissection zones.

Pain and numbness in the right lower limb completely resolved. Pulsation on the lower leg and in the area of ​​the popliteal artery is satisfactory. The patient was transferred to the intensive care unit under medical supervision in a stable condition. The stents are patency on the control color duplex scan. The patient was discharged on the 5th day in stable condition.

Add case

When the vessels are clogged with cholesterol plaques, atherosclerotic occlusion of the vascular bed of the lower extremities occurs. The disease has several varieties, 3 degrees of severity and is accompanied by the appearance of lameness, changes in temperature and skin tone. The disease is dangerous with complications such as gangrene, trophic ulcer, sepsis, leading to disability. At the first symptoms, you should consult a doctor who will prescribe medications, physiotherapy, perform surgery and give preventive recommendations.

Why does illness occur?

Pathological changes occur due to a violation of lipid metabolism, which reduces the rate of excretion of excess cholesterol, so it settles on the walls of blood vessels.

One of the causes of occlusion of the lower extremities is. Plaques are formed in the vascular bed, which consist of calcium salts, lipids, cholesterol, connective tissue fibers, dead cells and are covered with a fibrous layer. In advanced cases, cholesterol formations grow and clog the vessel, which stops the blood flow in the limb. Particles can break off from the plaques, which also block the vascular lumen. The following factors lead to the development of atherosclerosis and occlusion:

• bad habits;
• malnutrition;
• hypodynamia;
• hypertension;
• violation of the thyroid gland;
• genetic predisposition;
• obesity;
• diabetes;
• regular stress;
• age changes.

What are the types of pathology?

Depending on the localization, the disease is divided into the following varieties:

• Occlusion of the surface network. The peripheral arteries of the foot and lower leg are most often affected.
• Blockage of the popliteal artery. There is an occlusion of the femoral-popliteal segment, which prevents the blood supply to the thigh, foot and lower leg.
• Defeat on both sides. It is characterized by blockage of the aortic vessels in the region of the 4th and 5th vertebrae of the lumbar zone, where it branches, and disrupts blood flow in both limbs.

Stages and symptoms: how to recognize the disease?

Occlusion of the SFA (superficial femoral artery) and other parts of the lower extremities manifests itself as shown in the table:

What are the complications?

If atherosclerotic occlusion is not treated, the following consequences occur:

• Trophic ulcer. Due to oxygen starvation, rejection of skin tissues appears, which can penetrate deep into, affecting bones, muscles, tendons.
• Gangrene. It is characterized by tissue death and a black tint of the affected areas, which leads to the loss of a limb.
• Sepsis. Pathogenic microbes enter through ulcers and gangrenous lesions, which not only aggravate the local inflammatory process, but also spread throughout the body. Toxins released by dead tissues during gangrene also contribute to general intoxication and can be fatal.
• Disability. If a patient loses a limb due to atherosclerotic occlusion, this leads not only to loss of working capacity and movement, but also to a severe depressive state.

Diagnostic measures

Angiologist, vascular surgeon or phlebologist will be able to identify atherosclerotic occlusion of the lower extremities. The doctor performs a visual examination, checks the sensitivity of the limb, measures the pulse and prescribes diagnostic procedures, such as:

• blood test for cholesterol and coagulability;
• computer arteriography;
• duplex scanning;
• magnetic resonance angiography.

Treatment: how to get rid of pathology?

Medical therapy

All drugs should be prescribed by a doctor, it is not safe to self-medicate. Occlusion of the atherosclerotic type is treated in a complex with the drugs shown in the table:

Arterial occlusion is manifested by a sharp, acute violation of the blood supply. This occurs as a result of blockage of the vessel and the spread of the pathological process caused by thrombus formation or traumatic exposure.

Occlusion and its causes

We found that occlusion occurs due to blockage of the vessel. What factors can cause this blockage?

The causes of the pathological process are due to the types of damage:

1. The vessel is affected by an infectious inflammatory process. As a result, its blockage occurs through purulent accumulations and blood clots. This type of occlusion of the lower extremities is called an embolism.
2. Blockage of the vessel with air bubbles is a serious complication in case of illiterate setting of the intravenous infusion system and intravenous injection. The same complication can develop due to severe diseases and injuries of the lungs. It's called an air embolism.
3. In pathological diseases of the heart, arterial embolism may develop. It is characterized by blockage of the vessel by blood clots coming directly from the heart. In some cases, they form in its valves.
4. Due to injuries, metabolic disorders and obesity, fat embolism can develop. In this case, the vessel is clogged with a thrombus consisting of adipose tissue.

Blockage of blood vessels can occur against the background of the following diseases:

• thromboembolism (more than 90% of cases of occlusion occur against its background);
• myocardial infarction;
• heart disease;
• ischemic disease;
• hypertension and arrhythmia;
• atherosclerosis;
• heart aneurysms;
• postoperative period on the arteries;
• vasospasm;
• electrical injuries;
• leukemia;
• frostbite of the limbs.

The most common cause of occlusion of the lumen of the arteries of the legs is atherosclerosis.

The process of occlusion

Due to spasm or mechanical action, a thrombus is formed, a vessel is blocked. This is facilitated by a decrease in blood flow velocity, impaired coagulability and pathological change vessel walls.

Ischemic disorders are associated with the fact that metabolic disorders occur, oxygen starvation and acidosis are noted. As a result of these reactions, cellular elements die off, which causes edema and a persistent violation of blood exchange.

Types of occlusion

Depending on the localization of the pathological process, the following types of blockage of the lower extremities are distinguished:

1. The defeat of small arteries, as a result of which the feet and lower leg suffer. This is the most common type of occlusion.
2. Obstruction of the arteries of large and medium diameter. The iliac and femoral parts of the lower extremities are affected. There is a disease such as occlusion of the superficial femoral artery.
3. Often there is a mixed type of occlusion, when both of the previous types exist simultaneously. For example, damage to the popliteal artery and lower leg.

Symptoms

Symptoms develop gradually and cause the following stages of the disease.

I stage

It is characterized by pale skin and cold extremities. With long walking, leg fatigue occurs in the calf muscles.

II stage

A- there is pain of a compressive and growing nature when walking short distances. Characteristic features is stiffness and slight lameness.

B-pains are acute, do not allow walking long distances. The lameness is growing.

III stage

The pains are pronounced. Acute pain does not subside when the lower extremities are at rest.

IV stage

Violations of the integrity of the skin, expressed in trophic changes. Gangrenes and ulcers form on the affected limbs.

Consequences of ischemia of the lower extremities

Diagnostics

Diagnosis of occlusion of arteries of the lower extremities is based on a number of the following procedures:

1. Examination of limbs by a vascular surgeon. Visually, you can see dryness and thinning of the skin, swelling and swelling.
2. Arterial scanning. This method allows you to find the place of blockage of the vessel.
3. Ankle-brachial index. This is a study during which the blood flow of the limbs is assessed.
4. MSCT angiography. It is used as an additional method when the others are not informative.
5. Angiography with X-ray and contrast agent.

Treatment

Treatment is carried out by a vascular surgeon and is carried out depending on the stage of the disease.

Stage I of the disease is treated conservatively. To do this, use the following series of drugs:

Physiotherapy procedures are often prescribed, which have a positive effect. These are magnetotherapy, barotherapy and others. Plasmapheresis has also proven to be effective.

Stage II requires surgery, which includes:

• thrombectomy (excision of a blood clot);
• shunting;
• vessel prosthetics.

These manipulations allow you to restore normal blood flow in the lower extremities.

With severe occlusion of the main vessels, arterial stenting is performed

Stage III includes emergency surgery, which is:

Stage IV involves only amputation of the limb, since intervention at the vascular level can lead to complications and death.

Prevention

Prevention includes the following set of measures:

1. Level control blood pressure. Timely treatment of hypertension.
2. The diet should exclude fatty and fried foods and be enriched with vegetable fiber.
3. Moderate physical exercise, reducing excess body weight.
4. Excluded smoking and drinking alcohol.
5. Minimize stressful situations.

At the slightest sign of occlusion of the lower extremities, it is necessary to be examined by a vascular surgeon. Severe consequences can be avoided if you contact a specialist in time.

Method for the treatment of occlusions of the femoral artery

The invention relates to medicine, namely to surgery, and can be used in vascular surgery in the treatment of occlusions. A vein is taken, a new channel is formed with a combined shunt from a synthetic prosthesis in the central part and an autovein along the edges, the shunt is pulled in the subcutaneous layer and sutured into the artery above and below the site of occlusion. In this case, the connecting suture on the shunt must be at least 10 d from the edge of the wound surface, where d is the diameter of the autovein. 1 z.p. f-ly.

The invention relates to medicine, namely to vascular surgery, and can be used in the treatment of arterial occlusions.

A known method of autoplasty of small diameter vessels, including the use of a reversed autovenous graft, which is taken and transplanted as part of a fascial fat flap (see AS USSR N, class A 61 B 17/00.) The disadvantage of this method is that it can only be used for microsurgical transplantation of tissue complexes, and transplanted vessels can be less than 2 mm in size. When bypass operations on the main vessels, where the vein must be of sufficiently large caliber and considerable length, the known method of treatment cannot be applied.

The closest in technical essence and the achieved effect to the claimed method and selected as a prototype is a method for the treatment of occlusions of the femoral artery, including the formation of a new artery bed using a synthetic prosthesis, pulling it in the subcutaneous layer and sewing into the artery above and below the site of occlusion, and in as a synthetic prosthesis, an Eltex-type prosthesis is used. The disadvantage of this method is that foreign tissue is exposed to open wounds and therefore the probability of infection and rejection is quite high, which leads to postoperative complications, i.e., cessation of blood flow along the newly formed bed, and poses a risk of limb loss.

The objective of the invention is to create such a method of treatment, using which it would be possible to significantly reduce the likelihood of postoperative complications.

This task is achieved by the fact that in the known method for the treatment of femoral artery occlusions, including the formation of a new artery bed using a synthetic prosthesis, pulling it in the subcutaneous layer and suturing it into the artery above and below the occlusion site, according to the invention, an autovein is taken, and a new bed is formed with a combined shunt , in the central part of which a prosthesis is used, and sections of the autovein are sutured to it on both sides, and the length of these sections from the border of the wound surface to the prosthesis is at least 10 d, where d is the diameter of the autovein.

Conducting a study on patent and scientific and technical sources of information showed that the proposed set of treatment methods is unknown and does not follow explicitly from the material studied, that is, it meets the criteria of "novelty" and "inventive step".

The proposed method of treatment can be applied in hospitals equipped with standard instruments for performing operations on the vessels.

Thus, the method is accessible and therefore applicable.

The proposed method of treatment is a combination of treatment methods, which reduces postoperative complications.

The execution of the central part of the channel from the prosthesis provides the possibility of forming a universal shunt, i.e., the required length and caliber and does not make the surgeon dependent on the size of the autovein.

Suturing to the prosthesis on both sides of the autovein ensures that open wounds are provided with their own tissue (autotissue), which, in case of suppuration, is not rejected, but can be treated, which allows adequate sanitation of the wound focus until secondary wound healing, without transporting the newly formed vascular bed .

Making the length of the autovein sections from the border of the wound surface to the prosthesis at least 10 diameters of the autovein ensures the location of the suture of the connection of the prosthesis with the autovein under the skin, sufficiently remote from the open wound zone, which significantly reduces the likelihood of infection of the connecting suture.

All this significantly reduces the possibility of postoperative complications, improves blood circulation along the new channel to the operated limb.

The proposed method of treatment is carried out as follows.

sick under general anesthesia through several skin incisions, a great saphenous vein is taken from the lower leg and thigh, the vein is washed with saline with the addition of heparin 5 thousand units. from blood. After that, the vein can be used as a vascular prosthesis (autograft). Allocate areas of the shunted artery on the thigh and popliteal region. Suitable for bypass sections of the autovein on the graft are selected, their length is measured, then a section of the prosthesis, for example, of the Eltex type, of the length that is not enough for adequate bypass is selected. Sections of the vein are reversed to eliminate valvular obstructions in blood flow.

On the operating table, sections of the autovein are sutured to the prosthesis on both sides (Carrel suture), a combined shunt is obtained, with the central part being made from the prosthesis, and both distal segments form an autovein.

With the help of a forceps, this shunt is pulled through a tunnel in the subcutaneous layer along the inner surface of the thigh and sutured with an autovein into the artery above and below the site of occlusion.

After that, blood flow starts along the newly formed channel, which ensures normal blood supply to the operated limb.

In case of suppuration of the wound, the autovein is not rejected, but can be treated according to traditional method treatments festering wounds, which allows for adequate sanitation of the wound focus until the secondary wound healing, without ligation of the newly formed vascular bed.

Example 1. Patient Terentiev SI, 59 years old, was first admitted to the clinic in 1990 about obliterating atherosclerosis of the lower extremities II degree of occlusion of the right femoral artery. In April 1990, an endarterectomy was performed from the right femoral artery with profundoplasty; he was discharged on the 12th day after the operation.

Came again after 6 months in November of the same year due to thrombosis of the operated segment. After angiography, it was decided to perform a second femoropopliteal bypass operation. Since it was found that due to the small caliber, the large saphenous vein is unsuitable for a bypass, it was decided to perform a combined bypass with an Eltex prosthesis with an autogenous vein.

In the postoperative period there was suppuration of the wound in the inguinal region. Sanitation of the purulent focus of dressing with antiseptics was carried out, antibiotic therapy. After 43 days, the wound healed by secondary intention. The follow-up examination after 2 months showed that the shunt was functioning normally and providing blood supply to the operated limb.

Example 2. Patient Pavlov AS, 61 years old, was admitted to the clinic in November 1992 due to obliterating atherosclerosis of the lower extremities II degree, occlusion of the right femoral artery. Earlier, in 1991, a femoropopliteal bypass operation was performed on the right. Shunt thrombosis occurred 4 months later. Given the absence of one large saphenous vein, phlebography was performed on the left. It turned out that the second vein was of small caliber and unsuitable for shunting. Combined shunting was performed with the Eltex prosthesis in the central part and autoveins in the distal segments.

In the postoperative period, against the background of severe allergy to drugs, weeping eczema developed and, as a result, total suppuration of the wound. Conducted intensive antihistamine therapy, dressings with antiseptics. Clamp wound by secondary intention after 63 days. At discharge, the shunt functioned normally, which is confirmed by the presence of a normal filling pulse on the foot of the operated limb.

The proposed method for the treatment of occlusions of the femoral artery in comparison with the known allows to reduce the likelihood of postoperative complications; in the event of inflammatory processes, increase the possibility of their extraction; provide the possibility of forming a universal vascular prosthesis of the required length and caliber.

1. A method for the treatment of femoral artery occlusions, including the formation of a new artery bed using a synthetic prosthesis, pulling it in the subcutaneous layer and suturing it into the artery above and below the occlusion site, characterized in that an autovein is taken, and a new bed is formed with a combined shunt in the central parts of which use a prosthesis, and on both sides sections of the autovein are sutured to it.

2. The method according to p. 1, characterized in that the length of the sections of the autovein from the border of the wound surface to the prosthesis is at least 10d, where d is the diameter of the autovein.

Lower limb occlusion

Isolated atherosclerotic lesions of the femoral and popliteal arteries - occlusion of the lower extremities are distinguished into a separate group not only on the basis of symptoms, but also in connection with the peculiarities of diagnostic methods and surgical treatment.

Symptoms of occlusion of the lower extremities

The clinic of this lesion is characterized by severe limb ischemia. The more distal is the place of occlusion of the vessel, the more severe ischemia is accompanied by it. Pain in the lower extremities is always intense, often at rest and at night.

The syndrome of intermittent claudication with occlusions of the lower extremities usually reaches sharp degrees. Patients can sometimes walk only 5-10 m (average 30-50 m). Pain that occurs after walking is localized in the feet, legs, i.e., one segment of the limb below, in contrast to blockage of the bifurcation of the aorta and iliac arteries. As a result of severe ischemia, a purple-bluish coloration of the skin of the feet and fingers is often observed, as well as trophic changes in the distal sections in the form of hyperkeratosis, changes in the nails. Hair growth is usually absent on the entire lower leg. Symptoms of "plantar ischemia", "symptom of the groove" (retraction of the saphenous veins when lifting the limb), indicating poor blood supply, are almost always positive in these patients.

When examining skin temperature, a significant decrease in it is noted on the side of the lesion.

With a functional load, a perverted reaction of the vessels on the affected limb is revealed; So, under muscular load, the vessels narrow. With the help of oscillography, it is possible to determine the level of occlusion quite accurately. Below the site of occlusions, oscillations are sharply reduced or completely absent, and the waveform is an almost straight line. With rheovasography (a method of registering the volumetric pulse of a limb), it is possible to establish the level of arterial occlusions.

The clinical picture of atherosclerotic occlusion of the lower extremities is very similar to the picture of obliterating endarteritis, which makes it difficult differential diagnosis. In some cases, there are mixed forms: endarteritis and vascular sclerosis. However, more often these diseases are not differentiated. From the point of view of differential diagnostics, the duration of the disease matters. Endarteritis begins at a relatively young age (20-30 years). Vascular sclerosis is a disease of people of more mature age, 40-50 years old. With vascular sclerosis, the history of the disease is much shorter than with endarteritis; patients often note a sudden onset of the disease (with acute blockage of blood vessels). With endarteritis, on the contrary, a slow, undulating course with seasonal exacerbations of the disease and periods of remission is characteristic.

The degree of ischemia of the distal limbs (the degree of compensation of blood circulation) can also serve as a differential diagnostic sign. Vascular sclerosis is characterized by good compensation, gangrene is rare and only with advanced disease. With endarteritis, vascular occlusion is located in the more distal parts of the limb, compensation is poor, gangrene occurs more often and earlier. With endarteritis, trophic changes in the skin and nails are also more pronounced.

When examining the pulse in patients with endarteritis, the pulsation of not only the femoral, but also the popliteal arteries is often determined. With endarteritis (stages I-II), a test with nitroglycerin is accompanied by an increase in oscillation; with sclerosis, the oscillations do not change. With vascular sclerosis, unilateral lesions are more common and therefore, during oscillography, the oscillations on the healthy side are completely preserved, while they are absent on the opposite, affected limb, and the oscillogram is a straight line.

On the arteriogram with obliterating endarteritis, the vessels are narrowed along the entire length, but have a uniform caliber; the caliber of the collaterals is often equal to the caliber of the main trunk. With sclerotic lesions, the presence of blockage of the vessel is characteristic, and the distal sections of the main vessel are filled through collaterals, bypassing the occlusion of the vessel; quite often "corrodedness" of an artery wall comes to light. A survey picture sometimes shows calcified plaques.

The X-ray contrast study of the femoral and popliteal arteries has the greatest differential diagnostic value. Arteriography of the femoral artery is produced, as a rule, by percutaneous puncture immediately under the pupart ligament. If there is also a lesion of the iliac and upper femoral arteries (its pulsation is reduced, systolic murmur is heard), lumbar aortography is recommended.

On the angiogram with occlusion of the lower extremities determine:

place (level) of occlusion;

condition, caliber of collaterals;

the state of the distal segment of the vessel and the degree of its filling with a contrast agent;

patency of the vessels of the lower leg.

In addition, attention is paid to the condition of the walls of the artery (“filling defects” at the site of sclerotic plaques). Contrasting of the vessels distal to the site of occlusion is of the greatest importance. This makes it possible to judge the state of "distal blood flow", set indications for surgery and determine the nature of the upcoming surgical intervention.

The most common site of occlusion of the femoral artery is its section from the deep artery of the thigh to the level of the transition of the femoral artery to the popliteal, i.e., below the gunter's canal. There are the following typical places of sclerotic occlusions of the femoral artery: immediately below the origin of the deep artery of the thigh and at the place where the artery enters the gunter's canal. Often, the occlusion extends distally to the popliteal artery. There are also isolated occlusions of the popliteal artery, when the onset of the blockage is located at the exit of the femoral artery from the gunter's canal, sometimes the entire trunk of the femoral artery is turned off along with part of the popliteal artery.

Treatment of occlusion of the lower extremities

The indication for reconstructive vascular surgery is segmental occlusion of the artery while maintaining an unaffected portion of the artery distal to the site of the occlusion (“distal blood flow”). A widespread lesion of the artery is a contraindication for surgery, as well as a general serious condition, concomitant lesions of the heart, kidneys, and brain. For atherosclerotic occlusion of the lower extremities, either an endarterectomy operation or a permanent bypass operation from the femoral to popliteal artery can be done.

The operation of endarteriectomy can be recommended for localized occlusions of small extent (no more than 5 cm). Access to the artery is planned according to the arteriogram. Palpation of a naked vessel complements the diagnosis. The incision of the artery can be made transverse, immediately distal to the site of occlusion. Recently, a longitudinal arteriotomy has been recommended, sometimes over a large extent. Atheromatous plaques, blood clots and altered intima are removed under the control of the eye. The distal segment of the intima is sutured to the outer layers of the artery wall to prevent it from being wrapped by blood flow. The wound of the artery must be closed without vasoconstriction. To do this, hemming a patch of Dacron or Teflon may be recommended. To remove intima and blood clots, special tools such as spatulas and bougie are used.

The femoral-popliteal bypass operation is planned in strict accordance with the arteriogram data; it is possible to perform it only if there is a sufficient length of the segment of the popliteal artery, distal to the site of occlusion, free from atherosclerotic plaques, and a good condition of the vessels of the lower leg.

The operation can be started both with exposure of the femoral and popliteal arteries. It is necessary to choose for the anastomosis a section of the artery free from sclerotic changes. However, this is not always possible. The femoral artery is exposed from a small incision under the pupartite ligament, carried out parallel to the latter. After isolating the deep femoral artery, the area of ​​the femoral artery for anastomosis is isolated by applying three special vascular clamps or thin rubber tubes. The anastomosis is best positioned over the origin of the deep femoral artery in order to preserve the latter as the main collateral for the thigh. An artery incision 1.5 cm long is made longitudinally with excision of a part of the vessel wall. The anastomosis of the prosthesis with the artery is end-to-side with atraumatics with a synthetic thread with a twisting suture through all layers. To make the prosthesis impervious to blood, the clamp is removed from the artery and the prosthesis is filled with blood. After 2-3 minutes of waiting, blood is aspirated from the lumen of the prosthesis.

The popliteal artery is usually exposed from a lateral access in the jober fossa or from an incision on the posterior surface of the popliteal fossa. After that, the prosthesis is carried out in the subcutaneous or subfascial tunnel from top to bottom to the popliteal artery, a distal anastomosis is applied between the prosthesis and the artery, also end to side, using the same technique. After removing the vascular clamps, blood flow is restored through the prosthesis to the popliteal artery and to the distal parts of the vessels on the leg. With a correctly performed operation and the absence of occlusion of the vessels of the lower leg unnoticed on the arteriogram, the pulsation of the arteries of the foot is restored already on the operating table. In some cases, it can recover on the 2nd day after the operation. This is due to the presence of vascular spasm caused by surgical trauma, which is subsequently eliminated.

Of particular importance for the success of this operation is the distal anastomosis between the prosthesis and the popliteal artery, for the imposition of which it is necessary to choose a relatively healthy part of the artery. In case of occlusion of the upper part of the popliteal artery, the anastomosis is applied to the distal part of the popliteal artery. Its exposure is carried out from the rear access, which in these cases is expanded downward, crossing parts of the tendon arch m. solei. In this case, the nerve and vascular branches that feed the heads of the calf muscles are inevitably damaged.

The distal part of the popliteal artery can be easily exposed from a vertical incision on the medial surface of the leg. This access is very sparing, with it the muscles do not intersect, and after the access, the medial head of the gastrocnemius muscle is pulled medially, after which the popliteal artery is isolated.

Postoperative period, complications of lower limb occlusion

In the postoperative period with occlusion of the lower extremities, anticoagulant therapy is carried out only in some cases when increased blood clotting is established in this patient (thromboelastogram, coagulogram). In these cases, cautious heparin therapy is recommended 6 hours after surgery. It can be continued for 1-2 weeks (pelentan, phenylin).

If symptoms appear that indicate thrombosis of the prosthesis (disappearance of peripheral arterial pulsation recovered after the operation), its revision and removal of blood clots are indicated.

Another very serious complication is the infection of the wound with the formation of purulent streaks far reaching to the surface of the prosthesis. Plastic fibers are absolutely resistant to pus, and the prosthesis does not suffer from this complication, but purulent fusion in the area of ​​the anastomosis of the prosthesis and artery is dangerous, which can lead to secondary bleeding.

The results of surgery for occlusion of the lower extremities

The positive results of operations immediately after intervention for occlusions of the lower extremities with the use of prostheses fluctuate. However, in the future, during the first 2-3 years, thrombosis of the prosthesis often still occurs. Successful results after 3-5 years, which are already considered stable, were observed in 30-60% of patients. Thrombosis is mainly due to the further progression of the underlying disease (sclerotic narrowing of the anastomosis area).

Acute occlusion of the vessels of the extremities is a sudden thrombosis or embolism of a peripheral artery, accompanied by an acute circulatory disorder in the extremity distal to the place of obturation of the vessel. Acute vascular occlusion is characterized by pain, pallor of the skin, absence of pulsation, paresthesia, paralysis of the limb. The complex for diagnosing acute occlusion of the vessels of the extremities includes laboratory tests, dopplerography, and angiography. In acute occlusion of the vessels of the extremities, antithrombotic, fibrinolytic, antispasmodic, infusion therapy is performed; in case of inefficiency, thromboembolectomy, endarterectomy, bypass shunting, limb amputation are performed.

Acute vascular occlusion of the extremities

Acute vascular occlusion of the extremities is a sudden vascular obstruction caused by embolism, thrombosis or spasm of the arteries. Acute occlusion of the vessels of the limbs is accompanied by a sharp deterioration or cessation of arterial blood flow, the development of acute ischemic syndrome, which poses a potential threat to the viability of the limb. In cardiology and angiosurgery, acute vascular occlusion of the extremities is considered an emergency, as it can lead to limb loss and disability. Usually, acute occlusion of the vessels of the extremities develops in men over 60 years of age. Patients with acute occlusion of the vessels of the extremities account for 0.1% of all surgical patients.

Causes of acute occlusion of the vessels of the extremities

The concept of "acute occlusion of the vessels of the limb" is collective, since it combines cases of sudden arterial insufficiency of peripheral blood flow caused by acute thrombosis, embolism, spasm, or traumatic damage to the vessel.

Thromboembolism is the most common cause of acute vascular occlusion of the extremities, accounting for up to 95% of cases. The material substrate of arterial thromboembolism is fatty, tissue, air, microbial, tumor fragments, as well as fragments of the primary thrombus, which migrate to the periphery with the blood flow from the main focus.

Embologenic foci can serve as tumors of the lungs and heart, in particular left atrial myxoma. Perhaps the occurrence of paradoxical embolism, when a blood clot enters the artery great circle through an open foramen ovale, an open ductus arteriosus, atrial or ventricular septal defects. Less commonly, the causes of acute occlusion of the vessels of the extremities are previous operations on the arteries, frostbite, electrical trauma, diseases of the blood system (leukemia, polycythemia), extravasal compression, and vascular spasms.

Risk factors for acute occlusion of the vessels of the extremities are peripheral vascular diseases: obliterating atherosclerosis, obliterating endarteritis, nonspecific aortoarteritis (Takayasu's disease), periarteritis nodosa. Fragmentation and mobilization of the primary thromboembolism can occur with changes in the heart rate and force of heart contractions, changes in blood pressure, physical and mental stress, taking certain medications, etc. In 5-10% of cases, it is not possible to identify the source of the embolism either during clinical examination or autopsy.

Pathogenesis of acute occlusion of the vessels of the extremities

Acute ischemic disorders that develop with occlusion of the vessels of the extremities are caused not only by a mechanical factor (sudden blockage of the artery by an embolus), but also by arterial spasm. As soon as possible after occlusion and spasm of the artery, a thrombus forms in the lumen of the vessel. Conditions for thrombus formation are created in connection with a decrease in blood flow velocity, hypercoagulation and changes in the vascular wall. Spreading in the distal and proximal directions, the thrombus sequentially obturates the collaterals, further aggravating the picture of acute ischemia.

The primary formation of an arterial thrombus occurs in vessels with an already altered wall. Factors of local thrombosis are endothelial damage, slowing down of regional blood flow, and impaired blood clotting.

Ischemic disorders in the affected limb in acute vascular occlusion are pathogenetically associated with oxygen starvation of tissues, violation of all types of metabolism and severe acidosis. Due to the death of cellular elements and increased cellular permeability, subfascial muscle edema develops, which increases circulatory disorders.

Classification of acute occlusions of the vessels of the extremities

Among the occlusive lesions of arterial vessels, acute occlusion of mesenteric vessels ranks first in frequency of occurrence (40%), occlusion of cerebral arteries ranks second (35%), and thromboembolism of the bifurcation of the aorta and arteries of the extremities ranks third (25%). In descending order of frequency of occurrence, acute occlusions of the vessels of the extremities are as follows: occlusions of the femoral arteries (34-40%), iliac arteries and bifurcations of the aorta (22-28%), popliteal arteries (9-15%), subclavian and brachial arteries (14 -18%), leg arteries.

In practice, there are single and multiple thromboembolism of arteries. The latter can be multi-level (multilevel thromboembolism in one artery), combined (thromboembolism in the arteries of different limbs) and combined (with damage to the arteries of the limbs and cerebral or visceral artery).

Ischemic changes caused by acute occlusion of the vessels of the extremities go through several stages: At the stage of ischemia of tension, there are no signs of circulatory disorders at rest and appear only during exercise.

II degree - there are disorders of movement and sensitivity of the limb:

• IIA - limb paresis (decrease in muscle strength and range of active movements in the distal parts)
• IIB - limb paralysis (lack of active movements)

III degree - necrobiotic phenomena develop:

• IIIA - subfascial edema
• IIIB - partial muscle contracture
• IIIB - total muscle contracture

The degree of limb ischemia is taken into account when choosing a method of treating acute vascular occlusion.

Symptoms of acute occlusion of the vessels of the extremities

Acute occlusion of the vessels of the extremities is manifested by a symptom complex, referred to in the English literature as the "complex of five P" (rain - pain, pulselessness - lack of pulse, pallor - pallor, paresthesia - paresthesia, paralysis - paralysis). The presence of at least one of these signs makes one think about a possible acute occlusion of the vessels of the extremities.

Sudden pain distal to the site of occlusion occurs in 75-80% of cases and is usually the first sign of acute occlusion of the vessels of the extremities. When saved collateral circulation pain may be minimal or absent. More often, the pain is diffuse in nature with a tendency to increase, does not subside when the position of the limb changes; in rare cases of spontaneous resolution of occlusion, the pain disappears on its own.

An important diagnostic sign of acute occlusion of the vessels of the extremities is the absence of pulsation of the arteries distal to the site of occlusion. In this case, the limb first turns pale, then acquires a cyanotic hue with a marble pattern. The skin temperature is sharply reduced - the limb is cold to the touch. Sometimes on examination, signs of chronic ischemia are revealed - wrinkling and dry skin, lack of hair, brittle nails.

Disorders of sensitivity and motor sphere in acute occlusion of the vessels of the extremities are manifested by numbness, tingling and crawling sensations, decreased tactile sensitivity (paresthesia), decreased muscle strength (paresis) or lack of active movements (paralysis) first in the distal and then in the proximal joints . In the future, complete immobility of the affected limb may occur, which indicates deep ischemia and is a formidable prognostic sign. The end result of acute vascular occlusion may be gangrene of the limb.

Diagnosis of acute occlusion of the vessels of the extremities

The diagnostic algorithm for suspected acute occlusion of the vessels of the extremities provides for a complex of physical, laboratory, and instrumental studies. Palpation of the pulse at typical points (on the dorsal artery of the foot, in the popliteal fossa, on the posterotibial and femoral arteries, etc.) reveals the absence of arterial pulsation below the occlusion and its preservation above the affected area. Important information during the initial examination is given by functional tests: marching (Delbe-Perthes test), knee phenomenon (Panchenko's test), determination of the zone of reactive hyperemia (Moshkovich's test).

Laboratory blood tests (coagulogram) in acute occlusion of the vessels of the extremities reveal an increase in PTI, a decrease in bleeding time, and an increase in fibrinogen. Final diagnosis of acute occlusion of the vessels of the extremities and choice medical tactics determined by the data of ultrasound (duplex scanning) of the arteries of the upper or lower extremities, peripheral arteriography, CT arteriography, MR angiography.

Differential diagnosis is carried out with exfoliating abdominal aortic aneurysm and acute deep vein thrombophlebitis.

Treatment of acute vascular occlusion of the extremities

If acute occlusion of the vessels of the extremities is suspected, the patient needs urgent hospitalization and consultation with a vascular surgeon.

With ischemia of tension and ischemia of the IA degree, intensive conservative therapy is carried out, including the administration of thrombolytics (heparin intravenously), fibrinolytic agents (fibrinolysin, streptokinase, streptodecase, tissue plasminogen activator), antiplatelet agents, antispasmodics. Physiotherapeutic procedures (diadynamic therapy, magnetotherapy, barotherapy) and extracorporeal hemocorrection (plasmapheresis) are shown.

In the absence of positive dynamics within 24 hours from the onset of acute occlusion of the vessels of the extremities, it is necessary to perform an organ-preserving surgical operation - thromboembolectomy from a peripheral artery using a Fogarty balloon catheter or endarterectomy.

With ischemia of IB-IIB degrees, an emergency intervention is needed to restore blood flow: embolism or thrombectomy, bypass shunting. Prosthetics of a segment of a peripheral artery is performed with non-extended acute occlusions of the vessels of the extremities.

Ischemia IIIA-IIIB degrees is an indication for emergency thrombo- or embolectomy, bypass shunting, which are necessarily supplemented by fasciotomy. Restoration of circulation in limited contractures allows delayed necrectomy or subsequent amputation at a lower level.

With ischemia and IIIB degree, operations on the vessels are contraindicated, since the restoration of blood flow can lead to the development of a postischemic syndrome (similar to traumatic toxemia in the syndrome of prolonged crushing) and death of the patient. At this stage, amputation of the affected limb is performed.

In the postoperative period, anticoagulant therapy continues to prevent retrombosis and re-embolism.

Prediction and prevention of acute occlusion of the vessels of the extremities

The most important predictive criterion in acute occlusion of the vessels of the extremities is the time factor. Early surgery and intensive care can restore blood flow in 90% of cases. With late treatment or its absence, disability occurs due to loss of a limb or death. With the development of reperfusion syndrome, death can occur from sepsis, kidney failure, multiple organ failure.

Prevention of acute occlusion of the vessels of the extremities consists in the timely elimination of potential sources of thromboembolism, prophylactic administration of antiplatelet agents.

Violations of the patency of blood vessels and diseases associated with them can lead to serious consequences and even disability. Diseases of the organs and systems of hematopoiesis are becoming increasingly severe and are very common. Arterial occlusion is manifested by a sharp, acute violation of the blood supply. This occurs as a result of blockage of the vessel and the spread of the pathological process caused by thrombus formation or traumatic exposure.

Occlusion and its causes

We found that occlusion occurs due to blockage of the vessel. What factors can cause this blockage?

The causes of the pathological process are due to the types of damage:

1. The vessel is affected by an infectious inflammatory process. As a result, its blockage occurs through purulent accumulations and blood clots. This type of occlusion of the lower extremities is called an embolism.
2. Blockage of the vessel with air bubbles is a serious complication with an illiterate setting of the intravenous infusion and intravenous injection system. The same complication can develop due to severe diseases and injuries of the lungs. It's called .
3. In pathological diseases of the heart, arterial embolism may develop. It is characterized by blockage of the vessel by blood clots coming directly from the heart. In some cases, they form in its valves.
4. Due to injuries, metabolic disorders and obesity can develop. In this case, the vessel is clogged with a thrombus consisting of adipose tissue.

Blockage of blood vessels can occur against the background of the following diseases:

• thromboembolism (more than 90% of cases of occlusion occur against its background);
• myocardial infarction;
• heart disease;
• ischemic disease;
• hypertension and arrhythmia;
• atherosclerosis;
• heart aneurysms;
• postoperative period on the arteries;
• vasospasm;
• electrical injuries;
• leukemia;
• frostbite of the limbs.

The most common cause of occlusion of the lumen of the arteries of the legs is atherosclerosis.

The process of occlusion

Due to spasm or mechanical action, a thrombus is formed, a vessel is blocked. This is facilitated by a decrease in blood flow velocity, clotting disorders and a pathological change in the vessel wall.

Ischemic disorders are associated with the fact that metabolic disorders occur, oxygen starvation and acidosis are noted. As a result of these reactions, cellular elements die off, which causes edema and a persistent violation of blood exchange.

Types of occlusion

Depending on the localization of the pathological process, the following types of blockage of the lower extremities are distinguished:

1. The defeat of small arteries, as a result of which the feet and lower leg suffer. This is the most common type of occlusion.
2. Obstruction of the arteries of large and medium diameter. The iliac and femoral parts of the lower extremities are affected. There is a disease such as occlusion of the superficial femoral artery.
3. Often there is a mixed type of occlusion, when both of the previous types exist simultaneously. For example, damage to the popliteal artery and lower leg.

Symptoms

Symptoms develop gradually and cause the following stages of the disease.

I stage

It is characterized by pale skin and cold extremities. With long walking, leg fatigue occurs in the calf muscles.

II stage

A- there is pain of a compressive and growing nature when walking short distances. Characteristic features are stiffness and slight lameness.

B-pains are acute, do not allow walking long distances. The lameness is growing.

III stage

The pains are pronounced. Acute pain does not subside when the lower extremities are at rest.

IV stage

Violations of the integrity of the skin, expressed in trophic changes. Gangrenes and ulcers form on the affected limbs.

Consequences of ischemia of the lower extremities

Diagnostics

Diagnosis of occlusion of arteries of the lower extremities is based on a number of the following procedures:

1. Examination of limbs. Visually, you can see dryness and thinning of the skin, swelling and swelling.
2. Arterial scanning. This method allows you to find the place of blockage of the vessel.
3. Ankle-brachial index. This is a study during which the blood flow of the limbs is assessed.
4. MSCT angiography. It is used as an additional method when the others are not informative.
5. Angiography with X-ray and contrast agent.

Treatment

Treatment is carried out by a vascular surgeon and is carried out depending on the stage of the disease.

Stage I of the disease is treated conservatively. To do this, use the following series of drugs:

• thrombolytics;
• antispasmodics;
• fibrinolytic drugs.

Physiotherapy procedures are often prescribed, which have a positive effect. These are magnetotherapy, barotherapy and others. Plasmapheresis has also proven to be effective.

Stage II requires surgery, which includes:

• thrombectomy (excision of a blood clot);
• shunting;
• vessel prosthetics.

These manipulations allow you to restore normal blood flow in the lower extremities.

With severe occlusion of the main vessels, arterial stenting is performed

Stage III includes emergency surgery, which is:

• thrombectomy;
• shunting;
• fasciotomy;
• necrectomy;
• sparing amputation.

Stage IV involves only amputation of the limb, since intervention at the vascular level can lead to complications and death.

Prevention

Prevention includes the following set of measures:

1. Blood pressure control. Timely treatment of hypertension.
2. The diet should exclude fatty and fried foods and be enriched with vegetable fiber.
3. Moderate physical activity, weight loss.
4. Excluded smoking and drinking alcohol.
5. Minimize stressful situations.

At the slightest sign of occlusion of the lower extremities, it is necessary to be examined by a vascular surgeon. Severe consequences can be avoided if you contact a specialist in time.

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Occlusion of the arteries of the lower extremities is a fairly common disease. This pathology affects the vessels of the legs, but is dangerous for the entire human body.

Causes

There are reasons that cause occlusion of the vessels of the lower extremities:

• Embolism - blockage of the lumen of the veins by blood clots that have got to the site of blockage through the bloodstream. Embolism is formed in the zone of branching of vessels of small thickness.
• Thrombosis. If the pathology is caused by thrombosis, then it develops gradually. The thrombus is located on the vascular wall and gradually increases, closing the gap between the walls of the vessels.
• Aneurysm. Vessels expand and lengthen, blood flow is disturbed and occlusion develops.
• Trauma causes vessel disruption, occlusion or compression, which causes embolism or thrombosis, and subsequently occlusion.

Types and signs of the disease

Occlusion of the lower extremities can occur in any area of ​​the legs, while blocking the lumen of large and small vessels.

There are such types of diseases:

• Obstruction of large arteries, which disrupts the blood flow of the femoral areas.
• Blockage of the small arteries that supply blood to the feet and legs.
• Mixed blockage of small and large vessels at once.

Depending on what factors caused the development of the disease, its types are distinguished:

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21.10.2019

• Arterial. A thrombus appears in large arteries or on the valves of the heart, and then is carried by the movement of blood to the lower systems of the body.
• Air. The lumen of the vessel closes the air, which can occur due to lung injury.
• Fatty. After a bone fracture, a piece of fat blocks the vessel.

Arterial obstruction occurs acute form and chronic:

• Acute occlusion develops when a vessel is blocked by a thrombus, has a rapid course.
• Chronic occlusion develops slowly, its symptoms depend on the formation of cholesterol plaques on the walls of the arteries and the gradual decrease in the lumen of the vessel.

The initial symptom of the pathology is lameness. Fast walking causes pain, so the patient, sparing his leg, begins to limp. After rest, the pain goes away. But gradually the disease progresses, pain occurs more and more often.

The patient develops the following symptoms:

• Constant pain, which is aggravated by a small load.
• The skin on the affected area turns pale and becomes cold, then becomes cyanotic.
• There is no pulsation of the arteries at the site of blockage.
• Sensitivity decreases, numbness of the legs occurs.
• Paralysis of the legs develops.

After blockage of the vessel, after a few hours, tissue necrosis occurs at the site of occlusion, and gangrene may appear. This is an irreversible process that can lead to limb amputation. Therefore, if a person has symptoms of occlusion, he should immediately consult a doctor.

Diagnostics

Diagnostics on initial stage disease will help to prescribe treatment in a timely manner, it will be simple. If a person has fatigue when walking or has diseases that put a person at risk, he should see a doctor for an examination. The doctor makes an examination, finds out if the blood supply to the lower extremities has worsened.

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The survey includes:

• visual inspection;
• search for vessel pulsation;
• tomography;
• oscillogram, which will determine the presence of the disease.

Also, the doctor may prescribe an arteriography to the patient, which will determine the picture of the disease, the exact location of the vascular lesion. In this case, a contrast agent is injected into the vessels. Timely diagnosis helps to avoid the progression of the disease and prevent complications.

Treatment Methods

Vascular obstruction is treated with medicines. The first stage of the disease is treated conservatively with medication.

The second stage of the disease and the subsequent ones are treated with a surgical operation.

conservative

Before treating blockages on the legs, the patient is examined and the diagnosis is confirmed. Then treatment is prescribed. At the beginning of the disease, therapy is conservative, it can be carried out at home. The patient is prescribed various groups of drugs:

• Anticoagulants that reduce blood viscosity:
  • Aspirin;
  • Cardiomagnyl.
• Antispasmodics:
  • Spasmol;
  • No-Shpa.
• Fibrinolytics, which destroy and eliminate blood clots:
  • Actilase;
  • Prourokinase.
• Painkillers:
  • Ketanol;
  • Baralgin.
• cardiac glycosides:
  • Digoxin;
  • Korglikon.

Apply drugs that improve heart contractions, such as Novocainamide. For local therapy, Heparin ointment is used. Patients are recommended vitamin complexes and physiotherapy treatment. Electrophoresis promotes the rapid penetration of drugs to the affected area. Patients are prescribed magnetic therapy, which allows you to relieve pain, normalize blood circulation, and improve blood oxygen supply.

Operation

Patients in the second stage of the disease are prescribed a surgical operation:

• stenting;
• shunting;
• thrombus excision;
• prosthetics.

The operation is designed to restore blood circulation. When shunting, a shunt is brought to the affected area of ​​the vessel and the blood flow is restored. Thrombus is used to remove a clot from an artery. At stage 3 of the disease, patients are prescribed necrectomy, that is, amputation of necrotic tissues, as well as fasciotomy, when pressure on the muscle is reduced by dissecting the fascia. Important information: How to treat moderate myocardial hypoxia (oxygen starvation of the heart) and what are its symptoms

For internal use, you can use this recipe: take hawthorn and wild rose 1 tbsp. l., add 1 tsp. crushed lingonberry leaves and immortelle. Pour the composition into a thermos and pour boiling water. Insist 3 hours. Drink throughout the day. Tea cleanses blood vessels from cholesterol plaques.

Patients are prescribed a decoction of valerian root inside and as compresses. You can prepare a collection of fruits of hawthorn, strawberries, mountain ash. 2 tablespoons of berries pour 400 g of boiling water. Brew for half an hour. Drink during the day for 4 doses.

You can prepare an infusion of chestnut, fennel, adonis and lemon balm flowers. 1 st. l. a mixture of herbs is brewed with a glass of boiling water. The medicine is drunk per day. The course of treatment is a week, after which they take a break and repeat the course again.

Used for treatment walnuts, nettle leaves and garlic:

• A bath of nettle leaves will improve blood circulation. 4 tbsp. l. nettle pour 1 liter of boiling water. Add infusion to the bath. The procedure is carried out for 20 minutes.
• Take garlic infusion. It is necessary to grind 50 g of garlic, pour a glass of vodka, leave for 2 weeks in a dark place. 10 drops of infusion diluted in 100 g of boiled water, drink 3 times a day.
• For tincture, 1 kg of peeled walnuts is placed in a 3-liter bottle. Pour liquid honey, cover with cellophane. Fermentation takes place. The jar is closed with an iron lid and put in the cold for 3 months. Then the liquid is drained, 30 g of bee pollen are added. Within a month, you should consume 1 tsp daily. this tool. Then they take a break for 2 weeks and repeat the course.

Prevention

To prevent the development of occlusion of the lower extremities, it is necessary to follow the rules that prevent the development of vascular obstruction and have a positive effect on the entire body. Necessary:

• give up alcohol and smoking;
• get rid of excess weight;
• follow a diet;
• fulfill physical exercise;
• do morning runs
• normalize blood pressure.

Patients over 45 years of age should lead a healthy lifestyle, diagnose and treat atherosclerosis in a timely manner, regular treatment in a sanatorium is useful.