In our daily life, we often hear about arteriosclerosis of the heart (such as angina pectoris, myocardial infarction) and cerebral arteriosclerosis (such as cerebral thrombosis, cerebral hemorrhage), but few people know the term arteriosclerosis of the lower extremities (early symptoms are pain in the legs and feet after walking a few hundred meters). In people’s impression, how can arteries as thick as the lower extremities also become hardened and blocked? In fact, in the past 30 years after China’s reform and opening up, people’s lives have become better and their dietary structure has changed significantly, and the content of lipid foods has increased significantly, which, together with some family genetic or metabolic factors, has inevitably led to the hardening of the thicker arteries. The arteries of the lower extremities are hardened, which can bring big trouble. Patients: there is a trend of lower age lower extremity atherosclerotic occlusive disease to more than 60 years of age onset of the majority of the elderly. In general, the prevalence of lower extremity atherosclerosis increases with age. However, with the continuous improvement of national living standards, the prevalence of diabetes, hypertension, hyperlipidemia, obesity and other affluent diseases is increasing, and the age of the affected population is getting younger and younger, and there is a trend of lowering the age of lower extremity atherosclerotic occlusive disease. At present, there are not many people who suffer from this disease at the age of 50. Our hospital has treated several cases of patients around 50 years old. One of them was a patient surnamed Zhao from Jiangyan in northern Jiangsu, who suffered from “left lower limb vasculitis” (actually arteriosclerosis) at the age of 51, and underwent a high level amputation of the left lower limb in a local hospital. Five years later, the patient also began to experience pain and numbness in his right lower extremity, which worsened day by day and prevented him from sleeping all night. When he came to our hospital, his condition was already very serious, and the lower end of the abdominal aorta was found to be completely blocked during the action vein angiography, and necrotic ulcers had appeared on the 2, 3 and 4 toes of the right foot. Considering that the patient had only one leg left and the bilateral iliac arteries were completely occluded, we operated on the patient using an artificial vessel arterial bypass between the right axillary artery and the femoral artery, saving the patient’s right lower extremity. There was another case of a 49-year-old patient surnamed Lu, a traffic policeman, who started to have intermittent claudication in his right lower extremity two years ago, and was treated as thrombo-occlusive vasculitis in his hometown hospital without any effect, and his condition was getting worse. When he came to our hospital, he could not walk normally, his right toe was severely ulcerated, and he had pain every night and could not sleep. Using autologous saphenous vein femoral artery bypass bypass, the patient was completely relieved of pain and hidden danger, and soon returned to his job as a traffic police officer. The culprit: disorders of lipid metabolism In the early stages of lower extremity atherosclerotic occlusive lesions, the arterial intima is subjected to plasma lipoprotein infiltration and lipid deposition, producing lipid streaks, which in turn lead to intimal hyperplasia and atheromatous plaque formation, eventually forming arterial stenosis or blocked arteries. The initial progression of the lesion is slow and may be asymptomatic. As the disease develops, acute or chronic limb ischemia may occur, and all major arteries of the body may be involved, but mostly in the abdominal aorta, iliac artery, femoral artery, etc., while the upper limb arteries are rare. The etiology of lower extremity atherosclerosis is still not well understood, but it is clearly related to hyperlipidemia, hypertension, diabetes, low HDL, obesity, blood hypercoagulability, smoking, genetics and other factors. Many patients with atherosclerotic occlusive disease have higher than normal total blood cholesterol, triglycerides and β-lipoprotein. In recent years, it has been found that patients with lower limb atherosclerotic occlusive disease have decreased high-density lipoprotein and increased low-density lipoprotein, suggesting that disorders of lipid metabolism are closely related to the occurrence and development of this disease. Atherosclerotic occlusive disease occurs more often in diabetic patients than in those without diabetes, and the earlier it occurs and the more severe it is. In addition, the increase of blood coagulation can aggravate the atherosclerotic occlusion of the lower extremities. According to the survey, there is also a relationship between smoking and the occurrence and development of atherosclerotic occlusion. In conclusion, lower extremity atherosclerotic occlusive disease is often a local manifestation of systemic atherosclerosis, and many patients can be combined with atherosclerotic lesions of other important organs, such as coronary atherosclerotic heart disease and cerebral atherosclerosis. During the course of the disease, serious complications such as myocardial infarction, cerebral hemorrhage or cerebral thrombosis may occur, and the prognosis is worse than that of other chronic arterial obstructive diseases such as thromboembolic vasculitis. Early signs: walking claudication Lower limb atherosclerosis is divided into three stages: early, middle and late. The early stage is the ischemic stage, which can also be called “intermittent claudication”. The main manifestations are coldness, numbness and pins and needles in the affected limbs, petechial-like changes on the back of the foot, significant thickening and pallor of the toe tips and toenails, reduced skin temperature of the affected limbs, and weakened or even disappeared arterial pulsations on the back of the foot. This is followed by difficulty walking, i.e., slower walking speed, shorter distance, and claudication. Therefore, this symptom is also called “intermittent claudication”. Intermittent claudication is mainly caused by insufficient blood supply to the lower extremities due to arterial stenosis or occlusion, resulting in muscle pain, spasm and fatigue in the lower extremities, which require several minutes of rest before continuing to walk. If the disease progresses further, it enters the middle stage. On top of the gradual worsening of the above symptoms, the pain increases. The patient has pain when walking and also when resting, and the deeper the night is, the more intense and obvious the pain becomes, often making it difficult to sleep and often waking up in pain during sleep. At the same time, the skin temperature of the foot drops significantly, and some patients have a change in the color of the skin of the affected limb, such as obvious pallor or flushed purple spots, and the patient cannot feel a pulse in the foot, so this stage is also called the “resting pain stage”. The late stage is also called the “necrotic stage”. The atheromatous plaque partially or completely blocks the lumen of the artery, causing the blood to stop flowing in a small area or to flow very slowly, so that the blood clots rapidly and lengthens, completely blocking the lumen of the artery, mainly manifesting as blackening and necrosis in the end parts of the toe, outer ankle, heel, etc., and on the basis of necrosis, infection, ulceration and ulcers are formed, eventually facing amputation. Treatment: Drugs to alleviate the symptoms, surgery to treat the symptoms For lower limb atherosclerosis, vasodilators can be used in the early stage with the intention of promoting the formation of more collateral circulation to alleviate the symptoms. Such as dibazol, nifedipine, tolazurin and niacin can release vasospasm and promote collateral circulation, thus improving blood supply to the affected limb. Chinese herbal preparations such as compound danshen and mao dongqing have the effect of activating blood circulation and resolving stagnation, which are effective for this disease. It can also be used to put 20 ml of compound danshen injection into 500 ml of low molecular dextran for intravenous injection, which has the effect of reducing blood viscosity, increasing the negative charge on the surface of red blood cells and antiplatelet aggregation, etc., and has a certain effect on improving microcirculation and promoting collateral circulation. In addition, patients with high blood lipids who do not reduce their blood lipids after dietary control can be treated with lipid-lowering drugs. The commonly used drugs include statins, fibrates, niacin and its derivatives, etc., which can be taken under the guidance of doctors. About 40% to 50% of patients with arteriosclerotic occlusion have hypertension, which often poses a certain risk to surgery, so hypertension should be treated at the same time. Commonly used antihypertensive drugs include calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, which can be selected and the dose adjusted according to the individual patient’s condition. Atherosclerotic occlusion is an organic lesion, and there is no drug that can restore the elasticity and recanalization of diseased arteries. The main role of the drugs currently used is to slow down the progression of the disease, improve the collateral circulation of the affected limb, relieve pain and promote ulcer healing, and avoid amputation. However, if the symptoms are severe, surgical treatment should be undertaken. Patients with intermittent claudication and severe narrowing of the lower extremity arteries (less than 50% of the normal diameter) confirmed by arteriography require surgical treatment. Surgery is required when there is severe resting pain or toe ulceration and gangrene, but the results are not as good as they could be. In cases of limited arterial stenosis or occlusion, percutaneous puncture under local or general anesthesia can be performed to restore blood flow to the artery by ballooning the stenosis or occlusion and placing one or more stents for support. This procedure is less invasive and gives older people who have been lost to surgery in the past due to poor health a chance to regain surgical success. If transarterial balloon dilation and installation of an intra-arterial stent fails, vascular bypass surgery is necessary. Arterial stenosis or occlusion caused by diabetes mainly occurs in the lower leg and its distant arteries. Since there is no good outflow path, arterial bypass cannot be performed, and in recent years, small balloon dilation treatment or stem cell transplantation has been carried out, and good results have been achieved. Because arteriosclerosis of the lower extremities is a systemic disease, if there are no symptoms or mild symptoms and mild arterial stenosis, surgery can be suspended; recently, if there are serious lesions of important organs, such as angina pectoris, cerebrovascular accident, liver and kidney failure, surgery is also inappropriate. However, patients with a history of myocardial infarction in the past should not be listed as contraindicated for surgery in general, but should be selected according to their recent cardiac function and systemic condition. For example, arterial blood flow can be reestablished through arterial intervention with balloon dilation, placement of internal stents, or arterial bypass grafting with artificial vessels (or autologous saphenous vein) and bypass (or bridge) anastomosis at the proximal and distal ends of the occluded artery. It is worth reminding that some patients do not get attention because intermittent claudication appears only after walking longer distances, and many other patients have been misdiagnosed for a long time after the appearance of intermittent claudication as general back and leg pain or calcium deficiency, and individual patients have even undergone orthopedic surgery. There are also some patients who, because of their focus on TCM treatment, delay their reluctance to open surgery, often causing limb necrosis and eventually having to amputate their limbs due to the loss of valuable treatment time. This should not be taken lightly! Prevention: still the most important for our life plays an important role in supporting the two legs we should cherish, the lower limbs of atherosclerotic occlusive disease prevention is the most critical. Because atherosclerosis is a diffuse lesion, often involving the brain, heart, kidney and other important organs of the arterial blood supply, so prevention is particularly important. First of all, those who suffer from hypertension, hyperlipidemia and diabetes should actively treat the original disease. Secondly, diet should be reasonably regulated to prevent lipid metabolism disorders and high blood cholesterol. After middle age, you should avoid eating too much animal fat and foods with high cholesterol. Eat more foods rich in vitamins, such as fresh vegetables, beans, soy products, vegetable oils, various fruits, etc. Try to avoid high-fat diet, high sugar, indigestible and stimulating food, diet should be light; Third, from the young should pay attention to develop good habits, often appropriate physical exercise and physical labor, usually can do some appropriate regular walking exercise, give up smoking, alcohol and other bad habits; Fourth, once the lower limb atherosclerosis occlusive disease do not panic, as long as the timely treatment of the symptoms It is fine. But go to a regular hospital under the guidance of a specialist to take some vasodilator drugs to improve the blood circulation of the affected limbs. You can exercise properly, but the pace of walking should not be too fast, so as not to cause the onset of ischemic symptoms, and not to move heavy objects; the affected limb should pay attention to heat preservation, when the foot is cold, do not rashly use warm water bags to warm the feet or hot water soaking feet, because this will aggravate the lower limb ischemia, making the condition worse, usually the patient’s feet should be kept dry and clean, diligent toenail cutting, to wear appropriate shoes and socks to avoid injury.