Thrombo-occlusive vasculitis has obvious clinical signs and symptoms, and the diagnosis is generally not difficult.
1.Diagnostic description
(1) Diagnostic points
(1) The vast majority of young and middle-aged men, 20 to 40 years old is the most common. Most have a history of long-term, heavy smoking.
(2) There are clinical manifestations of chronic ischemia of the limbs in different degrees. Weakness or disappearance of arterial pulsation below the N or brachial artery of the affected limb.
(iii) It may be accompanied by recurrent episodes of wandering superficial thrombophlebitis.
(4) Generally no hypertension, hyperlipidemia, diabetes mellitus and other organ atherosclerosis manifestations.
(2) Clinical staging According to the evolution of the disease, it can be divided into three stages.
① Phase I (local ischemic phase)
The main manifestations are numbness, coldness, soreness and intermittent claudication of the affected limb. The dorsalis pedis artery or/and posterior tibial artery pulsation is weakened or absent. It may be accompanied by wandering thrombotic superficial phlebitis.
② Phase II (nutritional disorder phase)
In addition to the clinical manifestations of the first stage, the ischemic pain of the affected limb changes from intermittent claudication to persistent resting pain. And the manifestations of nutritional disorders of the affected limb appear, such as dry and sweatless skin, pale, bruised purple or flushed skin, thickened and deformed toenails, loss of sweat hair, and atrophy of calf muscles.
③Phase 3 (tissue necrosis phase)
In addition to the clinical manifestations of the first and second stages, ischemic ulcers and gangrene appear in the affected limbs. It starts as dry gangrene and transforms into wet gangrene after secondary infection.
2.Differential diagnosis
(1) Atherosclerotic occlusive disease This disease is also a common chronic occlusive disease of the limb arteries. Compared with thrombo-occlusive vasculitis, it has the following characteristics.
(i) It is mostly seen in middle-aged and elderly people, and can develop in both men and women.
②The lesions mainly involve large and medium-sized arteries. In particular, the lower abdominal aorta and the iliofemoral artery are the most common. Superficial arterial stiffness and distortion can be detected. Sometimes a vascular murmur can be heard.
(iii) Often combined with hypertension, hyperlipidemia, diabetes mellitus and visceral atherosclerotic ischemia.
④More often there is no wandering superficial thrombophlebitis.
(⑤) Thoracic and abdominal plain radiographs may show prominent aortic arch and arterial calcification, and arteriography may show irregular filling defects in the arterial lumen with worm-like changes, and the distal artery of occlusion may be visualized via collateral vessels.
(6) Pathological examination shows degeneration of both the middle layer and intima of the artery, while the veins are not involved.
(2) Multiple aortitis has the following characteristics.
(1) Most often seen in young women.
(2) Polyarteritis is characterized by the following features: ①Most often seen in young women. ②The lesions often involve multiple large arteries at the same time. It mainly invades the branches of the aortic arch or the aorta and its visceral branches. A vascular murmur can be heard and tremor can be detected at the site of the lesion.
(3) Clinical manifestations of chronic limb ischemia are often present, but ischemic ulcers and gangrene of the limbs are usually not present.
(4) Arteriography shows stenosis or occlusion at the opening of the main branches of the aorta.
(3) Idiopathic arterial thrombosis is rare. It has the following characteristics.
(1) It is mostly seen in patients with connective tissue diseases, hematologic diseases and metastatic carcinoma.
(2) The onset of the disease is acute, mainly manifested by sudden occlusion of the iliofemoral artery, which may cause extensive necrosis of the limb.
(3) It may be accompanied by iliofemoral vein thrombosis.
(4) Periarteritis nodosa This disease mainly involves the middle and small arteries and may present with limb ischemic symptoms similar to those of thromboembolic vasculitis, but with the following characteristics.
①More often accompanied by systemic symptoms such as fever, malaise and joint pain.
②The lesions are widespread, often involving the kidney, heart, liver, intestine and other visceral arteries, with clinical manifestations of corresponding visceral ischemia.
③Subcutaneous nodules arranged along the arterial line often appear.
④Laboratory tests show hyperglobulinemia and increased sedimentation.
⑤ Biopsy can clarify the diagnosis.
(5) The presence of gangrene in the limb of diabetic gangrene should be considered as a possibility. The following features can help in the differential diagnosis.
(1) Clinical manifestations of three excesses and one deficiency, i.e., excessive drinking, excessive urination, excessive eating and weight loss.
② Laboratory tests showing elevated blood glucose or positive urine glucose.