OBLITERATING ARTERIAL DISEASES
Chronic obliterating diseases of the arteries of the lower extremities affect 2-3% of the population, and in old age 10-17% of the population is affected. Despite the diverse nature of their occurrence, they all lead to gradual narrowing and complete occlusion of the lumen of the major arteries, and as a result to chronic ischemia of the extremities. According to various authors, in the natural course of diseases, 25-50% of patients develop gangrene of the limb within 5-8 years from the onset of the disease.
Among chronic obliterating diseases of the arteries of the lower extremities, the main nosological form is obliterating atherosclerosis. It accounts for 82% of clinical observations of patients with chronic limb ischemia. Other diseases include the peripheral form of Takayasu's arteritis (9% of patients), diabetic angiopathy (6%), Buerger's disease (1.4%) and Raynaud's disease (0.4%).
Etiology and pathogenesis of obliterating arterial diseases. Obliterating atherosclerosis (atherosclerosis obliterans) is a chronic systemic disease leading to degenerative changes in the arterial wall and the formation of atheromas in the subintimal layer. It is observed mainly in men over 40 years old. The process is localized mainly in largeand medium-sized arteries. The main reason for the development of this disease is hypercholesterolemia. In the bloodstream, cholesterol circulates in a bound state with proteins and lipoproteins. Low-density lipoproteins and very low-density lipoproteins (LDL and VLDL) are especially active carriers of cholesterol from the blood to tissues, which is why they are called atherogenic. Atherosclerosis often develops in individuals with a high level of these particular lipoprotein fractions.