Angiopathy bca. Arterial angiopathy and its manifestations. Retinal vascular angiopathy in children

Angiopathy of the retina, in fact, is not a separate disease, but only a manifestation of other pathologies that affect the entire blood supply system of the body, including the vessels of the retina. The manifestation of angiopathy consists of pathological changes in blood vessels due to impaired nervous regulation. This disorder threatens with very sad consequences, including complete loss of vision, so these days it is the object of a lot of attention. The pathological process can develop at any age, but angiopathy most often occurs in patients over 30 years of age.

Retinal angiopathy is classified according to the pathologies that caused its manifestation. There are the following types of this disease:

• Diabetic angiopathy. It occurs against the background of advanced diabetes mellitus, which causes damage to all the blood vessels of the body, and, accordingly, to the capillaries of the retina of the eyes. The result is a significant slowdown in blood flow, blockage of blood vessels, and ultimately deterioration of vision.
• Hypertensive angiopathy. In the presence of hypertension, a very common consequence is retinal angiopathy. Its manifestations are branching and dilated veins, frequent pinpoint hemorrhages in the eye and opacities. After successful treatment of hypertension, angiopathy disappears on its own.
• Hypotonic angiopathy. Due to a decrease in the tone of small vessels, they become overfilled with blood, and a decrease in blood flow leads to the formation of blood clots. Patients complain of strong pulsation of blood vessels in the eyes.
• Traumatic angiopathy. The causes of its development may be damage to the cervical spine, brain injury, or sudden compression of the chest. In these cases, compression of the blood vessels or increase in intracranial pressure occurs, and this leads to the development of angiopathy.
• Juvenile angiopathy. The causes of this disease are not fully understood, but it is considered the most unfavorable type of angiopathy. Its most common symptoms are inflammatory processes of blood vessels, frequent hemorrhages in the retina and vitreous body. There is a possibility of connective tissue formation on the retina. These pathological processes often cause the development of cataracts, glaucoma, retinal detachment and lead to complete loss of vision.

Video from our specialist about angiopathy

Causes of retinal angiopathy

• Pathology of the nervous regulation responsible for the tone of the walls of blood vessels;
• Trauma to the brain or cervical spine;
• Osteochondrosis of the cervical spine;
• High intracranial pressure;
• Blood diseases;
• Smoking;
• Age-related changes in older people;
• Arterial hypertension;
• Intoxication of the body;
• Harmful working conditions;
• Individual features of the structure of the walls of blood vessels.

Symptoms of retinal angiopathy

• Manifestation of blurred or deteriorating vision;
• Loss of vision:
• Nosebleeds;
• Progressive myopia;
• Dystrophic process of the retina;
• The appearance of “lightning” in the field of view.

Diagnostics

Retinal angiopathy is diagnosed by an ophthalmologist based on examination of the patient’s fundus (ophthalmoscopy, including with a wide pupil) and the symptoms of the disease. The diagnosis is clarified using special studies: Doppler ultrasound of blood vessels, which allows you to obtain data on the speed of blood circulation and assess the condition of the walls of blood vessels, as well as an X-ray study - FA (fluorescein angiography of the retina), which, through the introduction of a radiopaque substance, helps to study the patency of blood vessels. If necessary, to study the structure and condition of soft tissues, additional tomography of the retina is performed.

Treatment of retinal vascular angiopathy

Diagnosis and treatment of retinal angiopathy should be carried out by a highly qualified specialist (retinologist). In the drug therapy of angiopathy, drugs are always used that normalize blood circulation in the vessels of the eye: solcoseryl, arbiflex, pentilin, trental, emoxipin, vasonite, etc. The effect of these drugs is to increase the bendability of red blood cells, due to which capillary blood flow is normalized. For patients with fragile vessels, the use of calcium dobesilate is indicated, the effect of which is to thin the blood, improve blood circulation and the permeability of the vascular walls.

In certain cases, the course of treatment of retinal angiopathy of both eyes is supplemented with physiotherapeutic procedures: magnetotherapy, acupuncture, and laser irradiation. These therapeutic measures improve the general condition of the patient with angiopathy.

When treating hypertensive angiopathy, it is very important to normalize blood pressure and reduce blood cholesterol levels.

In the case of diabetic angiopathy, in addition to drug therapy, a special diet plays an important role, in which foods rich in carbohydrates are excluded from the diet. Light physical activity can also benefit the functioning of the heart and blood vessels.

When the disease progresses and turns into retinopathy, laser coagulation of the retina is used.

Although retinal angiopathy is a reversible side disease, it should be taken seriously. If the underlying disease is not treated, an advanced form of angiopathy can lead to very severe deterioration of vision and even complete loss.

With angiopathy, destabilization of the tone of blood vessels occurs, the cause of which is a disorder of nervous regulation. In the lumen, the inflow (outflow) of blood worsens. Retinal vascular angiopathy, as is known, manifests itself as a pathological change that is a continuation of many diseases. While not an independent disease, it signals other pathological processes affecting the blood vessels. Damage to the capillaries and blood vessels of the eye is caused mainly by spasms and vascular paresis. Doctors pay serious attention to this disorder, because in an advanced state, angiopathy threatens vision loss.

Damage to the vessels of the eye tissue affects adults and children, but more often it appears after 30 years. In a child, retinal angiopathy is characterized by a rather objective sign. It changes with the child’s position (sitting or standing) and with physical activity. In adults, naturally, against the background of a persistent increase in blood pressure, cerebral microangiopathy also quite often manifests itself. Inaction will lead to pathological, possibly irreversible processes.

Complications of the disease are expressed in optic nerve atrophy; narrowing of visual fields, loss of vision (partial, complete). There is a classification of diseases that cause retinal angiopathy. Accordingly, several types of this disease have been identified.

Types of eye angiopathy

The main types of retinal angiopathy are as follows:

1. Youthful.
2. Hypertensive.
3. Traumatic.
4. Hypotonic.
5. Diabetic.

Eales disease – a problem for young men

The first type is considered the most unfavorable. Also called Eales disease. The etiology of juvenile angiopathy is unclear. It is characterized by inflammation of the retinal vessels, usually venous. There is hemorrhage in the retina and vitreous body. Connective tissue also forms inside them. Sometimes complications arise, for example, retinal detachment, glaucoma, cataracts.

Hypertensive angiopathy: sharply narrowed second-order arterioles.

Hypertensive type

Hypertensive angiopathy is a consequence. Uneven narrowing of the arteries begins to appear in the fundus. The presence of hypertension almost always leads to disruption of the structure of the retina. This is marked by the branching of the veins, their expansion. Pinpoint hemorrhages occur in the eyeball. Clouding of the eyeball may occur. In advanced cases, a complete change in the retinal tissue is possible. When hypertension is eliminated, the condition of the fundus improves. This disease of the hypertensive type also occurs in pregnant women. It usually begins after the sixth month of fetal development.

Angiopathy as a consequence of injury

Traumatic angiopathy, as is known, occurs due to compression of the chest, damage to the spine (cervical spine), increased intracranial pressure, and brain injury. The occurrence of atrophy in the optic nerve is fraught with deterioration of vision. Timely treatment will prevent retinal detachment and glaucoma.

Hypotonic appearance

Hypotonic angiopathy usually manifests itself when the tone of (small) vessels decreases. The blood vessels begin to overflow with blood, and a decrease in blood flow may also occur. The result of this will be thrombus formation. This type of angiopathy is characterized by palpable pulsation, dilation of the arteries, and branching.

Micro and macro disorder in diabetes

Diabetic angiopathy is very common. Its appearance is associated with the fact of untimely treatment. Moreover, two types are noted: and macroangiopathy. The first type is damage to the capillaries, when their walls become thinner. Because of this, blood penetrates into the adjacent tissues - hemorrhage occurs. Blood circulation is also impaired. Damage to large vessels is macroangiopathy. If diabetes is not treated and high blood levels are recorded, there is a risk of diabetic microangiopathy. Fat will accumulate inside the vascular wall, which will lead to its thickening. Next, blockage of blood vessels will occur, causing hypoxia of the retinal tissue. This type of disorder causes ischemic disease. Peripheral vessels are also affected.

Causes of angiopathy. Symptoms

The reasons for the development of the disease, according to doctors, are the following factors:

• A disorder of nervous regulation, which is certainly responsible for vascular tone;
• Injuries to the brain, spine (namely the cervical vertebrae);
• Increased intracranial pressure;
• Harmful working conditions;
• Eye injuries;
• Smoking;
• Features of the structure of blood vessels (congenital);
• Various blood diseases;
• Elderly age;
• Arterial hypertension;
• Systemic (a form of vasopathy);
• Intoxication of the body;
• Presbyopia of the eyes.

The causes of juvenile angiopathy require additional research. This is a rare type of this disease. The main cause of vascular damage, without a doubt, is an advanced form of diabetes, causing impaired hemostasis. But sometimes, unfortunately, such a deviation is observed in a newborn, although he does not have the above diseases. Retinal angiopathy is detected in the maternity hospital. But worries about this are premature. The disease may be a consequence of a difficult birth. Most often, there is no threat to the newborn’s vision. After some time, this pathology will go away on its own.

Gvist's symptom, in which yellow spots appear on the eyeball, is a sign of a hypertensive type of eye damage.

Symptoms of angiopathy manifest themselves as follows:

1. Vision deteriorates (the image becomes cloudy);
2. “Lightning” in the eyes.
3. Vision is completely lost;
4. Disturb;
5. Leg pain;
6. Progressive myopia is observed;
7. Retinal dystrophy appears;
8. Blood in the urine;
9. Gastrointestinal bleeding occurs.

Yellow spots, branching of blood vessels, tortuous small vessels, and pinpoint hemorrhages are clearly visible on the eyeball. With hypotonic angiopathy, the patient often feels pulsation in the fundus.

Diagnostics. Purpose of treatment

For correct, effective treatment of retinal angiopathy, professional diagnosis is very important. The disease is diagnosed, naturally, only by an ophthalmologist. To clarify the diagnosis, special studies will be required, for example, ultrasound scanning of blood vessels, which provides information regarding the speed of blood circulation. Thanks to Doppler (duplex) scanning, the specialist sees the condition of the walls of blood vessels.

X-ray examination is also effective. During the procedure, an X-ray contrast agent is injected to determine the patency of blood vessels. Magnetic resonance imaging may sometimes be used. This helps to visually study the condition of the soft tissues.

Having discovered angiopathy, the doctor prescribes effective drugs to improve blood circulation: pentilin, vasonite, arbiflex, solcoseryl, trental. However, during pregnancy it is undesirable to treat angiopathy with medication. Chemical exposure to the fetus should be completely avoided to maintain health. Therefore, doctors prudently do not prescribe drugs, in particular those that improve blood circulation. Gentle physiotherapeutic methods are selected.

To treat diabetic angiopathy, a special diet must be added to the prescribed medications. It is necessary to exclude carbohydrate foods from the daily diet. Doctors also recommend light (non-straining) physical activity, which will contribute to the necessary consumption of sugar by muscles, improvement of condition, and normal functioning of the cardiovascular system. TO

When there is increased fragility of blood vessels, it is advisable to prescribe calcium dobesilate. Thanks to the drug, blood microcirculation improves, blood viscosity decreases to the required extent, and vascular permeability is quite effectively normalized.

The treatment of angiopathy of both eyes may involve the use of physiotherapeutic methods. Various procedures (for example, laser irradiation, magnetic therapy, acupuncture) improve the general condition.

For hypertensive angiopathy, treatment aimed at normalizing blood pressure and significantly lowering cholesterol levels is effective. An appropriate diet is prescribed. The ophthalmologist usually prescribes eye drops and vitamins (Anthocyanin Forte, Lutein). In advanced angiopathy, hemodialysis is prescribed. The procedure helps cleanse the blood.

What is retinal angiopathy? Such a diagnosis frightens the patient - the disease sounds so menacing. The question remains: what to do with angiopathy and how to detect it?

Description of retinal angiopathy

Retinal angiopathy is not an independent pathology. The condition occurs when the function of blood vessels is impaired, failure of which is a common symptom various diseases.

With angiopathy of the retina, disturbances occur in the functioning of blood vessels and capillaries, which often leads to hemorrhages

Delayed diagnosis and lack of treatment can have a negative impact on the patient’s health, as irreversible consequences arise. An example is necrotic changes in the affected area, the nutrition of which was carried out using a damaged vessel. The retina becomes thinner and weakens, which leads to rupture and detachment.

Types of disease and causes

The diversity of species is due to different reasons for the appearance and mechanisms of formation of pathology. The age of the patient also matters. There are the following forms of retinal angiopathy:

Predisposing factors are:

• elderly age;
• intoxication of the body;
• professional affiliation associated with hazardous and difficult production;
• smoking;
• scoliosis;
• the presence of congenital vascular anomalies.

Symptoms

Changes in the blood vessels are noticed almost immediately by the patient. Floaters and dark spots appear before the eyes, and some patients develop dark spots. The condition is accompanied by pain in the eyeball. After prolonged use, pulsation is felt.

Visual impairment also does not bypass the patient, progressing over time and becoming persistent.

Thus, the following manifestations are characteristic of retinal angiopathy:

1. Deterioration in visual acuity associated with clouding.
2. Development of myopia.
3. The appearance of flashes, dots and spots before the eyes.
4. The appearance of bleeding. Blood is even found in urine and feces.

Clinical picture for various types of pathology - table

Features of the disease during pregnancy

Retinal pathology occurs frequently in pregnant women. This is due to an increase in the volume of circulating blood, which results in enlarged blood vessels.

If the patient had angiopathy before conception and occurred against the background of hypertension, then retinal damage will progress throughout the entire period of gestation. This is a risk for women, as the pathology can cause serious complications. In this case, constant monitoring of the patient's condition is required.

For mild angiopathy, medical intervention is not required. A favorable birth will lead to spontaneous elimination of the disease within a few months.

If there is a threat to life, women raise the question of a caesarean section or termination of pregnancy. The need to use these methods is determined by doctors, who take into account the existing risks. Absolute indications include:

1. Thrombosis of central veins.
2. Retinal disinsertion.
3. Progressive retinopathy (damage to the retina).
4. Threat of vision loss.

Relative indications for the use of cesarean section are:

• arteriospasmolytic retinopathy in its initial form;
• the presence of timely detected visual impairments during a previous pregnancy that arose due to toxicosis.

With relative indications, the patient can give birth on her own. Childbirth is carried out under the supervision of a doctor.

Angiopathy in newborns, infants and older children

In childhood, the formation of angiopathy is also associated with the presence of serious pathologies. More often, retinal damage occurs due to endocrine diseases, but the following factors also include the following factors:

The appearance of diabetic angiopathy is typical for children in the later stages of development of diabetes mellitus. The child has tortuosity of the veins of the fundus, there are minor hemorrhages and a swollen state of the retina. For this reason, controlling your blood sugar levels is important. This is especially true for those families where the likelihood of diabetes is high.

Children often get injured, so the risk of traumatic angiopathy is quite high. With this form of the disease, the child feels pain in the eye area. The degree of visual acuity also decreases, and small hemorrhages are present on the retina or eyeball.

Pathology also occurs at an earlier age. Often, retinal abnormalities are detected while the mother and newborn are in the maternity hospital. At the early stage of the postpartum period, such changes do not relate to pathological conditions, but the appearance of angiopathy in the late period requires medical intervention.

It is extremely difficult to detect the disease on your own. Some babies have one symptom, which is small spots on the eyeball. It is necessary to visit an ophthalmologist and neurologist and consult, because the condition of the baby may indicate other problems with the organs of vision.

Features of eye angiopathy in children - video

The diagnosis is made by an ophthalmologist based on the patient’s complaints, the results of an eye examination and additional studies.

Treatment

Choosing a treatment method is a responsible undertaking. The selection of the technique is carried out on an individual basis, since the patient’s age, type of angiopathy and the reasons that caused the development of the pathology are taken into account.

Therapy is aimed at eliminating the factors that led to the formation of the disease, for example, for diabetes mellitus, drugs are used to lower blood sugar.

Treatment is carried out comprehensively, using several techniques:

1. Conservative tactics.
2. Surgical intervention.
3. Physiotherapeutic treatment.
4. Traditional medicine.

Conservative treatment

Therapy includes several groups of drugs aimed at eliminating the pathological process.

1. Vitamin therapy. Vitamins C, P, E and B (B15, B12, B1, B6) are prescribed.
2. To reduce vascular permeability: Parmidine, Dobesilate and Ginkgo Biloba.
3. In order to strengthen the walls of blood vessels and improve blood microcirculation: Cavinton, Solcoseryl, Actovegin, Trental, Arbiflex, Vazonit, Pentoxifylline.
4. To improve blood microcirculation: eye drops Taufon and Emoxipin.
5. To prevent the formation of blood clots: Dipyridamole, Trombonet, Ticlodipine, Lospirin and Magnicor.

Conservative therapy is rarely used to treat pregnant women. This is due to the risk of side effects on fetal development. Exceptions include conditions that threaten the life of the mother, as well as severe forms of gestosis (a complication of the normal course of pregnancy).

Medicines for angiopathy - gallery

Ginkgo Biloba is necessary to reduce vascular permeability Trental is used to strengthen the walls of blood vessels and improve blood microcirculation Trombonet is used to prevent blood clots Taufon drops are designed to improve blood microcirculation

Physiotherapy

For retinal angiopathy, physiotherapy is indicated. Effective methods are:

• laser irradiation - aimed at purifying the blood. Reduces its toxicity and strengthens the patient’s immune system. Recommended for diabetic angiopathy;
• Magnetic therapy - leads to increased blood circulation, increased cell permeability and increased enzyme activity, reduces tissue swelling, eliminates inflammation and pain. The technique is prescribed for stage 1 or 2 hypertension, as well as for atherosclerosis. Contraindication: hypotension;
• acupuncture - suitable for people whose angiopathy is caused by injury, hypertension or hypotension.

ethnoscience

Traditional recipes are also included in the treatment of angiopathy. The technique will not get rid of the pathology, but will have a beneficial effect on the patient’s well-being.

1. Mix 0.5 tbsp. l. chamomile and 0.5 tbsp. l. St. John's wort, pour 0.5 liters of boiling water and leave for 20 minutes. Strain and take half the resulting volume on an empty stomach in the morning and after dinner.
2. Take 50 g of yarrow herb, 15 g of lemon balm leaves, 15 g of crushed valerian rhizomes. 2 tsp. pour the mixture with a glass of water and leave for 3 hours in the cold. Boil the product for about 15 minutes in a water bath. Cool, strain and dilute with water, bringing the volume of liquid to 0.25 liters. Take the decoction in small portions throughout the day.
3. Take 50 g of hawthorn flowers, 30 g of knotweed grass and 20 g of horsetail grass. 2 tsp. pour a glass of boiling water over the mixture, leave for 30 minutes, then strain. Take the medicine 3 times a day, 1 tbsp. l. 30 minutes before meals.

Folk remedies can be used after visiting a doctor and receiving recommendations. This technique should not be used as the only and main method of treatment.

Alternative remedies - gallery

Horsetail grass Knotweed grass Hawthorn flowers Valerian rhizomes with roots Melissa officinalis herb Common yarrow herb pharmaceutical camomile St. John's wort herb

Diet

Diet is needed during the development of hypertensive and diabetic angiopathy. The principle of nutrition is to avoid foods that contain a lot of cholesterol and easily digestible carbohydrates.

Important! It is necessary to create a diet with a doctor.

In case of diabetic angiopathy, the following products are excluded from the patient’s menu:

• pepper, mustard;
• vegetables with a lot of carbohydrates and starch: beans, beets, carrots, potatoes, peas;
• hot, spicy, salty and smoked snacks and dishes, lamb and pork fats;
• fatty meat, sausages and salami;
• grapes, bananas, raisins and other sweet fruits;
• alcoholic drinks;
• confectionery, baked goods, jam, honey;
• meals from fast food chains;
• sugar (allowed only in small quantities with doctor's permission);
• ice cream.

During the development of hypertensive angiopathy, exclude:

• offal (liver, kidneys, tongue, brains);
• rich broths and soups made from them;
• hard-boiled and fried eggs;
• chocolate, ice cream;
• strong tea and coffee, cocoa, sweet carbonated drinks;
• margarine and cooking oil;
• sausages and sausage products;
• canned fish and meat;
• fatty varieties of fish, poultry and meat (lamb, pork, goose, duck, mackerel, salmon, halibut);
• pepper, horseradish, mustard;
• spicy snacks and dishes;
• cream, sour cream, full-fat cottage cheese and milk;
• sharp and fatty cheeses;
• salted and marinated fish, corned beef;
• fresh bread made from premium flour, all baked goods (pies, pancakes, pancakes, cakes and pastries with cream, puff pastry);
• salo.

Prohibited products - gallery

Alcohol is completely avoided Beets, like potatoes, contain a lot of starch If you have retinal angiopathy, it is better to avoid ice cream and sweets. Lard is not recommended for diabetic and hypertensive forms of angiopathy Potatoes contain a lot of starch, and therefore are harmful for diabetic angiopathy

Prognosis and complications

If the disease is detected on time and treatment is started in a timely manner, the prognosis is favorable. It is recommended to pay attention to the underlying disease, follow the doctor’s recommendations and prevent the development of angiopathy.

Lack of therapy leads to the formation and complete loss of vision.

The greatest danger is the juvenile form of angiopathy, which is difficult to treat. Complications with this type are serious:

• vitreous hemorrhage;
• retinal disinsertion;
• cataract;
• retinal rubeosis (increased number of blood vessels).

Prevention

Prevention is aimed at preventing an unfavorable outcome from the underlying disease: diabetes mellitus, low or high blood pressure. The patient observes the following rules:

1. Regularly undergoes preventive examinations.
2. Gives up bad habits.
3. Follows daily and nutritional regimen.
4. Normalizes physical activity.
5. Seek medical help in a timely manner to treat diseases that have a negative impact on blood vessels.

Retinal angiopathy requires monitoring. There is no need to despair, as with timely treatment the chances of recovery increase. Therefore, if signs indicating the development of a pathological process appear, it is necessary to consult a doctor as soon as possible and undergo an examination.

Vascular diseases can manifest themselves in the form of various angiopathies, which cause irreversible changes in the body. In some cases, they are quite dangerous, as they lead to disability or even death for the patient. Therefore, in such cases, correct diagnosis and effective treatment are necessary.

Angiopathy (AP) is characterized by damage to blood vessels, most often small and medium-sized, resulting in the development of a corresponding clinical picture. It occurs against the background of various diseases (diabetes mellitus, hypertension, due to injury), and is therefore considered a complication of them.

The long course of angiopathy threatens the occurrence of chronic disorders in the blood supply system, which leads to disruption of the functioning of various organs and parts of the body.

Examination of patients with angiopathy plays an important role in making the correct diagnosis, since it is important to determine the main cause of the development of the pathology. The course of AP may be more or less pronounced, but appropriate treatment must be carried out. Otherwise, the tissues that supplied blood to the affected vessels begin to die.

Video Hypertensive retinal angiopathy. What is it and why is it dangerous?

What is angiopathy?

In normal condition, small-caliber vessels are elastic and free for blood flow. With angiopathy, their structure is disrupted, as a result of which they become brittle, with thick walls, and in some cases the lumen of the vessel is partially or completely blocked. All this contributes to a change in normal blood circulation, which disrupts the blood supply to tissues and organs.

Angiopathy most often affects:

1. Lower limbs
2. Retina
3. Brain
4. Kidneys.

It is in these organs and parts of the body that small-caliber vessels are most concentrated. If the structure of a small part of the capillary network is disrupted, mild signs of the disease develop quite quickly at first, and over time they become more pronounced and clinically unfavorable.

Predisposing factors leading to angiopathy:

• A disorder of nervous regulation, expressed in changes in vascular tone (persistent expansion, that is, dilatation, or excessive narrowing, that is, spasm).
• The presence of abnormal proteins in the blood that permeate the vascular walls, thereby changing their structure.
• Increased pressure in blood vessels, which has a negative effect on the vascular wall.
• Inflammation that lasts for a long time.

Angiopathy is more often diagnosed in diabetes mellitus, since this disease is very common today. Other forms of the disease are no less complex and dangerous in their development, so there is this opinion:

“Angiopathy develops suddenly and leads to serious consequences”

Some statistics:

• Damage to the kidney vessels in 60% of cases develops against the background of diabetes mellitus, and in 40% - arterial hypertension.
• 80% of patients with angiopathy have bad habits, are over 50 years old, or have other risk factors.
• In patients with diabetes, angiopathy occurs after 10-15 years of development of the underlying disease.
• In 35-40% of patients of working age, angiopathy is found in the vessels of the heart.
• Depending on the clinical form of AP, a complication in the form of cerebral angiopathy occurs in 5-75% of cases.

Causes

Angiopathy in 90% of cases is a secondary pathology, as it develops against the background of other diseases. The remaining 10% are defined as primary angiopathy, which is an independent pathological condition.

The main causes of AP:

• Atherosclerosis.
• Hypotonic angiopathy. Associated with a decrease in peripheral vascular tone.
• Hypertensive angiopathy. Develops due to increased pressure in the peripheral vascular bed of the blood.
• Traumatic angiopathy. Occurs due to compressive injuries to various parts of the body and other injuries.
• Diabetes. Causes damage to capillaries in various organs due to the deposition of sorbitol and fructose in the vessels.
• Amyloidosis. Associated with abnormal proteins circulating in the blood, which cause chronic intoxication to organs and tissues.
• Connective tissue diseases(lupus, rheumatoid arthritis).
• Autoimmune diseases. Angiopathy can be complicated by scleroderma, sclerotic vasopathy, and polyarthritis.
• Blood diseases. In diseases such as thrombocytosis, leukemia, and polycythemia, an increased number of blood cells is observed, which also has an adverse effect on the walls of blood vessels.

In addition, angiopathy may be associated with disorders of the spinal cord, brain, autonomic and peripheral nervous systems. This also often affects the structure and performance of the capillary system.

Risk factors contributing to the development of angiopathy:

• Having bad habits (smoking, drinking alcohol).
• Metabolic disorder.
• Unfavorable working conditions.
• Hereditary diseases.
• Age 50 years and above.

The more risk factors a patient has, the more severe and pronounced the underlying disease and its complication in the form of vascular damage.

Kinds

Angiopathy is divided into clinical forms taking into account the causes of the disease, the size of the lesion and its location.

The following types of angiopathic lesions are distinguished:

• because of:
  • diabetic;
  • hypertensive;
  • hypotensive;
  • traumatic;
  • toxic;
  • neurogenic;
  • amyloid.
• by localization:
  • retinopathy (the retina of the eye is affected);
  • nephropathy (pathological process affects the kidneys);
  • angiopathy of the extremities, most often the lower ones;
  • angiopathy of cerebral vessels;
  • angiopathy of other organs (intestines, heart, lungs).
• according to the size of the affected area:
  • microangiopathies (affect small-caliber vessels, that is, capillaries);
  • macroangiopathy (medium and large vessels are involved in the pathological process, in such cases their atherosclerosis is additionally observed).

One patient may experience several clinical forms of angiopathy (for example, damage to the vessels of the retina, kidneys and lower extremities, which is typical for the diabetic form of angiopathy). Such multiple vascular lesions are observed in 65% of patients with AP.

In some cases, temporary vascular lesions are identified, which, with proper observation, may not require specific treatment. In particular, careful attention to capillaries is required in the following cases:

1. The patient was subject to oxygen starvation.
2. The birth of the child was accompanied by complicated or difficult labor, after which angiopathy was discovered.
3. During pregnancy, angiopathy caused by increased vascular load is determined.

Diabetic angiopathy

Typical angiopathy develops against the background of diabetes mellitus, when the capillary bed changes against the background of an increased amount of sugar in the blood. After the capillaries, the damage affects larger vessels, which, with a long course of the disease, leads the patient to severe disability.

In diabetes mellitus, the glucose level often rises above 6 mmol/l, which contributes to the deposition of its various derivatives on the walls of blood vessels. As a result, the vascular walls thicken, the lumen of the vessel narrows, and their fragility increases, which subsequently leads to the death of soft tissues.

Diabetic angiopathy is most often expressed in:

• angiopathy of the lower extremities (diabetic foot);
• retinal angiopathy;
• nephropathy.

The disease is dangerous because of its consequences, since in diabetic foot the affected limb is often subject to amputation. Involvement of larger vessels in the pathological process leads to heart attacks, strokes, and heart failure.

Video Diabetic angiopathy: symptoms, diagnosis, treatment

Hypertensive angiopathy

High pressure in the circulatory system leads to consequences no less severe than diabetes. During the development of hypertension, the vascular endothelium is damaged because it is constantly exposed to high pressure. As a result, the muscle layer begins to hypertrophy, which subsequently leads to fibrosis.

Blood circulation becomes more complicated, multiple places of narrowing and even blockage of blood vessels appear. At the same time, blood pressure remains high, which in severe cases leads to more or less hemorrhages.

Hypertensive angiopathy most often affects:

• retina;
• cerebral vessels;
• renal arteries;
• coronary vessels of the heart.

Hypotonic angiopathy

The disease mainly affects the peripheral bloodstream, which, due to decreased vascular tone, begins to overflow with blood. This leads to an increase in the permeability of the walls of blood vessels, due to which formed blood elements accumulate in the lumen of the capillaries. These are predisposing conditions for the formation of blood clots and edema. Such changes are more often observed in the lower extremities, although as the disease progresses, the vessels of other parts of the body undergo changes.

Hypotonic angiopathy can develop into hypertension, since prolonged stretching of the vessels leads to the opposite reaction - vascular tone increases, but due to the resulting rigidity of the vessels and the deposition of calcium in their walls, the prerequisites are created for the development of hypertension.

The appearance of hypotensive angiopathy is most often accompanied by:

• damage to retinal vessels;
• cerebral vessels;
• change in skin color.

For example, a patient may have a cyanotic tint to the skin of the nose, ears, cheeks, and chin. If blood circulation in the brain is impaired, autonomic disorders may develop, as well as dizziness, combined with headaches. Damage to arterioles and venules is also often observed on the retina at this time.

Traumatic angiopathy

Compressive injuries to the chest and skull lead to a very sharp increase in blood pressure. As a result of such a lesion, light spots form on the retina, in addition, some blood vessels become clogged. All this leads to deterioration of vision. With timely medical care, the condition can be improved, but most often it is not possible to completely restore vision.

Clinic

Angiopathy of the first degree can be asymptomatic and in such cases small changes in the retina of the eyes can be detected, which should necessarily lead to elucidation of the cause of the development of the pathological condition.

Typical complaints with angiopathy:

• Vision has deteriorated (the patient sees blurry pictures).
• Stars may begin to flash before your eyes.
• Color perception is also impaired.

Other symptoms are associated with damage to the blood vessels of internal organs and lower extremities:

• You may feel pain in your legs.
• Convulsive conditions develop.
• During physical activity, intermittent claudication often occurs.
• There is a tingling sensation or abnormal sensations in the feet and hands.
• Minor nosebleeds may develop, and blood is often detected in the stool and urine.

Thrombotic microangiopathy is a characteristic sign of tissue dystrophy and microthrombosis, which manifests itself as cutaneous erosions and ulcers.

The clinical determination of blood flow disorders must necessarily be supplemented by laboratory and instrumental studies, which will make it possible to make a more accurate diagnosis and prescribe effective treatment.

Diagnostics

After determining the clinical manifestations, a comprehensive examination of the patient is required. For this purpose, various research methods are used to evaluate the functioning of internal organs, the nervous system, and the state of the vascular bed.

The main way to determine signs of arterial microangiopathy is performing ophthalmoscopy. To do this, visit an ophthalmologist who examines the fundus of the eye and determines the following disorders:

• capillaries are narrowed;
• vessels often intersect, there is tortuosity of arteries and veins;
• compensatory expansion of the capillary network;
• foci of hemorrhage are most often point-like;
• formation of small blood clots.

Additionally, the following studies can be carried out:

• angiography;
• Dopplerometry;
• duplex scanning;
• Magnetic resonance imaging.

Determining vascular lesions with the maximum likelihood of developing complications is considered an indication for specific therapy, which is selected on an individual basis.

Treatment

Much depends on the clinical form of the disease, so various specialists are involved in the treatment of angiopathy:

1. An ophthalmologist deals with retinal angiopathy.
2. Vascular surgeon or general surgeon - angiopathy of the lower extremities.
3. Neurologist - cerebral angiopathy.
4. Therapist or nephrologist - damage to the blood vessels of internal organs, such as the kidneys.
5. Cardiologist - diseases of the cardiovascular system.

The direction of drug therapy largely depends on the clinical form of angiopathy and the underlying disease against which it developed.

• In diabetes mellitus, it is important to keep glucose levels within acceptable limits so that vascular damage does not develop.
• The presence of hypertension requires controlled use of antihypertensive drugs.
• The definition of atherosclerosis forces one to adhere to dietary nutrition, acceptable physical activity, and treatment/prevention of impaired metabolic processes.

In most cases, drugs from the following pharmacological groups are used:

• Anticoagulants. They help treat and prevent thrombosis.
• Angioprotectors. The action of the drugs is aimed at protecting the walls of blood vessels.
• Metabolic substances. Improve exchange processes.

Additionally, all measures must be taken to eliminate unmodified risk factors, that is, those that are subject to change.

Prognosis and prevention

In the majority of patients (about 85% of cases) who adhere to medical recommendations, the disease progresses poorly and does not contribute to the development of severe complications.

In the case of a malignant course of the underlying disease (hypertension, diabetes mellitus), in 99% of cases angiopathy also develops unfavorably. In such cases, blindness, kidney failure or tissue death develop. Therefore, the earlier treatment is started, the greater the chances of maintaining health.