What is atherosclerosis-occlusive disease?
Atherosclerotic occlusive disease (ASO) is a chronic arterial occlusive disease caused by atherosclerosis in the arterial wall, most commonly in the lower extremities, and is most common in middle-aged and older men.
Risk factors
Family history
Age (male >45 years, female >55 years)
Smoking
Obesity Zhang Shaobo, Department of Surgery, Xi’an Red Society Hospital
Low exercise
Irregular life
Excessive stress (high pressure of work and life)
Unhealthy diet
What are the manifestations of lower limb atherosclerosis occlusive disease
Symptoms
Clinical symptoms depend mainly on the speed and degree of development of limb ischemia.
The initial symptoms are coldness, numbness, abnormal sensation and intermittent claudication in the affected limb.
After development, symptoms such as rest pain and tissue gangrene, ischemic neuropathy, skin color change, dystrophy of skin appendages, disuse muscle atrophy and joint stiffness may appear.
Physical signs
On physical examination, there are pale and florid complexion of ischemic limbs, skin wrinkling, dry and scaly, thickened toenails, loss of body hair, and muscle atrophy of limbs.
On palpation, the skin temperature is cool and cold, the arterial pulsation distal to the occlusion site is weakened or absent, and the filling time of the terminal vessels is delayed.
In severe ischemia, there is loss of limb sensation and motor function, drooping feet, local skin ulceration and even gangrene of the limb.
What is intermittent claudication?
Pain, soreness and weakness of the muscles of the lower limbs after walking for a certain distance, forced to stop walking because the symptoms are aggravated by continuing to walk, and can continue to walk after resting for a few moments to relieve the pain, and the above symptoms occur repeatedly under the same conditions.
The distance and duration of claudication often reflect the severity of the disease.
Intermittent claudication includes arterial ischemic claudication, venous claudication and neurogenic claudication.
Differential diagnosis
1, thrombo-occlusive vasculitis This disease is mostly seen in male young adults, more than 90% of patients have a history of smoking, it is a chronic, periodically increasing occlusive disease of the whole body of small and medium-sized arteries and veins. It mainly involves arteries of the lower extremities such as the dorsalis pedis, posterior tibial artery, nasal artery or femoral artery. Approximately 40% of patients have recurrent wandering superficial thrombophlebitis in the lower legs and feet early or during the course of the disease. People with vasculitis generally do not have a history of hypertension, diabetes mellitus, or coronary heart disease. Arteriography shows segmental stenosis or occlusion of the artery, with smooth and flat arteries proximal and distal to the lesion, without distortion or dilated segments. It can be differentiated from AS0 according to the age of onset, location and imaging.
2. Multiple aortitis Most often seen in young women, mainly invades the beginning of the aorta and its branches, such as the carotid artery, subclavian artery and renal artery. The lesions cause arterial stenosis or obstruction and symptoms of ischemia in the brain, upper or lower extremities. Clinical manifestations include memory loss, headache, vertigo, fainting, coldness, numbness, soreness, weakness, intermittent claudication in the affected limbs, but no resting pain or gangrene in the lower limbs, arterial pulsation may be weakened or disappear, and blood pressure may be reduced or undetectable. Renal artery stenosis, i.e., renal hypertension, may be combined with bilateral subclavian artery stenosis to produce upper extremity hypotension and lower extremity hypertension; thoracoabdominal aortic stenosis, producing upper extremity hypertension and lower extremity hypotension. There is a systolic murmur in the vicinity of the arterial stenosis. Fever and increased sedimentation are present during the active phase of the lesion. It is easier to differentiate from AS0 based on the patient’s age of onset and symptoms, signs, and arteriography.
Physical examination of lower extremity arteriosclerosis occlusive disease
Doppler
Ultrasound
MRA
CTA
DSA
Natural course of lower extremity atherosclerotic occlusive disease
1/4 May improve spontaneously
1/3 to 1/2 Remains unchanged
1/4 Aggravated
Lower extremity ischemia treatment plan
1.Eliminate cardiovascular risk factors (lipid reduction, sugar reduction, smoking cessation, etc.)
2.Exercise and exercise help establish collateral circulation
3.Medication (combined Chinese and Western medicine treatment)
4.Surgery and interventional treatment
5.Explore new methods of biological treatment
Drug therapy is an important means of treating lower limb ischemia
We should pay attention to the drug treatment of vascular diseases.
General treatment: control the factors of atherosclerosis and occlusive disease, quit smoking, control hypertension, lower lipid treatment, strictly control blood sugar, effective control of postprandial blood sugar is the key to treatment, pay attention to the warmth of the affected limb, but do not give hot compresses or physical therapy to the ischemic limb, otherwise it will aggravate the necrosis of the ischemic limb, exercise method of the affected limb and hyperbaric oxygen therapy, obesity, hypoxia, vitamin C deficiency, mental tension, emotional excitement, etc. are also predisposing factors for atherosclerosis and need to be effectively controlled.
Special medication includes anticoagulation, de-agglomeration, vasodilation, thrombolysis and analgesic treatment. The aim is to prevent thrombosis of autologous arteries or diverting vessels and to promote the formation of collateral circulation. Patients with limb ischemia are mostly unable to sleep and do not think of eating because of the pain of the affected limb. Drugs with good analgesic effect, long duration of action and low side effects should be chosen, and hypnotic drugs can be added at the same time.