Orodan Leucian Mihaela, MD
Clinical Hospital of Emergency, Arad
Mîndrescu Dorin, MD
Filantropia, Clinical Hospital Craiova
The occlusive arterial disease represent the consequence of a partial or total obstruction of arteries which generates a cronical peripheral ischemia;
The disease appears more often after the years of 50 especially male, the intensity and the extent of ischemia is corelated with the degree of the vascular obstruction and the rapidity of her appearance; the development of a collateral circulation is important in the evolution and prophylaxy of this disease;
ETIOLOGY: most patients with occlusive arterial disease have underlying atherosclerosis (the most important etiology);
The main important factors which determine the appearance of the arterial obstructive lesion are:
- Allergic factor-the reaction between Ag-Ac which determines the hyperplasia of the vascular endothelium and where also the arterial spasm appears
- Metabolic factors – which involves the formation of the fibrous plaque (consistingof intimal smooth muscle cells surrounded by connective tissue and intracellular and extracellular lipid)
- Prolonged stress-which generates through endocrinal mechanism the arterial spasm
- Other risk factors – cigarette smoking, alcohol – imunoallergic mechanism.
SYMPTOMS, SIGNS, DIAGNOSIS; the initial but very important symptom is intermittent claudication, a defficient blood supply in exercising muscle; the distress is described as a pain, ache, cramp, or tired feeling that occurs on walking; Progression of the disease is indicated when the distance that the patient can walk is diminishing; a severely ischemic foot is painful, cold and often numb. The skin is dry and scaly with poor nail and hair growth. As ischemia worsens, ulceration may appear, especially after local trauma, typically on the toes or heel or occasionally on the leg. The most extensive obliterative disease may compromise the viability of tissues and lead to necrosis or gangrane; Doppler examination, but also arteriography are the main important investigation which establish the exact diagnosis of the arteriosclerosis and of the damages of the principle arteries.
the main important affected meridians are STOMACH (insufficiency) and SPLEEN_PANCREAS.
It can appear a collateral obstruction by cold – humidity, stagnation of blood, defficiency of Yin and/or excess of humidity – heat
PARTICULARITY OF TREATMENT:
the association of acupuncture (selective vasodilatation on the obstructive arteries) with the apitoxina contained in the beevenom on the acupuncture points;
TCM-through acupuncture can ameliorate the gentle disorder, like pain but also the other disorders (necrosis-Ulcer and gangrena) and the other risk factors (smoking, diabet, hypertrigliceridemia
The important steps of the treatment are the following:
1.The prevention of progression of the disease and of the complications;
2.Increasing the supply of the blood in the ischemic extremity by development of the collateral circulation;
3.The amelioration of the intermitent claudicatio
4.The prevention of the trofic lesion like necrosis and gangrena
- Controlling the other risk factors;
- Stop smoking
- Controlling the metabolic risk factors through a more properly diet (hypolipidic, hypoglucidic), controlling the hypertension if there is one;
- Gemotherapeutical preparation (Populus Nigra-3×30 drops, Cornus Sanguinea-3x30drops, Salix alba cortex-3×30 drops, Syringa vulgaris-3×30 drops); chinese preparation (Full qi – Buzhongyiqiwan, Fufang-Fufangdanshendiwan); all the patients were prepared for the treatment with bee venom-Venex – 20 combining pollen, propolis, royal jelly, honey).
- Bee venom important effect is increasing vascular permeability and tisssue oxigenation, combined with the anticoagulant effect by decreasing the blood viscosity.
Acupuncture points used from the following meridian: HEART (H), PERICARDIUM (P), URINARY BLADDER (UB), CONCEPTION VESSEL (CV), STOMACH (ST), LIVER (Liv)
Some important acupoints:
- H7 (Shenmen)-regulation of the arterial tension
- P6 (Neiguan)-sedativ point, increasing also the performance of the heart;
- UB14 (Jueyinshu)-SHU point of TE meridian
- UB 15 (Xinshu)-SHU point of H meridian
- ST-30 (Qichong), 36 (Zusanli), 40 (Fenglung), 44 (Neiting)-decrease the pain and the other symptoms like parestesia, numbness.
- Liv.2 (Xingjian), Liv3 (Taichong), Liv 8 (Ququan)-bilateral
- CV17-point which is main part from the sea of energy with action on the circulatory system
Auriculotherapy-Shenmen, lung, heart
All the patients made 10 acupoints treatment repeated 3 times with a periodicity of 6-8 weeks; they also received some homeopatic preparation on some particular acupoints (ST36, VB34, LIV2): CUPRUM ACETICUM (antispastic effect) SECALE / BLEIGLANZ COMP. (vasodilatation effect especially useful for the claudication symptom), Arteria femoralis. Bee venom was administrated especially on the UB and GV meridian
1.B. C. 84 years, male; Dg; Critical ischemia of right leg (StIV Leriche), Obliterant arterial disease with infrainghinal lesions; HTA st. III;
2.I. P. 49 years old, male. Dg; HTA ST. II. Hypercolesterolemia Obstructive arterial disease with occlusion of common femoral artera;
3.W. E. -72 years old, male Dg. Monovascular coronarian disease, subocclusion of anterior descendent artera. Obliterant arterial disease St2 left leg, St.3 right leg. HTA st.II. Bilateral subocclusion of carotida artera. Diabetus mellitus st. II;
4.M. M. 64 years, male Dg. HTA St.II, Cronic Ischemic Cardiopathy, Occlusive atherosclerotic arteriopathy both legs. Arterial trombosis of the anterior left tibial artera;
5.O. V. 81 years, male Dg. Occlusive arterial disease St.IV Leriche. Complete obstruction of the left femoral arteria. HTA stII. Cronic atrial fibrilation with medium ventricular alura; Cancer of colon operated;
6.S. R. 81 years, male Dg. HTA st.III with very high risk. Stable angina; Cronic atrial fibrilation. Diabetus mellitus stII. Hypertrigliceridemia. Cerebral vascular ischemia;
7.D. F. 78 years, male Dg. Obstructive arterial disease st.II Leriche;
8.G. S. 64 years, male Dg. Obstructive arterial disease st.II/III Leriche.
Eco Doppler established the amelioration of the collateral circulation; Even without this examination all the patients confirmed the amelioration of the clinical symptomatology: intermitent claudicatio, decreasing the nocturnal pain of the legs, the pain by walking, the amelioration of the trofic modifications and legs started to be warmer;
the complexity complementary therapy combining acupuncture, mezotherapy with apitoxina and homeopathic prepartion can improve the clinical simptomatology demonstrated by Doppler ultrasonography, diminishing the risk of necrosis and the amputation of the affected member