People have the impression that vasculitis is scary and is often considered a sign of “amputation”. In people’s minds, vasculitis is a serious disease that leads to amputation. Many people seeking treatment for their “vasculitis” everywhere seeking medical treatment, eat a lot of “vasculitis drugs”, spent a lot of money, and even some patients because they did not go to the regular hospital and delayed the time of surgery.
According to incomplete statistics, in our outpatient clinic to “vasculitis” to see the patient, about 70% to 80% of patients are not vasculitis. Most of them are lower extremity arteriosclerosis occlusive disease, varicose veins, deep vein thrombosis and aortitis. So what exactly is vasculitis?
I. The real vasculitis: thrombo-occlusive vasculitis
Vasculitis is short for thrombo-occlusive vasculitis, also known as Buerger’s disease. The lesions mainly involve the distal middle and small arteries of the limbs, and the accompanying veins are often involved, and the pathological changes are segmental, non-suppurative inflammation of the walls of the middle and small arterial vessels with thrombosis in the lumen of the arterial vessels, and luminal occlusion causing ischemia and pain in the distal limbs. The main features of the disease are.
1. Features of pathogenesis.
(1) The disease mostly occurs in young and middle-aged men.
(2) The onset is closely related to smoking.
(3) The disease has certain geographical distribution characteristics, i.e., the incidence is higher in residents of cold and humid areas.
(4) The factor of increased blood viscosity is also associated with this disease.
2. Clinical features.
(1) Coldness, coldness, numbness and abnormal sensation of the limbs, especially the toes, are common early symptoms.
(2) pain is the main symptom of the disease, manifested as follows: ① intermittent claudication: when the patient walks a certain distance, numbness, swelling, pain, twitching, weakness and other symptoms occur in the calf or foot muscles, and if you continue to walk, the symptoms are aggravated, and finally forced to stop walking, and after standing in place for a few moments to rest, the pain is quickly relieved, and you can continue to walk, but after walking the above-mentioned symptoms reappear. This symptom is called intermittent claudication, and it is a typical manifestation of insufficient arterial blood supply to the lower limbs. ② Resting pain: When arterial ischemia is severe, the pain in the affected limb is intense and persistent, and the pain continues at rest, making it difficult to sleep through the night. The pain is even more severe when the toe is broken and infected.
(3) Nutritional disorders of the limb: manifested as thickening and deformation of toenail, dry skin, loss of sweat and hair, atrophy of calf or foot muscles, etc. Ischemic dryness and blackness, necrosis, etc. appear at the end of the toe when the disease develops and deteriorates.
According to the above clinical features, a preliminary understanding of vasculitis can be obtained. So how to prevent and treat this disease?
1, quit smoking: smoking has a hundred harm to vasculitis without benefit. In the early stages of the disease should immediately quit smoking, and then with the correct treatment, most patients symptoms can be relieved. But the smoking habit does not change, no matter how much medicine is also a drop in the bucket. In the end, it will inevitably lead to limb necrosis and amputation. So quit smoking is an important measure to prevent and treat vasculitis.
2, keep warm and cold, prevent trauma: keep warm and cold has a positive effect on the prevention and treatment of the disease, can improve microcirculation. After suffering from this disease due to poor blood supply to the extremities, once broken it is difficult to heal, and even easy to cause ulcers and necrosis.
3, active exercise: improve and promote the formation of the lateral limb circulation of the limb.
4, drug treatment: should go to the regular specialist hospital to confirm the diagnosis, symptomatic treatment.
Second, the elderly “vasculitis”: lower limb arteriosclerosis occlusive disease
Lower extremity arteriosclerosis occlusive disease is not vasculitis, it is a manifestation of systemic arteriosclerosis, is one of the common vascular diseases of the middle and elderly. Its pathological features are abdominal aorta, iliac artery, femoral artery, ? arteries and other large and medium-sized arteries intima thicken and harden, forming atheromatous plaques and calcification, as well as secondary thrombosis, resulting in arterial lumen narrowing or occlusion, manifesting as lower limb ischemic symptoms similar to vasculitis, and therefore often mistaken for vasculitis. Many middle-aged and elderly patients have lower limb pain, muscle pain and weakness, and cannot walk normally (i.e., intermittent claudication), etc. They often think it is caused by osteophytes, osteoporosis, lumbar disc protrusion, rheumatism, etc. They take a lot of drugs for a long time, but they do not go to the hospital to see a specialist in time, and some patients are even forced to amputate their limbs because of the delayed timing of the consultation.
The etiology, pathology and age of onset of arteriosclerosis and thrombo-occlusive vasculitis are different and should not be confused. In addition, diabetes mellitus is closely related to atherosclerosis, and in many patients with “diabetic foot” who have toe necrosis, the primary cause of limb necrosis is arterial occlusion rather than diabetes mellitus itself.
The clinical characteristics of lower limb atherosclerosis-occlusive disease are.
1, the age of onset is mostly over 60 years old, and it can be accompanied by hyperlipidemia, hypertension, coronary heart disease, diabetes, etc.
2, lower limb ischemic symptoms: manifested as symptoms similar to vasculitis, both limb cold, cold, numbness, toenail thickening, sweat hair loss and intermittent claudication, etc., but the pain site is mainly located in the calf gastrocnemius muscle, if the main and iliac arteries are occluded, it can also manifest with thigh and buttock muscle pain. Resting pain and limb necrosis may occur when limb ischemia is severe.
Based on the characteristics of the disease and examination of the dorsalis pedis artery and posterior tibial artery pulsation, clinical diagnosis is relatively easy. For symptoms of coldness, soreness and weakness of the lower limbs and inability to walk normally (i.e. intermittent claudication), careful examination and active treatment should be carried out in the vascular surgery department of a large hospital.
The treatment of arteriosclerosis occlusive disease is mainly non-surgical treatment and surgical treatment. For those with mild symptoms, non-surgical treatment methods can be used, mainly including.
1, quit smoking: because smoking can increase blood viscosity and aggravate atherosclerosis.
2, appropriate exercise: has a positive effect on promoting the formation of collateral circulation.
3, control of high blood lipids, prevention and control of atherosclerosis.
4, anticoagulation and antithrombotic drug therapy to reduce blood viscosity.
For those with intermittent claudication or more severe symptoms, surgical treatment should be adopted. Arterial bypass grafting is an effective treatment for atherosclerosis occlusive disease.
Third, venous “vasculitis”: lower extremity venous disease
To the aviation center hospital vascular surgery outpatient clinic many patients with lower extremity venous disease have mistakenly believed that they suffer from vasculitis, fearful, lest face the bad luck of amputation. In fact, this is a mistake in understanding, venous disease is not vasculitis. In fact, venous disease of the lower extremities is characterized by the return of venous blood flow is affected, and rarely causes disorders of the arterial supply of the limb, and should not be confused with vasculitis. The common lower extremity venous diseases in clinical practice mainly include.
1, saphenous varicose vein: that is commonly known as the lower limb “bruises exposed”. Saphenous varicose veins are mainly caused by congenital weakness of the vein wall and damage to the venous valves. Women who work long hours on their feet or who are pregnant are prone to this condition. The clinical features of saphenous varicose veins are: swelling, heaviness, fatigue and weakness of the affected limb, bulging and dilated superficial veins of the lower leg, and mild swelling of the ankle, which may be aggravated by standing. The varicose veins are prone to thrombophlebitis, which is characterized by painful varicose veins with red, swollen, hard streaks and pressure pain. In addition, tissue hypoxia is caused by venous stasis. Once the skin is broken, it can easily become infected and form an ulcer that will not heal. The disease can be prevented and controlled to some extent by avoiding prolonged standing and wearing compression stockings. For mild superficial varicose veins, injection therapy can be taken, while for more serious varicose veins patients should still be treated mainly by surgery.
2.Deep venous valve insufficiency: Due to the destruction of deep venous valve, it causes blood backflow venous hypertension and stasis and produces clinical symptoms. The clinical symptoms are heavy, swollen lower limbs and pigmentation of lower leg skin, etc. Most patients have saphenous varicose veins in combination. Treatment should be mainly surgical. Wearing elastic stockings and avoiding standing for a long time can relieve the symptoms.
3.Deep vein thrombosis of lower limbs: The clinical characteristics of deep vein thrombosis of lower limbs are severe lower limb swelling, increased calf muscle tone, swelling and pain, pressure pain and so on. Stagnant venous blood flow, increased blood viscosity and venous injury are the main causes of this disease. It is mostly seen in prolonged bed rest, fracture, surgery or prolonged car or airplane travel, etc. Lack of limb activity causes stagnant blood flow in the deep veins of lower limbs. The main dangerous complication of lower limb deep vein thrombosis is pulmonary artery embolism, which is life-threatening once it occurs. Therefore, deep vein thrombosis should be treated actively in the acute stage, and bed rest should be taken to avoid thrombus dislodgement caused by strenuous activities of the affected limbs, leading to pulmonary embolism.
The main treatment methods for DVT are thrombolysis, anticoagulation and surgery. For patients with acute lower limb DVT who have had pulmonary embolism or are at risk of pulmonary embolism, implantation of inferior vena cava filter is a better way to prevent pulmonary embolism and protect life.
In conclusion, lower limb arterial disease is characterized by ischemic pain and intermittent claudication, while lower limb venous disease is characterized by lower limb venous reflux obstruction and limb stasis and swelling.