Clinical manifestations, regardless of the origin of circulatory disorders (atherosclerosis obliterans, diabetic macro- and micro-hygiopathies, or combined lesions) in the expressed stages are characterized by intermittent claudication cysts, ulceration of the feet and gangrene.
In the I (preclinical) stage of leg angiopathy, there are usually no subjective and visible manifestations. Changes are detected only with special research methods (capillaroscopy, rheography).
The most characteristic complaint with vascular lesions of the legs of the second (functional) stage is pain in the distal sections. Initially, it occurs with prolonged walking. Rapid stenosis of the main arteries, insufficient development of collaterals leads to ischemia, exacerbated by manifestations of microangiopathy and peripheral polyneuropathy. The pain appears at rest, combined with paresthesia, a feeling of chilliness or burning, spasms of the calf muscles, often at night. On examination, cooling and blanching of the feet, weakening of pulsation in the dorsal and posterior tibial arteries are noted. With the prevalence of diabetic microangiopathy, pulsation on the arteries is preserved, trophic disorders prevail – pallor, marbling, dryness, decreased skin temperature, nails are dull, thickened, with an uneven surface.
Gangrene in diabetes occurs 50 times more often (and in women in 70) than in people without diabetes.
As the process progresses (stage III), the syndrome of intermittent claudication develops, intensifying, gradually the pain becomes constant, does not subside at rest and at night. In some cases, if the phenomena of diabetic microangiopathy prevail, the pain syndrome is not so pronounced, and severe trophic disorders appear as if suddenly.
The skin becomes shiny, even drier, thinner, easily vulnerable. The pallor is gradually replaced by a crimson-cyanotic color. Ripple on the arteries of the rear foot, popliteal artery is sharply weakened or absent. The iliac and femoral arteries are less commonly affected; their involvement in the process indicates the extreme severity of obliterating atherosclerosis. Blisters with serous hemorrhagic fluid can form on the toes, often on the large, dorsal and plantar surfaces. The progression of ischemia, trophic disorders leads to ulceration, the formation of long-term non-healing trophic ulcers.
Among the causes of death of patients with diabetes as a result of complications of gangrene takes the 4th place.
An extremely dangerous complication of vascular lesions (obliterating atherosclerosis and diabetic microangiopathy) is gangrene. It can complicate the course of a trophic ulcer or serous-hemorrhagic bladder. Often occurs at the site of abrasion, corns, cracks. Gangrene can develop as a “dry” one, when gradual mummification, demarcation and rejection of necrotic masses occurs, or as a “wet” one with severe general symptoms, up to the rapid development of a septic state.
The course of diabetic macro- and microangiopathy in different patients is different. Sometimes the process lasts for years, even for decades it remains compensated. But there are patients in whom changes progress rapidly, right up to the fulminant development of gangrene. As a rule, the speed of the process depends on the nature of the course of diabetes, the state of its compensation. The prognosis is significantly worsened by diabetic coma.