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Abstract: This article describes a young male patient who came to the hospital with “pain, coldness and numbness in both lower extremities for 2 years and a 3-day rupture in the left foot”. The patient was given anticoagulation, vasodilatation, circulation improvement, etc. After treatment, his symptoms were relieved and his condition was controlled and stabilized.
Basic information】Male, 33 years old
Disease Type】Thrombo-occlusive vasculitis
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】July 2021
Treatment plan】Intravenous infusion (poppyine hydrochloride injection, prostaglandin for injection) + subcutaneous injection (low molecular weight heparin sodium injection) + oral medication (aspirin tablets, beraprost sodium tablets)
Treatment period】Inpatient treatment for 14 days, regular outpatient follow-up
Effect of treatment] Pain, numbness, and chills in the lower limbs were relieved, and the rupture healed
I. Initial consultation
In July 2021, a 33-year-old male patient came to our clinic with the chief complaint of “pain, coldness and numbness in both lower limbs for 2 years, and left foot rupture for 3 days”. The patient reported that he had pain in both lower limbs with numbness and coldness and intermittent limping for about 500 meters at the beginning without treatment. Three days ago, he developed a broken left bunion. The patient had a history of previous health, but had a history of smoking for more than 20 years and smoked a lot. On examination, he had a pale skin color and low skin temperature in both lower extremities, a bruise in the left foot, and a broken bunion of about 1×1.5 cm with surrounding redness and exudation. The patient had a normal diet, poor sleep, normal bowel movements and no significant weight loss.
II. Treatment history
CTA of both lower limbs showed that the arterial lumen was narrowed to different degrees, and the left common iliac artery, bilateral external iliac arteries, and superficial femoral artery were segmentally occluded, with abundant peripheral collateral circulation established. The rheumatologic immunologic indexes indicated that C-reactive protein was 11.08 mg/L and sedimentation was 18 mm/h. Because of the patient’s poor vascular condition and many occluded segments, if intracavitary surgery was performed, it would stimulate inflammatory hyperplasia in the endothelium of the artery, so the patient was given anticoagulation with low-molecular-weight heparin sodium injection, antiplatelet with aspirin tablets, improvement of microcirculation with poppine hydrochloride injection, and symptomatic treatment with vasodilatation with prostaglandin injection. The foot ulcer was locally debrided.
III. Treatment effect
After 7 days of hospitalization, the patient’s symptoms were relieved and fresh granulation was seen at the ulcer. After 14 days, the patient’s symptoms were further relieved, the ulcer was partially healed, the blood supply to the lower extremity was improved, the collateral circulation was established, the numbness, coldness and pain of the lower extremity were relieved, and the ulcer was partially healed, and the patient was discharged. The patient’s outpatient review after 3 months showed that the ulcer was basically healed and the ischemic symptoms of the lower limb were not further aggravated, and the overall effect was satisfactory.
IV. Notes
We are glad that the patient’s symptoms have improved, but we need to advise the patient to quit smoking absolutely and continue to take oral medication regularly after discharge to improve the ischemia of the lower limbs, and not to stop or change medication on their own. In daily life, rest is the main focus, to ensure sufficient sleep, avoid staying up late, tiredness and long hours of heavy physical labor, pay attention to strengthening nutrition in the diet, a balanced mix of various nutrients, appropriate outdoor activities, and maintain a cheerful mood to help control the stability of the disease.
V. Personal insight
This patient is a young adult with a long history of smoking and no underlying diseases such as hypertension, diabetes mellitus, hyperlipidemia, etc. However, his condition has developed seriously, and if he is not treated regularly, the disease may be prolonged. The patient’s condition was too complicated to perform endoluminal surgery, which could lead to re-occlusion or even aggravation of the disease within a short period of time after surgery and a high incidence of long-term amputation. Therefore, this patient must absolutely quit smoking, undergo professional treatment, and strictly follow medical advice on medication in order to obtain a better prognosis and outcome.