Peripheral Artery Disease Peripheral artery disease (PAD) is a common and clinically overlooked health problem, mostly in the lower extremities. Although PAD is extremely common in clinical practice, it is rarely diagnosed correctly and only a few people receive treatment. In recent years, with increased awareness of the disease, improved diagnostic rates, and evolving treatment options, this situation is gradually changing. The most common early clinical manifestation of PAD is intermittent claudication due to pain, numbness, and fatigue in the lower extremity muscles, with approximately 25% of patients progressing to severe limb ischemia, often requiring amputation. It is reported that 12 million people in the United States have peripheral arterial disease, primarily lower extremity arterial disease, and about 20% of symptomatic lower extremity arterial disease patients have diabetes mellitus. Patients with PAD have a high incidence of cardiovascular disease (40% to 60% of PAD patients have coronary artery disease and 25% to 50% have carotid artery disease) and a high mortality rate (about 2.5 times that of the normal population). ), and the main causes of death are stroke and myocardial infarction. Lack of physician awareness of PAD is an important cause of underdiagnosis, as most physicians are not aware of the history of PAD and often ignore subtle signs of the disease on physical examination. It is estimated that even in the United States, less than 20% of patients with PAD are diagnosed. Continuing medical education for primary care physicians in PAD is therefore urgent. Incorrect initial diagnosis of PAD directly affects the effectiveness of secondary prevention strategies. Treatment strategies for PAD include risk factor control, physical exercise, pharmacotherapy, and hemodynamic reconstruction. Smoking is most closely associated with PAD and is the most important risk factor. Quitting smoking slows the progression of PAD and reduces the risk of myocardial ischemia and mortality from other vascular diseases. Fewer than 10% of patients succeed in quitting with their own efforts, but physician advice can increase the success rate of patients quitting by up to 30%, and nicotine replacement products can increase the success rate of long-term smoking cessation. Controlling blood glucose can reduce the incidence of PAD and alleviate clinical symptoms such as intermittent claudication, and intensive insulin therapy is required for patients with severe diabetes. Effective control of blood pressure and lipids is also necessary, with blood pressure and lipids reaching the same level as coronary artery disease. beta-blockers can aggravate the symptoms of intermittent claudication in some cases and need to be used with caution. Physical exercise is an effective treatment for PAD, significantly improving walking ability, improving blood viscosity, increasing blood oxygen-carrying capacity, and reducing ischemia. The best results can be achieved with exercises longer than 30 minutes per session, at least 3 times per week for a period of >3 months. Antiplatelet therapy significantly reduces the incidence of cardiovascular disease and death in patients with PAD, significantly improves patient symptoms, reduces the need for patient surgery, and improves post-transplant vascular patency. All patients with PAD should receive antiplatelet therapy unless contraindicated. Antiplatelet agents include aspirin, clobigrel, and cilostazol, a type III phosphodiesterase inhibitor that is the only drug that combines antiplatelet, vasodilatory, and antiendothelial thickening effects. Reconstructive therapy includes vascular bypass graft surgery and medical intervention. Reconstructive therapy is required when PAD is too severe to improve with medication. Vascular bypass grafting can be performed using either artificial or autologous vessels with high success rates and good long-term results. Extensive lesions, combined aneurysms and atherosclerotic emboli are indications for bypass grafting. However, bypass grafting is an invasive treatment with relatively high rates of death and complications. With the development of interventional cardiology, PAD interventional techniques have improved rapidly, and endovascular stenting has gradually replaced vascular bypass grafting and has become the main treatment for PAD. Due to the improvement of PAD interventional devices and the accumulation of physicians’ experience, the success rate and safety of the procedure have been significantly improved, and the complications have been significantly reduced. The involvement of cardiologists in the field of peripheral artery disease has allowed the use of one or more interventional techniques to treat patients in a comprehensive manner, and has also allowed for a better integration of preoperative diagnosis and management, intraoperative operation and postoperative treatment. It is now recommended that once PAD is diagnosed, early interventional treatment should be performed to prevent the development of severe limb artery ischemia. In conclusion, with the greatly improved understanding of PAD, the bottleneck in the treatment of PAD will be broken through better control of risk factors and with the help of new therapeutic approaches; the increasingly mature technology of interventional therapy and the visionary gene therapy will bring new hope for PAD patients. Vasculitis Vasculitis, known as occlusive thrombotic vasculitis, is a serious disease caused by vascular inflammation due to thrombotic occlusion of small and medium-sized arteries in the lower extremities. The cause of vasculitis is unknown. Statistics show that the incidence of vasculitis is higher in cold regions than in warm regions, and the incidence is higher in smokers than in nonsmokers, so most scholars believe that the onset of the disease is related to long-term smoking and exposure to cold. Others believe that it is related to immunogenetic factors, etc. The disease occurs mostly in young people between 20 and 40 years of age, and the ratio of men to women is 29:1. It mainly involves the anterior tibial, posterior tibial, and dorsalis pedis arteries of the lower leg, and in severe cases, it may involve the femoral artery upwards, or even all the blood vessels of the extremities. Due to thrombosis, lumen occlusion, insufficient blood supply, can cause thrombophlebitis, arteritis, intermittent claudication, tissue dystrophy or even necrosis and other damage, can seriously endanger the health of the body. Clinical manifestations of vasculitis: Early symptoms: 1, numbness, cold, pain 2, easy fatigue, calf soreness 3, weakened pulse, gradually disappeared Intermediate symptoms: 1, pain in the calf during activity 2, muscle twitching, especially obvious at night 3, intermittent claudication Late symptoms: 1, continuous severe pain 2, skin dark red, dark brown, ulcers 3, feet, toes darkened, necrosis Treatment of vasculitis: 1, vascular The diversion surgery, we understand as vascular bypass surgery. In fact, and heart bypass is a meaning, except that this lesion appears on the limbs, and the lower extremities mainly, for example, this lesion is limited to just a few centimeters, a dozen centimeters, we can abandon this section of the road, and then open a new path. There are two possibilities, one is that we need to spend a lot of work to repair it, so we might as well have another one, and the other possibility is that it is simply beyond repair, so another artificial vessel. We need to ensure the nutrition of the blood supply below the knee joint. 2, drug nuclear physical therapy. Drug treatment mainly means that the vasculitis lesion produced in the chest, or further deterioration of the lesion we suppress it through drugs. 3, interventional therapy. Interventional therapy is equivalent to an intravascular surgery, without the need for an incision to complete the effect of surgery. The most representative interventional technology is the intravascular ultrasound ablation technology, which reopens the blocked blood vessels through a wavelength of ultrasound. The use of treatment methods is considered on a patient-by-patient basis and involves many factors that are strictly defined in medicine. We can simply understand that, for example, a blood vessel is a tunnel in a mountain, due to various reasons, such as earthquakes or soil erosion, involving the collapse, or has collapsed, then we must hurry to check to see what the tunnel, if completely collapsed, then there is no way, and then play a line, that is, we say the bypass surgery, if it is a local fallen stone, or a bit cracked, then we first If it is a localized rock fall, or a little crack, then we first clean the tunnel, as mentioned earlier, there is an ultrasonic ablation technique. If it is just a little bit of water flowing in the tunnel, a little bit of cement is used locally, and some trees are planted on the mountain to maintain the erosion, and this is the drug treatment. The repeatability of the operation is very good and the patient can tolerate it. Interventional, surgical and pharmacological treatments cannot be separated, but can complement each other. Raynaud syndrome is an arterial spasm disorder, a syndrome in which spasm of small arteries at the extremities causes a series of skin color changes on the hands or feet. It can be divided into two categories: primary and secondary. Primary Raynaud’s disease occurs without any associated systemic disease or identifiable underlying cause. Secondary cases are also known as Raynaud phenomenon, which means that there is an underlying disease that causes Raynaud phenomenon. The latter is more common and clinically important, accounting for about 2/3 of the cases, while Raynaud’s disease is rare. The etiology of Raynaud’s disease is not clear, but may be related to neuroendocrine dysfunction, as some cases are aggravated during menstruation. Patients often have a family history, which may also be related to heredity. Raynaud’s phenomenon can be seen in many primary underlying diseases, the most common being connective tissue diseases, especially scleroderma. Systemic erythema vera, vasculitis, rheumatoid arthritis, dermatomyositis, etc. can also occur. Other causes include: occlusive atherosclerosis, cryoglobulinemia, neurovascular compression diseases such as thoracic outlet syndrome, and occupational diseases such as air hammer disease with long-term application of vibrating tools. In addition, the application of certain drugs such as ergot and beta blockers can also cause. Raynaud’s phenomenon secondary to connective tissue disease is mostly seen in women; in men, it is mostly in middle-aged and elderly patients secondary to occlusive atherosclerosis. The pathophysiological changes of Raynaud’s syndrome can be divided into three phases: ① spastic ischemic phase: spasm occurs first in finger and toe arteries, followed by spasm in capillaries and small veins, and pale skin. (ii) Stasis and hypoxia phase: the arterial spasm subsides first, the blood in the capillaries is depressed and hypoxic, and the skin appears cyanotic. ③Dilated and congested period: After all spasms are released, there is reactive vasodilatation and congestion, and the skin is flushed. Then it turns to normal skin color. Raynaud’s syndrome often develops when cold or emotionally agitated, manifesting as the fingers presenting pale, turning cyanotic and then flushed after the attack is relieved. Prevention, pay attention to insulation, quit smoking, avoid trauma, clear mental concerns; try to avoid exposure to dry cold, contact with cold water, drink a small amount of alcoholic beverages in daily life, protect the fingers from pricking and cutting, to quit smoking, prevent emotional impulses and other mental factors interference .