On the effectiveness of functional tests in the determination of obliterating atherosclerosis of the arteries of the lower extremities

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Introduction. One of the reasons for the development of pathologies of the cardiovascular system is the processes of atherogenesis and the formation of atherosclerotic plaques. According to the World Health Organization, atherosclerosis is defined as a community of changes in the intima of the artery, expressed in the accumulation of lipids, complex carbohydrates, fibrous tissue, plasma components of blood, calcification, which leads to a change not only in intima, but also in the media of the artery [1]. Obliterating atherosclerosis of the arteries of the lower extremities can lead to disability not only in senile and elderly patients, but also in the young able-bodied population. The variability of clinical manifestations makes this disease difficult to diagnose at the initial stages [2].
Arterial hypertension is one of the factors of peripheral atherosclerosis, which often aggravates its course. Modern studies have shown that the presence of arterial hypertension contributes to the development of peripheral atherosclerosis 2.5 times in men and 3.9 times in women compared with people who do not have this pathology [3].
In the course of modern research, it has been revealed that smokers and alcohol drinkers have more pronounced hemodynamic disorders of the small circle of blood circulation. Nicotine also has a direct damaging effect on the artery wall, and ethanol has a damaging effect directed at the vascular wall [4].
The relationship between diabetes mellitus and atherosclerosis is that in diabetes mellitus, the activity of arterial calcification processes increases, which leads to the development of endothelial dysfunction and atherosclerosis [5].
A number of studies have confirmed that there is a direct correlation between the severity of a decrease in glomerular filtration rate and the rate of progression of heart and vascular pathology at the structural and functional levels. Currently, it has been proven that the level of annexin-5, which increases with a decrease in the glomerular filtration rate, affects the lipid composition of the blood and possibly disrupts the function of the vascular endothelium [6].
Constant mental stress causes a cascade of protective reactions that contribute to early aging of the body. Metabolic processes change from predominantly carbohydrate to predominantly lipid, which is where vascular endothelial dysfunction begins [7].
Often, poor nutrition and physical inactivity lead to an increase in body mass index – to obesity, which is undoubtedly one of the leading factors in the development of atherosclerosis. With excessive production of adipose tissue, there is a violation of the production of adipokines and adiponectins, whose properties directly affect the vascular wall, protecting it, but in overweight people their content in the blood is extremely low, which leads to a decrease in the protective properties of the vessel wall [8].
Familial hypercholesterolemia is a hereditary disease that increases the risk of atherosclerosis. It is important to screen for this pathology in young people in order to prevent the onset of the disease [9].
With age, a person's body condition worsens, including the cardiovascular system. Studies show that the risk of complications and progression of atherosclerosis increases with age. In addition, age-related patients often have concomitant diseases that also negatively affect the condition of blood vessels [10].
The aim of the study is to determine the effectiveness of functional tests for obliterating atherosclerosis of the arteries of the lower extremities in the conditions of initial examination of the patient.
Materials and methods of research. To identify the trigger factors for the development of atherosclerosis and to determine the effectiveness of functional tests for obliterating atherosclerosis of the lower extremities, an initial examination was performed taking into account the above methods. 100 people participated in the study. Among them, 58% are women (65% are over 40 years old and 35% are under 40 years old), 42% are men (62% are over 50 years old, 38% are under 50 years old).
The results of the study. During the study, the following results were obtained: 61% of the respondents confirmed the presence of hypertension, of which 58% were women over 40 years old, 2% were women under 40 years old, 34% were men over 50 years old, 6% were men under 50 years old. To the question “Do you smoke?” 42% of the respondents responded positively, among whom 34 men and 8 women were men. The presence of type 2 diabetes was confirmed by 21% of respondents, among whom women predominate - 68% and 32%- men. To the question “Do you drink alcohol?” 42% answered in the affirmative. Among them, 38 people prefer strong alcoholic beverages, 4 people prefer low-alcohol drinks. It is worth noting that this statistic includes people who drink alcohol at least 2 times a month. The respondents also described their physical activity. 72% noted physical inactivity, of which 44% were women and 28% were men. An increase in sensitivity to a decrease in temperature and cramps in the lower extremities was noted by 26% of respondents. Numbness and fatigue of the lower extremities were noted by 13% of the respondents. The phenomenon of intermittent lameness was noted by 40% of the respondents, the remaining 60% did not encounter such a problem. Arterial insufficiency of the pelvic floor muscles, manifested by incontinence of gases or feces, was noted by 44% of respondents. Chronic kidney disease was confirmed by 16% of the respondents. 36% of the respondents experienced prolonged mental stress. Eating disorders were observed in 58% of the respondents.
After the survey, the respondents were examined using functional atherosclerotic samples. Ratshov's test, characterized by the appearance of pain in the calf muscles, was noted by 36% of respondents. The Samuels test consists in observing the color of the foot after the Ratshov test, a positive result, paleness of the foot, was also noted in 36% of respondents.
A study was also conducted on the Panchenko phenomenon, the respondents took a sitting position and crossed their legs, when this phenomenon occurs, the patient experiences pain, numbness, paresthesia. The percentage of respondents who showed this phenomenon is also 36%.
The phenomenon of a pale spot is observed with impaired blood supply to the capillaries of the skin after their compression. This phenomenon was observed in 20% of the respondents.
Let's summarize the interim results from the above statistics. Since intermittent claudication is the main symptom of progressive obliterating atherosclerosis of the arteries of the lower extremities, the following calculations were performed for those 40 people who had this symptom.
70% noted an increase in sensitivity to a decrease in temperature and seizures. 80% experienced numbness. Arterial insufficiency of the pelvic floor muscles is 60%. 45% smoke. 80% have a history of hypertension. 40% have type 2 diabetes.
80% of people are obese, 40% had alcoholism, 80% of people led a sedentary lifestyle, 45% of people had constant mental stress, 75% violated the dietary regime.
The respondents encountered the term "hereditary dyslipidemia" for the first time, therefore, statistical data related to this factor are not of scientific value, but based on such results, sanitary and educational work on this topic should be carried out to educate the population about possible pathologies.
Violation of pulsation in the femoral artery was detected in 50%, upon detailed examination of this violation from the circulatory side, the following indicators of pulsation disorders in the peripheral arteries of the lower extremities are noted: popliteal - 60%, posterior tibial- 60%, dorsal- 90%. Functional atherosclerotic tests were positive in 60% of the patients, and the pale spot phenomenon was detected in 25%.
Conclusion. Based on individual risk factors for the occurrence of obliterating atherosclerosis of the arteries of the lower extremities, it is possible to assume the risk of the occurrence or progression of atherosclerosis without complex laboratory studies. But it is important to remember that the use of only functional tests for the early diagnosis of atherosclerosis of the arteries is not suitable, since the samples are positive only in people with terminal stages of the disease.

About the authors

Valeria Antonovna Utkina

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0000-4449-4995

Student

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Alina Sergeevna Filich

Tver State Medical University

Email: ammorozovv@gmail.com
ORCID iD: 0009-0004-3942-9717

Student

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

Artem Мihailovich Morozov

Tver State Medical University

Author for correspondence.
Email: ammorozovv@gmail.com
ORCID iD: 0000-0003-4213-5379
SPIN-code: 6815-9332

Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of General Surgery

Russian Federation, 170100, Russia, Tver, Sovetskaya str., 4

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