ХРОНИЧЕСКАЯ ИШЕМИЯ, УГРОЖАЮЩАЯ ПОТЕРЕЙ КОНЕЧНОСТИ, — ЭПИДЕМИОЛОГИЯ, ПАТОГЕНЕЗ, ДИАГНОСТИКА И СТРАТЕГИИ ЛЕЧЕНИЯ
Аннотация
Хроническая ишемия, угрожающая потерей конечности (ХИУПК), — это синдром хронических облитерирующих заболеваний периферических артерий, различных по этиологии и патогенезу. Заболевания, вызванные дегенеративным поражением артериального русла, могут приводить к ХИУПК, вызывая аневризмы и длительные хронические окклюзии. К таким заболеваниям относятся: Синдром Марфана, Элерса–Данло, опухоль Эрдгейма, нейрофиброматоз, фиброзная дисплазия. Множественные васкулиты встречаются при системных васкулитах и заболеваниях соединительной ткани. В подавляющем большинстве случаев (75–80%) патогенетическим механизмом, приводящим к развитию хронических облитерирующих заболеваний артерий нижних конечностей и ХИУПК, являются атеросклероз и сосудистые осложнения, связанные с сахарным диабетом. Все эти заболевания приводят к значительному снижению перфузионного кровотока на уровне микроциркуляции, вызывая тяжелые метаболические нарушения. Со временем нарушаются реологические свойства крови, способствуя прогрессированию ишемии тканей. При ХИУПК многие компенсаторные возможности организма уже исчерпаны, но проведение реваскуляризации нижней
конечности все еще возможно.
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