On the evening of February 3, Zhu Yuefeng, deputy director of the Vascular Surgery Center of Shaw Hospital Affiliated to Zhejiang University School of Medicine, wrote depressingly in his circle of friends: The 80-year-old man did not seek medical treatment in time due to arterial occlusion, which worsened to the most serious situation. Within half a month, his right calf turned black and ulcerated. It was seriously infected and accompanied by severe pain, and amputation was necessary to save his life. However, after the family held a family meeting, they firmly disagreed with the amputation plan. They believed that people can die, but they cannot die without a complete body! The editor will take you to understand what is lower limb arteriosclerosis obliterans ?
Definitions related to lower extremity arteriosclerosis obliterans
1. Arteriosclerosis obliterans of the lower limbs (ASO):
refers to a chronic progressive disease caused by arteriosclerosis, intima thickening, lumen stenosis or occlusion of the blood supply arteries of the lower limbs, and insufficient blood supply to the diseased limbs, causing clinical manifestations such as intermittent claudication, lowered skin temperature, pain, and even ulcers or necrosis. It is often a manifestation of systemic arteriosclerotic vascular lesions in the arteries of the lower limbs.
2． Intermittent claudication:
One of the main clinical manifestations of lower limb ASO.
3． Ischemic rest pain :
is one of the main clinical manifestations of severe limb ischemia caused by ASO of the lower limbs, indicating that the limb is at risk of near-term ischemic necrosis.
4． Critical limb ischemia (CLI):
refers to the critical ischemic stage of the limb suffering from ASO.
5． Diabetic foot:
In patients with diabetes , foot infections, ulcers and/or deep tissue destruction are related to distal nerve abnormalities in the lower limbs and varying degrees of peripheral vascular disease.
6． Diabetic lower limb ischemia:
refers to diabetic patients with lower limb arteriosclerosis and occlusion at the same time. Regardless of the order in which they occur, as long as they exist at the same time, it can be called diabetic lower limb ischemia.
7． Ankle-brachial index (ABI):
refers to the ratio of the systolic pressure of the ankle artery to the systolic pressure of the upper arm ( brachial artery ). It is obtained through segmental pressure measurement of the limb. It is a method for evaluating the blood supply status of non-damaged arteries. This ratio helps determine the degree of ischemia.
8． Toe-brachial index (TBI):
refers to the ratio of the systolic pressure of the toe artery to the systolic pressure of the brachial artery. Like ABI, it is a commonly used indicator to evaluate the degree of ischemia in the lower limbs.
Risk factors for lower extremity arteriosclerosis obliterans
The main cause of lower extremity ASO is atherosclerosis. The incidence rate increases with age, and the incidence rate in people over 70 years old is 15% to 20%. The incidence rate is slightly higher in men than in women.
1． Smoking:
Smoking is significantly related to the occurrence of lower limb ASO.
2． Diabetes:
Diabetes increases the incidence of this disease by 2 to 4 times.
3． Hypertension :
Hypertension is one of the main risk factors for lower limb ASO, which is relatively weaker than smoking and diabetes.
4． Hyperlipidemia:
Hyperlipidemia increases the prevalence of ASO in the lower limbs and increases the risk of intermittent claudication.
5． Hyperhomocysteinemia:
Compared with the general population, the combined probability of hyperhomocysteinemia in ASO patients is significantly higher.
6． chronic renal insufficiency :
Some studies have shown that chronic renal insufficiency is related to ASO. For postmenopausal women, chronic renal insufficiency is an independent risk predictor of ASO.
7． Inflammatory indicators:
Atherosclerosis is a chronic inflammatory reaction involving a variety of inflammatory cells and factors.
Lower extremity Arteriosclerosis obliterans Is it common?
Arteriosclerosis obliterans of the lower extremities belongs to the category of vascular surgery and is a very common disease. The incidence of arteriosclerosis obliterans is relatively high in Western countries, with an incidence rate of 10% among people over 70 years old in the United States; and an incidence rate of 1% to 2% among people aged 37 to 69. Currently, about 100,000 people receive surgical treatment every year. In China, with the improvement of people's living standards, changes in dietary structure, aging of the population, and the widespread application of non-invasive vascular examination technology, ASO has now become a common peripheral vascular occlusive disease in middle-aged and elderly people. Survey results in Shanghai in 1990 showed that 34 cases of ASO (0.74%) were found among 4,609 people over 50 years old. According to a 1993 peripheral vascular disease survey in four provinces and one city in East China, 51 cases of ASO (0.78%) were found among 6,500 people over 55 years old.In 1992, Shanghai Sixth Hospital reported that 40 cases of arteriosclerosis obliterans had been diagnosed and treated in the past five years. The First Affiliated Hospital of China Medical University treated a total of 22 cases in the five years from 1990 to 1994. Since the introduction of the first domestic vascular scanning equipment in 1994, a total of 20 cases of lower limb arteriosclerosis obliterans were treated in 1995. It can be seen that the incidence of arteriosclerosis obliterans in the lower extremities in my country is gradually increasing compared with the past years.
According to observations of a large number of cases, 12% require amputation 10 years after the onset of symptoms. Every year, about 100,000 ischemic patients undergo vascular reconstruction surgery. Males are more likely to suffer from this disease than females at a ratio of 6 to 8:1. In patients with diabetes and hypertension, age and gender differences are not very obvious.
What are the symptoms of lower extremity arteriosclerosis obliterans?
1. The affected limb is afraid of coldness and feels cold;
2. Leg or buttock muscles are prone to fatigue and muscle pain after activity, which can be relieved after rest. This is the most common, that is, the legs often feel weak;
3. Cramps in the feet, calves and even thighs;
4. Abnormal sensation in the legs, including numbness and burning;
5 .Legs feel cold to the touch;
6. Pale or purple skin;
7. Impotence;
8. Difficulty healing of foot wounds;
9. Muscle atrophy;
10. Necrosis of feet or toes;
11. Toenails are deformed and thickened;
12. Calf hair is sparse.
Is lower extremity arteriosclerosis obliterans dangerous?
Many people think that arteriosclerosis obliterans of the lower limbs is "old cold legs", which is quite common. Dress warmly, or get some medicine at a small clinic, prescribe some painkillers, apply a plaster, and you will be fine after this winter. However, it can be seen from the development of symptoms of arteriosclerosis obliterans in the lower limbs that this disease is quite dangerous. If you do not go to a regular hospital for diagnosis and treatment in time, it will seriously affect the quality of life, and there is a risk of amputation or even death. We understand the risk of this disease through a set of data: the 5-year mortality rate of all patients with lower limb arteriosclerosis obliterans is 10-15%, the 5-year mortality rate of patients with "intermittent claudication" is 30%, and the 5-year mortality rate of severe patients with "rest pain" and ulcer gangrene is as high as 70%, and the 1-year amputation rate of severe patients is as high as 30%.
How do you know if you have arteriosclerosis obliterans of the lower limbs?
Arteriosclerosis obliterans of the lower limbs is so dangerous that you must seek medical treatment as soon as possible. However, because the early symptoms of the disease are not typical enough, patients must not self-diagnose or treat themselves. This will delay the disease on the one hand, and abuse of drugs will also cause harm to the body. Patients should go to a regular hospital that specializes in vascular surgery for scientific diagnosis. For example, arterial pressure measurement, lower limb arterial color ultrasound, CTA, magnetic resonance imaging (MRI), etc. These examinations can help determine whether there is stenosis and occlusion of limb arteries. If necessary, the doctor will also recommend an arteriography examination, injecting a contrast agent that develops under radiation into the blood vessels, and using X-rays to accurately display the location and extent of intravascular lesions.
What are the treatments for arteriosclerosis obliterans of the lower limbs?
Once arteriosclerosis obliterans of the lower limbs is diagnosed, treatment must be started as soon as possible to avoid worsening of the condition. Treatment includes general conventional treatment, drug treatment, endovascular interventional treatment and surgical treatment. Vascular surgeons will choose different treatment methods according to the severity of the patient's condition.
General treatment includes: quitting smoking, which can significantly delay the progression of the disease; arranging meals reasonably, eating more low-salt, low-sugar, high-fiber and plant-based foods containing unsaturated fatty acids, such as beans, fruits, vegetables, etc.; carrying out appropriate walking exercises and insisting on walking several times a day60 min, can increase the formation of collateral circulation in the affected limb and improve ischemia. Introduce an exercise method to patients with difficulty in walking, that is, raise the affected limb for 1-2 minutes, hang down for 2-3 minutes, lie down for 2-3 minutes, rotate the foot, flex and extend, and exercise repeatedly for 20-30 minutes; pay attention to foot care, keep warm, and avoid limb injuries. General treatment also includes active treatment of diseases that induce arteriosclerosis of the lower limbs, such as diabetes, hypertension, and hyperlipidemia.
In addition to taking anti-diabetic, anti-hypertensive and anti-hyperlipidemic drugs on time to control blood sugar, blood pressure and blood lipids, for patients with severe claudication symptoms, vascular surgeons will also prescribe some arterial dilation drugs, anti-platelet drugs or anti-coagulant drugs, and if necessary, some analgesics. The main functions of these drugs are to control the continued development of the disease, improve limb ischemia, relieve pain and promote ulcer healing.
The condition of most patients can be effectively controlled through general treatment and drug treatment. Only some seriously ill patients, such as patients with severe lameness affecting their quality of life, “rest pain”, or even limb ulcers and gangrene, require endovascular treatment or surgical treatment.
Endovascular treatment selects relatively superficial blood vessels without disease in the human body, such as the arteries at the base of the thigh and the arteries at the elbow. A special puncture needle is used to pierce a small eye. Some special guide wires and catheters are inserted from the puncture eye. Under X-ray monitoring, the diseased blood vessel is reached, a special balloon is used to dilate the narrowed artery, and then a special metal stent is used to support the narrowed area to achieve the purpose of treatment without the need for surgery.
However, endovascular treatment is not necessarily suitable for all patients. Some patients with more serious lesions still need surgery to clear the narrowed area. Sometimes, autologous blood vessels or artificial blood vessels are used to "bypass" the blood to re-transmit blood to the blood vessels distal to the disease through the newly built "bridge".
Whether it is endovascular treatment or surgical surgery, drug treatment is still required after surgery. Drugs can consolidate the postoperative efficacy and delay the recurrence of the disease.
How to prevent arteriosclerosis obliterans in the lower limbs?
Prevention-based, scientific and healthy lifestyle and good living habits can greatly reduce the risk of disease: (1) Quit smoking; (2) Eat a light diet low in salt, low fat, and low sugar, and eat more fresh vegetables, fruits and other vitamin-rich foods; (3) Proper health Physical exercise can control body weight, which is equivalent to regular gymnastics for blood vessels, which can enhance elasticity and prevent aging; (4) Be good at adjusting emotions to avoid long-term mental stress and depression; (5) Pay attention to keeping warm, but do not use hot water bottles to warm your feet or soak your feet in hot water. Some patients may suffer burns due to reduced skin sensation and insensitivity to heat.
Go to the hospital regularly for formal and comprehensive physical examinations, which can early detect high blood pressure, diabetes, hyperlipidemia and other factors that induce arteriosclerosis and occlusion of the lower limbs. When you find yourself suffering from these diseases, it is necessary to take drugs that lower blood pressure, blood sugar, or blood lipids under the guidance of a doctor to avoid the risk factors of arteriosclerosis and occlusion of the lower limbs.
How to exercise for patients with lower limb arteriosclerosis occlusive disease
1. Walking exercise is suitable for patients with early arteriosclerosis occlusive disease or in the recovery period. They should insist on walking exercise every day. The speed and distance of walking should be such that it does not cause limb pain. Generally, after several months of walking exercise, the intermittent claudication of many affected limbs has been significantly improved.
2. The Berg exercise is suitable for patients with arteriosclerosis obliterans who are basically unable to walk and can be exercised in bed. First, let the affected limb be elevated for 2 to 3 minutes, then hang down on the edge of the bed for 3 to 5 minutes, and then semi-lying for 2 to 3 minutes. Repeat the exercise 5 to 10 times, 3 times a day, to prevent muscle atrophy and facilitate the recovery of limb function.
3. Other exercise methods should be selected according to the patient's physique, environment and hobbies, such as qigong, gymnastics, walking, Tai Chi, etc. However, rehabilitation exercises should be carried out step by step, gradually increasing the amount of exercise and extending the activity time, and it is not advisable to force strenuous activities.
This article is compiled from the Internet and does not represent the views of the tertiary hospital network. If there is any infringement of your rights, please contact us.
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