Intermittent chromotype treatment and signs. Intermittent chromotype - treatment, symptoms, folk remedies Treatment of intermittent chromium with multiple sclerosis

Intermittent chromotype is a complex of symptoms that are manifested in the blood supply to the lower extremities. The condition is characterized by pain appearing after the load, especially when a person walks a lot.

The disease is mainly the pathology of the vascular system, less frequently transferred infectious diseases, the consequences of intoxication or injury. Chromota often threatens people suffering from diabetes mellitus and other states associated with metabolic disorders. The person suffers from spasm in the peripheral vessels, which is why the muscles and the nerves are not supplied to the legs, after which the pain occurs.

The diagnosis of intermittent chromotype does not constitute difficulties, since the disease can be determined by external signs. In addition to changing the shade of skin, the doctor reveals the missing pulse on the leg. Additionally, angiography, doppler-research is required for surveys and setting an accurate diagnosis. For treatment, special drugs are prescribed, improving blood supply, normalizing metabolism and strengthening the body as a whole.

Most often, intermittent lameness causes the presence of atherosclerosis, which, in turn, affects the vessels of the lower extremities.

On the walls of the vessels, small plaques are formed, called atherosclerotic, which worsen blood supply, and in some cases, in general, clocked vessels. Atherosclerosis is characterized by clogging both small vessels and large arteries, and even aorta is often amazed.

Normally, that is, the vessels are cope with the vessels, and in the right amount, the blood goes both to nerves and to the muscles, which is why symptoms does not appear. But during the load of the vessels begin to be blocked, the blood enters insufficient quantities, which is why the state of ischemia occurs, which, in turn, is accompanied by pain. If you do not carry out the treatment of intermittent chromotype, then a person in the future will threaten the appearance of ulcers on the legs, moving to Gangren, and this is fraught with a leg amputation.

To other reasons leading to pathology include such conditions:

• infectious diseases such as syphilis, tit, flu;
• the states of intoxication associated with smoking, alcohol use;
• supercooling;
• injuries of the lower extremities;
• endocrine diseases, including diabetes and gout.

Smoking is playing a significant role in the appearance of chromotype. It is the resin and tobacco that have a negative impact on the vessels that are infected.

Due to the fact that the disease slowly progresses, symptoms are not manifested immediately, a person may not know about the pathology for several years. Over time, the first symptoms will begin to appear.

The main sign of the intermittent chromotype is pain in the legs after the load, that is, walking or running, which begins suddenly and quickly passes at rest.

If a person continues to tolerate pain and gives a load on his feet further, it leads to a strong pain syndrome. The fact is that when the muscle load requires more blood flow, and the narrowed artery cannot provide it.

A person begins to pay attention to the pathology at the time of lifting on the stairs or when walking up. So, symptoms arises faster, due to the fact that the muscles are in a tense state. So that the symptoms of pain passed, you have to take breaks, and all this affects the patient's activity. By the way, in order for the pain in the legs, sometimes enough of the literally one minute of rest.

The character of pain happens differently from a stupid attack of pain and ending with acute pain. Sometimes there is a burning sensation in the limbs, pulsation in the vessels. It all depends on which reasons cause disease, from age and duration of the disease. Begins the disease to manifest themselves most often in the arteries that are most removed from the heart, why fingers suffer from the beginning, ankles. Over time, the main sign - pain, arises in the field of groin, buttocks, hips, which indicates the launch of the pathological process.

There are also external signs of the disease. These include a trophic change in the skin of the lower extremities, which is associated with a deterioration in power. The skin begins to peel, it changes its shade, it becomes pale. When progression, hair loss is observed, detachment of nails and the formation of an ulcer.

If you do not carry out treatment, then the person can decrease the erectile function. From complications of intermittent chromium, it is also possible to distinguish the threat of formation of collaterals - bypass vessels necessary to compensate for reduced blood supply. With the complete blockage of the vessels, Gangrena is beginning to develop, in such cases there is a surgical intervention, and in an emergency.

With such a disease, one reception of medicines will not be enough. First of all, it is necessary to save a person from bad habits, that is, smoking, alcohol consumption. The diet is adjusted, the use of oily, fried dishes, smoked salts, salt is limited. It is recommended to avoid hypothermia of the lower extremities, injuries. Shoes need to wear comfortable so that it does not compress the foot.

The main task in the treatment of intermittent chromium is the elimination of the negative impact on the vessels. If a person is diagnosed with diabetes mellitus, then he needs to take drugs and comply with the diet to normalize the glucose level. When gougring, medicines are prescribed to normalize metabolic processes and the derivation of urea from the body. In case of infections, antibiotics must be taken, antimicrobial means. As well as, if necessary, the treatment of atherosclerosis of the lower extremities, varicose veins and other vascular pathologies is prescribed.

The medications are required to receive funds aimed at normalizing the blood supply to the legs: aspirin, trental (oxopurin). Recommended drugs to reduce cholesterol levels.

Treatment of physiotherapy is used, among whose methods are popular:

• UHF procedures;
• diathermy method;
• application of steam barocamera;
• hydrogen sulfide baths.

In the launched state, the operation may be required. No need to forget about additional treatment with the means of traditional medicine, which can be combined with traditional treatment.

Folk remedies

To facilitate the state and improve the blood supply to the lower limbs, contrasting baths are popular to be made before bedtime. To cook the bath, fresh needles or pine needle. About 2 liters of water is boiling, after which there are 2 cups of needles or pines and it insists to a warm solution. After that, you need to add 5 tablespoons of salt in the infusion, it's better to strain, and strain. Now you need to take 2 basins, in one of them add boiling water and liter infusion so that the water becomes hot and lower the legs alternately. Initially, in the bath with hot water, then with the cold, where the infusion and water is also poured. The total time of the procedure is 15 minutes.

There are other recipes of traditional medicine:

1. The recipe consists in the use of horse chestnut, for which 2 tablespoons of crushed fruits are taken, 3 spoons of grinding rope of the Saflor Rope and 4.5 spoons of hops are added to them. 1 tablespoon of the mixture obtained is taken, falling asleep into a thermos, where the glass of boiling water is poured and the infusion is left for 4 hours, after which they are filled and take 100 milliliters per day.
2. It takes unrefined olive and sea buckthorn oils, mixed in equal proportion, and the resulting mixture is rubbed into the skin on the legs. The procedure is performed on the night for a month.
3. When inflammation in the vessels, the reception of the donon, red clover, burdock and hawthorn, which must be taken alternately 1 week are recommended. The course as a whole takes 1 month, after which a break is taken for 3 months.
4. Another recipe consists when applying a ragger of 5 tablespoons of pine needles, 3 spoons of rosehip, 1 spoons of onion husk. The resulting mixture is flooded with a liter of water and is brought to a boil, after which it must be insisted in a dark place for 12 hours and take decoction a day 3-4 times, drinking everything per day. Course treatment - 4 months.

No need to forget that before starting treatment with folk remedies, you need to consult with the attending physician. Some recipes are contraindicated in diabetes or allergies, which is combined with a mixed chromota.

As a result, it can be said that to get rid of chromotypes you need not only to apply medicines and folk treatment methods, but also to stick to the diet, eliminate negative factors. Special attention deserves treatment of acute and chronic states. Well, of course, we must not forget about the prevention in the future.

Intermittent chromotype is not a disease in a wide concept, but rather a symptom of certain diseases. It occurs as a result of certain pathological conditions in the human body and requires compulsory attention to themselves.

The disease is a consequence of the failures of the neuromuscular apparatus or disorders in the blood circulation of the lower extremities. This symptom is able to pretrately spoil the life to its owner. The syndrome of the intermittent chromotype, its second name - Charcot syndrome, is characterized by the occurrence of discomfort and pain in the field of shin when walking at a distance of 200-1000 m. The intermittent feature is that this pain passes after a short rest and the patient can continue to move. However, pain quickly returns, forcing the person to chrome.

Disease varieties

Based on research on the causes of this disease, the conclusion was concluded that this happens two types:

1. Caudogenic, it is neurogenic. It occurs due to the narrowing of the spinal channel in the lumbar department, which is congenital or acquired. The cause of the acquisition of the narrowing becomes spondylopathy and osteochondrosis. The changes arisen violate the transmission of nerve pulses to the lower limbs and their correct return to the central nervous system.
2. Wascular, is true and arises due to atherosclerotic damage to the vessels of the lower extremities. The narrowing of the arterial lumen disrupts blood circulation in the tissues and the supply of muscles with oxygen, causing them ischemia.

Signs of the disease, both neurogenic (caudogenic) and vascular, are manifested by pain and discomfort when walking. The differences are that the chromotype of vascular origin is accompanied by pain, and the nervous - paresthesia and the feeling of running goosebumps. Such paresthesias can spread on both legs and achieve a groin fold.
To determine the severity and tactics of treatment, a clinical classification is adopted by Pokrovsky, which highlights its varieties:

1. The 1st degree is characterized by the fact that the patient already has violations in the blood supply to the lower limbs, but does not feel pain when walking. The main feature is discomfort that occurs when walking at a distance of more than 1000 m or when the stairs is lifted. At this stage, few people appeal to the doctor, so often changes progress.
2. The 2nd degree for convenience is subdivided into two more types. 2A - a distance of walking without pronounced pain is 200 - 1000 m. 2b degree - the patient is able to overcome without pain distance up to 200 m. In the second stage, medication can still be effective.
3. The 3rd degree, referred to as critical ischemia, is accompanied by pain in the legs, which does not disappear and at rest. Skin covers change the color, the symptoms of blood stagnation are obvious. Urgent surgical intervention can still save the limb or part of it.
4. The 4th degree is characterized by irreversible changes in vessels and muscles, the development of trophic ulcers or even gangrene. The limb is usually amputated. If this is not done, the patient can die from septic complications.

Diagnostic algorithm

Pathology is detected using a variety of tests aimed at measuring the distance, which the patient is able to overcome painlessly. If this syndrome is confirmed, the next step is to search for the cause of its occurrence. The main method of determining the width of the arterial lumen is the ultrasound of the limb vessels with Doppler. It allows you to identify the length of atherosclerotic lesion or the location of individual plaques.

Angiography is the main method of examining the vessels, the essence of which is to introduce a contrast agent into the vascular channel and observing its "traveling" by arteries using a special X-ray installation. Allows you to reliably verify the location location and the size of the refrovers of the artery.

What should be treatment and prevention

Effective medicine used at the initial stages of the disease - training walking. Moreover, doctors advise to engage in this sport with special instructors, since independent execution is often incorrect and does not have a positive impact in due measure.

In the second stage of pathology, manipulation of modulation of risk factors is also effective. Thus, treatment is the therapy of system atherosclerosis. Basic groups of drugs:

1. Deagregants and anticoagulants for the prevention of thrombosis.
2. Hydolipidemic drugs to reduce the level of total cholesterol in the blood.
3. There are studies confirming that the use of pentoxyfalline in the maximum dose (1200 mg) can alleviate symptoms, improve peripheral blood circulation, which contributes to the formation of collaterals.
4. Strong pain in the legs are permissible to occasionally stop nonsteroidal anti-inflammatory drugs. After a long walk, relevant rest is needed.

In the third stage, to treat the disease, the surgical intervention is most often required, the purpose of which is to optimize the arterial blood flow of the urgent zone. All sorts of shunting and stenting of narrowed plots are performed in the hope of preserving the patient limb. However, such aid measures may be ineffective.

The fourth stage is the sad finale. Changes are not reversible, and the amputation of the limbs often provokes large blood loss and infection, as the place of amputation due to the common system atherosclerosis is very bad.

The prevention of this disease is all measures that are used to prevent system atherosclerosis. Victory over bad habits, proper nutrition, active pastime is capable not only to help restore the body, but also to prevent the emergence and development of diseases. Preventive measures are particularly needed by patients from risk group. These include older people, hypertensive, diabetics, smokers, overweight people, as well as with impaired metabolism.

Intermittent lameness, the treatment of which is a difficult task, potentially leads to the disability of the younger population. Attentive attitude towards yourself, as well as the observance of the rules of a healthy lifestyle can prevent the majority of diseases.

In the current 2013, a new revision of national recommendations for conducting patients with peripheral arterial diseases was published. An important place in it is given to diseases of the vessels of the legs. Despite the absence of full-fledged statistical data, it can be stated that the calculated number of suffering from this disease is based on the prevalence (0.9-7% of the population, depending on the age group) in Russia at least 1.5 million, it means that 100,000 citizens reveal terminal (critical) form of the disease; Which annually leads only to this indication to fulfill 20,000-40,000 ammputations.

Intermittent chromoty (PC) is the main clinical syndrome of atherosclerotic damage to the arteries of the lower extremities. Unfortunately, most of the specialists forget about the relevance of this disease; Perhaps against the background of the dramatic course of other manifestations of atherosclerosis, this form is not increasingly attracting close attention. At the same time, the prevalence of PC depending on age is from 0.9% to 7.0%. According to authoritative publications and major population research (Sage, 2010 Group; Russian conciliation document, 2013; Pandora study, 2012) The prevalence of peripheral arterial diseases is high, varying from 5.8% in the United States and 7% in Russia to 12.2% and 22.9% in France and Italy, respectively. It is important that up to 50% of patients with PC never appealed to doctors about these symptoms, but at the same time they experience discomfort due to pains in the legs. Medical professionals when examining such patients in the event of their treatment to medical and prophylactic institutions about other complaints do not interview them for the presence of ischemic pains in the legs when walking.

It was established that precisely atherosclerosis is the cause of the damage to the peripheral arteries in 80-90% of cases, the remaining part is "clean" diabetic angiopathy (without the background significant atherosclerosis of the lower extremities vessels) and the damage to autoimmune bezes. It has long been known that patients with PC have a high risk of developing myocardial infarction (im) and acute brain circulation disorders. So, in comparison with the usual population, they are increased by them from 20% to 60%, and the risk of death from coronary pathology from 2 to 6 times. When the risk of developing acute violation of the brain circulation rises by 40%.

More than half of patients with peripheral arterial diseases already at the time of treatment, IIB (surgical) is recorded in the classification of A. V. Pokrovsky-Fontaine, which corresponds to a mixed chromotype that occurs during the passage of 50-200 m. Such patients are candidates for conducting endovascular open or hybrid surgical treatment. Nevertheless, the high level of development of modern reconstructive surgery of the lower limbs arteries cannot solve all problems in this group of patients. The success of reconstructive interventions directly depends on the state of the T.N. Flock paths - vessels located below the groin fold. According to some data, up to 40% of patients in need of operational treatment cannot be performed by the arterial reconstruction due to the distal or common multifocal lesion of the arterial bed.

The appearance of resting pain and ulcerative-necrotic changes of the skin up to gangrens in patients with UFA testifies to the development of critical ischemia of the lower extremities (kink), the state of decompensation of arterial blood flow. Cynic treatment requires a more active approach of both pharmacotherapy and surgical interventions. The dynamics and statistics of kink is such that during the first 6 months after the diagnosis of kink, the limb can be maintained only in 40% of cases, since 20% of patients will die, and the rest will be made a large amputation. As a result, by the end of the first year after verification of the diagnosis, only 45% of patients have a chance of preserving the limb, about 30% continue to live after amputation of the thigh or leg, a quarter of patients will not survive this temporary frontier (Fig. 1).

Recognized (A. V. Gavrilenko et al., 2010) that when the diagnosis of peripheral arterial diseases in a patient with px or kink, conservative therapy is shown regardless of the localization and prevalence of vascular lesion and is appointed life. After performing endovascular or operational interventions on the arteries, the need for conservative treatment is also preserved. In cases where there is no possibility to achieve adequate blood circulation compensation by surgical methods, the isolated use of the therapeutic treatment remains the only medical tactic of the doctor.

Modern approaches to conservative therapy

According to the management of the American Association of Cardiologists (2005), the main goal of conservative therapy in patients with UP and KIN is an improvement in the quality of life and reduce the risk of developing fatal cardiovascular events. For this, the medical tactics of the doctor should include both the correction of risk factors and the purpose of effective drugs. One of the leading directions of correction of risk factors is smoking refusal, which includes modification of behavior, nicotine-replacement therapy, therapy by bupropion) (Problem I) (Fig. 2).

All patients with PC are shown effective physical activity - dosage walking, that is, walking until the appearance of almost maximum ischemic pain (evidence class I). The medical physical education program is recommended as the initial form of treatment of patients with intelligible chromota as the main manifestation of chronic ischemia of the lower extremities (Hink) (level of evidence A). The duration of the treatment of therapeutic physical education is from 30 to 45 minutes; classes take place 3 times a week, the minimum course is 12 weeks. The maximum efficiency of the dosage walk is manifested after 1-2 months and persisted after 3 or more months. A favorable effect is explained by improving the metabolism of skeletal muscles, an increase in muscle mass, as well as improved endothelium function and, to a lesser extent, the formation of collateral blood circulation.

In addition to the modification of risk factors and dosage walking, the target conservative treatment has the following main vectors: the prevention of thrombotic and cardiovascular complications (im, stroke, death due to cardiovascular events) by long-term admission of antitrombocytic agents, the reception of pharmaceutical preparations of complex and metabolic action . Durable, often lifelong taking drugs involves a clear observance of the dosing and reception of drugs, the implementation of non-pharmacological medical measures, as well as regular observation by the doctor. The "adherence to therapy" of the patient is a key factor in achieving high treatment efficacy.

An important direction is to control the level of lipids in the blood. Treatment of hydroxymethylglutary-acetyl coenzyme a-reductase (statins) hydroxymethylglutazyl-acetyl-coenzyme (statins) is shown to all patients with diseases of the peripheral arteries (soup) to achieve the target level of low density lipoproteins (LDL) less than 100 mg / dL (evidence class I). The treatment of dyslipidemia reduces the risk of developing undesirable cardiovascular events in patients with atherosclerosis. However, the clinical picture of severe damage to the arterial bed of the lower limbs does not always strictly correlate with changes in the lipid spectrum of blood and the level of cholesterol and LDL.

All patients with PCs, both with PC and kink, is shown to control blood glucose levels (decrease in the level of glycosylated hemoglobin to 7%), and in the presence of diabetes mellitus - intensive therapy with antihyperglycemic drugs or insulin, as well as thorough skin care and heads (Problem I).

In addition to controlling the level of glucose, an important direction in the correction of the risk factors is the level of blood pressure (AD). Optimal in patients without concomitant pathology should be considered the level of ad less than 140/90 mm RT. Art., While the presence of such conditions as arterial hypertension, ischemic heart disease, chronic heart failure, diabetes mellitus and renal failure, determine the need to maintain the digits of blood pressure at the level of less than 130/80 mm RT. Art. (Problem I). The target preparations are inhibitors of an angiotensin glider enzyme (ACE), reliably reduce the risk of developing them, stroke and death due to cardiovascular events in patients with soup.

Antiagrageant (antithrombocyte) therapy in the form of aspirin intake in the dosage of 75-325 mg / day or clopidogrel 75 mg / day is shown to patients with atherosclerosis of the lower limb arteries to reduce the risk of cardiovascular events (evidence class I). A practical doctor should be remembered that in patients with PRS, oral anticoagulants in order to prevent unwanted cardiovascular ischemic events should not be applied.

It is advisable to prescribe to patients with Px phosphodiesterase III - cyclostazole inhibitor, which has a vasodilative, metabolic and disaggregative effect (evidence class I). In the dosage of 100 mg twice a day, the drug increases the freezing walking distance (dBX) by 40-60% compared with placebo after 12-24 weeks of treatment. Cylostazol, however, is not registered in the Russian Federation. Another obstacle to its widespread use is the need for a patient with concomitant pathology in the form of chronic heart failure of any class on the classification of the New York Association of Cardiologists (New York Heart Association, NYHA), as well as the restrictions imposed by the European Medical Agency for its use in 2013 . due to the high probability of side effects.

Pentoxifyllin in a dose of 1200 mg per day can be considered as one of the main drugs to increase the maximum passable distance (MDD) in patients with PC (evidence class IIB). Pentoxifillain improves the microcirculation and rheological properties of blood, has a vasodilatory effect, blocks phosphodiesterase and helps the accumulation of cyclic adenosine monophosphate in cells, which leads to a minimal, but statistically significant increase in dBH 21-29 meters and the maximum passable distance by 43-48 meters.

Sulodekside (250 Le orally 2 times a day), previously recommended for use in patients with kink, is currently recommended for patients with PC. In this cohort patients, the Sulodeksid increases dBH to 95% in exchange rate in combination with parenteral administration (evidence class IIA). The effectiveness of the drug is explained by the complex impact on the main links of the pathogenesis of the disease: the correction of the dysfunction of the endothelium, the normalization of blood rheology and the microcirculatory stream, an increase in fibrinolytic activity.

A promising direction in the complex treatment of patients with PC atherosclerotic etiology is the correction of endothelium dysfunction, aimed at stimulating the synthesis of nitrogen oxide (NO) cells of the endothelium. The endothelium dysfunction is expressed in increased permeability and adhesiveness, as well as in the increased secretion of the procoagulant and vasoconductive factors, which can be considered as an early stage of the development of vascular defeat. NO is an important regulator of cell metabolism and plays an important role in the pathogenesis of endothelial dysfunction. A positive effect aimed at the endothelium dysfunction correction may have intermittent pneumatic compression, including patients with critical ischemia lower extremities. Another vector correction vector of endothelial dysfunction is the use of drugs of a group of inhibitors of angiotensin glossy enzymes, mainly perindopril, angiotensin receptor blockers, mainly losartan, as well as beta-adrenoblockers, mainly nebivolol. This is especially important, given the high prevalence of arterial hypertension, as well as ischemic heart disease and chronic heart failure in patients with Hink. Beta-adrenoblockers are effective antihypertensive drugs and are not contraindicated by patients with the disease of the lower limbs, as it seems to most practical doctors.

The endothelium dysfunction correction is also possible by stimulating the secretion of NO exogenous factors of the L-arginine system - NO - guanillates, in particular, using the predecessor of nitrogen oxide L-arginine. Therapy aimed at the correction of endothelial dysfunction is extremely promising, but currently is mostly at the stage of clinical studies.

As indicated in the National Recommendations (2013), the use of genetically therapeutic drugs is applied to the high class of evidence of IIA. This group of drugs is actively investigated by the last two decades. They are agents t. N. "Therapeutic angiogenesis" - the new therapeutic tactics called by the introduction of genetic-therapeutic drugs encoding the synthesis of various short-lived and short-flowing molecules (growth factors, transcription factors) to induce the development of the microvascular network, and further lead to the formation of collaterals. It is believed that the development of a microcirculatory line in the ushizheny muscular massif of the lower extremities contributes to the oxygenation of tissues, reduces the overall peripheral vascular resistance, and new vessels formed at the level level are able to evolve into functional collaterals. Plasmid and adenoviral gene structures are tested as potential medicines. A large number of clinical studies are shown their safety, including oncological. At the II Phase II Phase of Clinical Studies, significant results for increasing the freezing distance were obtained with genes encoding an endothelial growth factor (Vascular Endothelial Growth Factor, VEGF165), the main fibroblast growth factor (Basic Fibroblast Growth Factor, BFGF), hepatocyte growth factor (Hepatocyte Growth Factor, HGF) and others. However, at stage III phases, the effectiveness for treatment was not established for all structures. In particular, the use of the drug based on the BFGF gene in patients with the IV stage of the disease (according to A. V. Pokrovsky-Fontaine) did not affect the life expectancy and preservation of the limb. At the same time, the plasmid design with the HGF gene applied according to the same testimony, significantly reduced the severity of pain syndrome, has positively influenced the quality of life, contributed to the healing of the ulcers, which was the basis for recognizing its effectiveness.

Currently, the State Register of Drugs of Russia includes a gennom-therapeutic drug Neovasculgen, the active substance of which is the super-propal plasmid with the VEGF165 gene. Its safety and efficiency were investigated during multicenter controlled randomized studies, which showed a reliable increase in the distance of nonsense walking, as well as a number of other effects, including an increase in oxygen tissue voltage, to some extent - linear blood flow velocity, an ankle-brachial index. The drug is intended for inclusion in the complex therapy of patients with the IIA-III degree of PC (by Pokrovsky-Fonene) atherosclerotic genesis. The drug is introduced at 1.2 mg of locally intramuscularly twice with an interval of 14 days. The possibilities of the drug are implemented in comprehensive therapy. As part of clinical studies, the effectiveness of the drug was estimated in patients who did not perform surgical methods of revascularization and which were not prescribed therapy with the drugs of a group of prostaglandins. It has been established that during the half a year in patients detected an increase in the freezer's walking distance by an average of 110.4%, and in a year by 167.2%. Patients with a more severe process of process - III were responsible to therapy with a more severe stage of process, 231.2 and 547.5% increases, respectively. Also, statistically significant shifts are recorded in control of the percutaneously determined oxygen voltage. Macroheremodynamics indicators are substantiated to a lesser extent - an ankle-shoulder index and a linear blood flow rate. It is important that in assessing the quality of life, such patients have a significant increase in the "Physical Health Component" scale (p \u003d 0.001).

In the treatment of kink, in case of the impossibility of performing endovascular or open arterial reconstruction, the therapeutic approach differs from the treatment of PC. Prostanoids, preparations of prostaglandin E1 (PGE1) and prostacyclin I2 (PGI2), are most studied in the treatment of kink. Numerous studies have shown that parenteral administration of them for 7-28 days can reduce pain alone and contribute to the healing of trophic ulcers and, in some cases, avoids or delay the amputation of the limb (the class of evidence IIB, the level of evidence A).

Therapeutic angiogenic drugs recommended for use in the treatment of PC are considered potentially effective in the treatment of cink patients. Their role is shown in the complex treatment of patients with kink in terms of improving remote results of reconstructive interventions. The first data (I. N. Brodsky, 2013) appear on the successful combination of prostacycline preparations with the induction of the development of the microcirculatory bed neovasculgen in heavy patients with kink.

Data on the effectiveness of hyperbaric oxygenation, spinal neurostimulation, as well as traditional physiotherapy (laser therapy, magnetotherapy) in the territory of Russia) in the treatment of cink, are contradictory, and there is no clear recommendations regarding their application. Encouraging data was obtained in relation to regional catheter thrombolysis in complex kink's integrated therapy in diabetic angiopathy. The purpose of local thrombolysis in this cohort of patients is the treatment and prevention of microtromotic formation, stabilization of the coagulation properties of blood.

Effective treatment of patients with interspersed chromota and its formidable complication in the form of critical ischemia of the lower extremities is an urgent problem of practical medicine due to insufficient attention, high burbidity, difficulties of treatment. The authors of the article hopes that the material given in the work will be useful in the work not only angiohurgeons, but also doctors of other medical specialties.

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R. E. Kalinin *, 1, doctor of Medical Sciences, Professor
N. D. Mzhavanadze *
R. V. Deev **, candidate of Medical Sciences

Chromota is a pathological change in the gait due to the violation of the function of one or both of the lower limbs. It occurs when the length of the limb, impaired motor and sensitive function. The chromoty in the form of a savings on a shorter leg is observed with a congenital underdevelopment of the limb, systemic lesions, curvature and defects of bones, pseudartropses of various origins, after incorrect fractures, as a result of inflammatory diseases (, osteomyelitis). The chromota occurs at various defects in the joints ("duck" gait during the bilateral dislocation of the thigh), there is a chromotype with rachitic or post-traumatic deformations of the hip neck. Sometimes chromoty arises as a result of pain due to various pathological processes in soft tissues, bones, joints and nerves. For the gait of such patients, the desire to move the support to a healthy leg faster.

Intermittent chromoty is caused by sharp oxygen starvation of tissues due to insufficient blood supply (see, obliterating). Chromotype can be the first symptom of a very serious disease (tuberculosis arthritis, bone tumor, etc.).

Treatment of chromoth. Elimination of the reasons for its causing, which requires clinical, radiological and other studies. More often use complex surgical treatments, orthopedic shoes (see shoes, orthopedic) and functional orthopedic devices.

Chromoty (Claudicatio) is a pathological change in the gait due to the impairment of the function of one or both of the lower limbs when the length of the limb, its curvature, violation of motor and sensitive functions is changed.

The change in the length of the limb, absolute or relative, is observed with micromelia, hondoderodistrophia, congenital dislocation of hips and other congenital diseases, as well as in a number of acquired skeleton lesions: as a result of incorrect fractures or after various inflammatory processes that have tested to destroy part of the skeleton of the limb or violation Its enchondral zones in the period of unfinished bone growth, for example, with epiphyseal osteomyelitis in childhood, bone-joint tuberculosis.

When shortering one of the lower extremities, the chromotype is expressed by the step in the step, "false" on a shorter leg. With a bilateral disorder of the legulation of the legs, for example, when bilateral (usually congenital) dislocation of the thigh, the gait acquires the character swinging from the side on the side, "duck", which is due to the alternate glide of the dislocated heads on the wing of the pelvis at the time of coming to the leg while at the same time weakening the tone of the jagium muscles. A similar chromoty is observed in the bilateral varetle curvature of the femoral-cereal angle (richite or traumatic origin). Chromoty arises in contractures, dislocation, false joints, vius, hughous curvatures of the thigh and shin also due to the shortening of the deformed leg. Chromoty as a result of motor disorders occurs during paresis and paralymps of the lower extremities. Depending on the type of paralysis (sluggish, spastic), the degree of its prevalence, the combination of the affected muscles, one- or bilateral damage, the nature of the chromotype is very diverse, especially since paralysis is often combined with shortening the affected leg, for example, after polio. The chromotomotic disorders of the sensitive sphere are two-way: less often due to the disappearance of sensitivity (anesthesia) and very often with its pathological increase - pain. The anesthesia of the limbs is developing at a traumatic or inflammatory break of centripetal nerve paths; The gait of such patients wears a screaming, astactic character.

The pain causing chromotomomium occurs as a result of lesions of nerve conductors, when irritating their foreign bodies (after injuries), scars, which is often accompanied by trophic disorders (chronic ulcers and osteoporosis). Most often to chromotype, pain caused by various pathological processes in soft tissues, bones and joints: myozit, neuritis, osteomyelitis, arthritis, faster bone corn after a fracture, tensile ligaments, flatfoot, etc. The gate of such patients is characterized by cautious advancing on Sick leg and desire as quickly as possible to move the support to a healthy, which, according to the opposite of chromotype, with a simple shortening of the leg, the patient begins to chrome upon the advancing not on the affected, but on a healthy leg.

The special type of chromotype develops with pain caused by the oxygen starvation of the finiteness of the finiteness due to the starting binding endarterity; Pains acutely occur when walking, often with a spasm of the calf muscle; After a short stop, they calm down, but repeated with the resumption of movement. This is the so-called intermittent lameness (see).

It should be borne in mind that lameness is often the first symptom of a very serious disease, such as tuberculous arthritis, bone sarcoma, etc.

Radical treatment of chromotype consists of eliminating the cause, its defiant, which requires careful clinical, radiological and other studies. With small degrees of anatomical shortening, it is enough to put in the liner shoe (cork, lime, felt, plastic).

With a more significant shortening, special orthopedic shoes are needed (see) or the extension operation of a shortened leg is sometimes combined with shortening healthy. With a chromotype due to paralysis, various plastic surgery (muscle transplantation, tendase, arthrodez, arthrium) are shown, and in case of insufficient effectiveness - functional orthopedic devices. When chromotypes, due to contractures, bone curvatures, false joints - operational treatment (redressation, motomy, osteotomy, etc.). With chromotype of painful origin - immobilization of the limb, the blockade of the painful hearth (in arthrosis, some forms of chronic arthritis) and the main treatment of the main disease accompanied by chromota.