Poor Circulation (incl Buergers & Raynauds Disease)

Poor circulation occurs when the flow of blood through a part of the body is impaired. It can occur because of a gradual narrowing of an artery which may be associated with diabetes mellitus, raised blood pressure, raised blood levels of cholesterol and smoking. Blood clots can dramatically block off the circulation of blood in an artery.

Sudden narrowing or spasm of blood vessels which interferes with circulation can be caused by certain drugs, exposure to cold and smoking.

The commonest of poor circulation is atherosclerosis. This narrowing of the arteries is aggravated by smoking, the level of blood cholesterol and by high blood pressure.

In the past the usual approach to poor circulation in the legs was to get people to stop smoking and then to operate on their arteries.

It is possible to put plastic tube with a balloon attached into the narrowed artery, stretch it and then remove the tube and the balloon - this is called an angioplasty.

There is also increasing evidence that atherosclerosis is reversible. If in addition to stopping smoking, blood pressure is controlled and blood cholesterol lowered to 5.5 MMOL/L or below, the narrowing gets less over a 1 to 2 year period. Two specific but rare diseases are also important. Buergers disease is seen only in men who are heavy smokers and are aged between 20 and 40. It is caused by progressive inflammatory narrowing of the medium and small blood vessels which supply the lower legs. It also occurs less often in the hands.

Symptoms of the disease are due to the poor circulation of blood but later on infection and ulceration can occur and even gangrene if the condition is allowed to continue.

Treatment consists of completely stopping smoking. Good foot care is essential and very selective physiotherapy to help restore circulation may be possible. Surgery on the nerve supply to the arteries will help but amputation may eventually be necessary for persistent pain and the presence of gangrene.

Raynauds disease is the second important disease interfering with circulation. It occurs mostly in females between the ages of 15 to 45. The cause is not known. It exerts its effect on the small blood vessels to the fingers and less often to the toes which appear to be abnormally sensitive to cold and spasm if exposed to a cold environment. the affected fingers go through 3 characteristic colour changes. They first become numb and white with the cold, then blue and finally if warmed a flushed red as the circulation returns.

During the attack fine finger movement is difficult and there may be a dull aching pain and diminished sensation in the fingers and toes. Recovery can be accompanied by swelling and intense pain which can least for 15 to 30 minutes.

Attacks of Raynauds disease are more likely to occur in winter months and in between there may be a complete absence of symptoms and signs.

Treatment consists of keeping the body warm and hands and feet protected from the cold. The hands should be protected at all times from injury and infections, vibrating tools should never be handled, hand lotions should be used to control dry skin and smoking should be stopped. Drugs which dilate the small blood vessels may help.

Surgery on the nerve supplying the small blood vessels of the hands and feet may be justified in certain cases if the attacks are frequent and severe although surgery is of limited value in advanced cases.

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