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Abstract: Because the symptoms of lower extremity atherosclerosis and lumbar disc herniation are similar, many patients have taken a detour in treatment. Therefore, once claudication after activity occurs, it is important to visit the vascular surgery department as soon as possible, and a simple arterial examination can initially determine whether there is a vascular problem. In this case, the patient had pain in the leg after activity for more than 2 years, which was not relieved by the treatment of lumbar disc herniation.
Basic information】Male, 58 years old
Disease Type】Lower Extremity Atherosclerosis
Hospital】Xing’an League People’s Hospital in Inner Mongolia
Date of consultation】April 2022
Treatment plan】Lower limb artery balloon extension stent implantation + drug therapy (bye aspirin + atorvastatin)
Treatment period】Inpatient treatment for 10 days, followed up by outpatient clinic after surgery
Treatment effect] The pain in the lower extremity improved significantly.
I. Initial consultation
It was time for the weekly outpatient clinic on Monday morning, and a patient referred from the orthopedic department was seen near the end of the day. Two years ago, this patient presented with numbness and pain in the right lower limb after walking about 300 meters, with occasional cold sensation in the foot, which could be relieved after 1-2 minutes of rest. A CT scan of the lumbar spine performed at a local hospital showed a herniated lumbar disc, and the symptoms did not improve significantly after treatment with physiotherapy and massage. After examination, the orthopedic surgeon suggested that the patient should be seen in our outpatient clinic.
The right foot temperature was slightly cooler than the opposite side. The patient was considered to have atherosclerosis of the lower extremity arteries, and ultrasound examination of the lower extremity arteries was prescribed, which showed severe stenosis and near occlusion of the right superficial femoral artery and popliteal artery.
II. Treatment history
Lower extremity atherosclerosis is a common arterial disease in vascular surgery. The operation was performed in a hybridized operating room. Parallel puncture of the right femoral artery was taken, and the right femoral artery was successfully punctured after local anesthesia. After imaging to clarify the location and extent of the lesion, the guidewire and catheter were applied to pass through the stenotic segment of the vessel smoothly, and the application of balloon dilation showed good arterial morphology and no obvious arterial entrapment, and the operation ended successfully. After the operation, the patient was instructed to bed brake the right lower extremity for 24 hours and was discharged on the third day after the operation.
III. Treatment effect
Immediately after the operation, the patient felt that the temperature of the right foot was higher than before. 24 hours after the operation, after removing the bandage of the puncture site, he felt no obvious pain in the lower leg and moved freely, and the puncture site was well healed by the drug change. The numbness and pain of the right calf after activity and the occasional cold feeling in the foot were significantly reduced, and the patient recovered well.
IV. Precautions
Lower extremity atherosclerosis is a common arterial disease in vascular surgery, and once the artery reaches severe stenosis, it will cause discomfort in the legs. However, because the patient’s symptoms were similar to those of lumbar disc herniation, a treatment detour was taken, but the extent of the patient’s recovery after surgical treatment was gratifying.
Patients must strictly quit smoking, eat a balanced diet, and perform functional exercises for the lower extremities, such as brisk walking, jogging, and cycling. The patient’s artery was severely stenosed and had claudication within 200 meters, so surgery was performed. In the future, we should pay attention to the condition of the leg, and if there are uncomfortable symptoms, we should diagnose and treat them early.
V. Personal insight
The incidence of atherosclerosis in the lower limbs is very high, and without attention and maintenance, severe narrowing or even occlusion of the arteries in the lower limbs may occur, causing claudication, lower limb numbness, pain, and even ischemic necrosis of the limbs. Patients are advised to control blood pressure, blood sugar, lipids and other high-risk factors of lower limb atherosclerosis, avoid skin abrasions and other damages, and increase the number of lower limb artery ultrasound examinations during annual physical examinations to detect lower limb artery lesions and intervene in time, which can effectively prevent further development of the disease.