In recent years, the term “atherosclerosis” has become more and more common in people’s eyes and lives as the living standards of our people continue to improve, and the incidence of common diseases among the elderly, and the trend is increasing. In older people over 60 years of age, the incidence of atherosclerosis is as high as 80%, which includes lower limb atherosclerotic occlusive disease. In daily life, we often hear about coronary heart disease (heart atherosclerosis), cerebral thrombosis and hemiplegia (cerebral atherosclerosis), but few people know the term lower extremity atherosclerotic occlusive disease. In people’s impression, how can the thick arteries of the lower extremities also become sclerotic and blocked? In fact, due to the change of people’s diet structure, lipid food content increased, coupled with some family genetic or metabolic factors, making people’s impression of the thicker arterial vascular also inevitably occurred hardening. First, the symptoms of lower limb atherosclerotic occlusive disease lower limb atherosclerotic occlusive disease from the symptoms, can be divided into early, medium and late three stages. The early stage is the ischemic stage, which can also be called “intermittent claudication”. The main symptoms are coldness, numbness and pins and needles in the affected limb, petechial-like changes on the dorsum of the foot, marked thickening and pallor of the toe tips and toenails, decreased skin temperature of the affected limb, and weakened or even disappeared arterial pulsation on the dorsum 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 being relieved and then continuing to walk; if the disease progresses further, it enters the middle stage. Based on the gradual aggravation of the above-mentioned symptoms, the main characteristic of the middle stage is pain. The more the patient walks, the more painful it is at rest, and the deeper the night, 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 the skin color of the affected limb changes in some patients, 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 arterial blood, which makes the blood in a small area stop flowing or flow very slowly, so that the blood clots rapidly and lengthens, completely blocking the arterial lumen, mainly manifesting as blackening and necrosis in the terminal parts of the toes, outer ankles and heels, and on the basis of necrosis, infection, ulceration and ulcers are formed, eventually facing amputation. Second, the onset of lower extremity atherosclerosis has a tendency to advance The onset of lower extremity atherosclerotic occlusive disease is predominant in elderly people over 60 years old. In general, the incidence of lower extremity atherosclerosis increases with age. However, with the continuous improvement of the national living standard, the incidence of hypertension, hyperlipidemia, obesity, diabetes and other affluent diseases is increasing, and the age of the people with the disease is getting younger and younger, and there is a trend of lowering the incidence of lower extremity atherosclerotic occlusive disease in relation to this. At present, there are not many people who suffer from this disease at the age of 50, and our hospital has treated several cases of this disease in their 50s. One of the patients surnamed Zhao from Jiangyan, northern Jiangsu, had “left lower limb vasculitis” at the age of 51 and underwent a high level amputation of the left lower limb in the local hospital. Today, five years later, the patient’s right lower extremity began to show symptoms of atherosclerosis occlusion again, with numbness and pain in the leg day and night, and he could not sleep at night. When he came to our hospital, his condition was already very serious, the lower end of the abdominal aorta was completely blocked, and necrotic ulcers had appeared on the 2, 3 and 4 toes of his right foot. Considering that the patient only had one leg left, we operated on him with an artificial vessel artery bypass between the axillary artery and the femoral artery, saving his right lower limb. There was another case of a 49-year-old patient surnamed Lv, a traffic policeman from Sihong County in northern Jiangsu Province, who began to have intermittent claudication in his right lower extremity two years ago, and was treated as thrombo-occlusive vasculitis in his home hospital without any effect, and his condition was getting worse. When he came to the Second Affiliated Hospital of Southern Medical University, he could not walk normally, his right toe was severely ulcerated, and he had unbearable pain and could not sleep every night. The etiology of lower extremity atherosclerosis occlusive disease The etiology of lower extremity atherosclerosis occlusive disease is still not very clear, but apparently related to hyperlipidemia, hypertension, diabetes, low high-density lipoprotein, obesity, blood hypercoagulability, smoking, genetics and other factors. Early in the lesion, the intima of the artery is subjected to plasma lipoprotein infiltration and lipid deposition, producing fatty streaks. Then intimal hyperplasia and atheromatous plaque formation occur. Eventually, arterial stenosis or blockage of the artery occurs. With the development of the disease, acute or chronic limb ischemia can occur, and all major arteries in the body can be involved, but mostly in the abdominal aorta, iliac artery, femoral artery, etc. The upper limb arteries are rare. The main clinical manifestations are coldness, numbness (nerve ischemia), pain, intermittent claudication, diminished or absent arterial pulses, impaired nutrition of the limb tissues, and ulceration or gangrene of the toes or feet. Although the ultimate cause has not been confirmed, many patients with atherosclerotic occlusive disease have higher than normal blood total cholesterol, triglycerides, and β-lipoproteins, especially in recent years it has been found that patients with lower extremity atherosclerotic occlusive disease have decreased high-density lipoproteins and increased low-density lipoproteins, suggesting that disorders of lipid metabolism are closely related to the occurrence and development of this disease. In addition, the occurrence of atherosclerotic occlusive disease is more frequent in diabetic patients than in those without diabetes, and it makes atherosclerosis occur early and to a severe degree. In addition, increased blood coagulation can aggravate atherosclerotic occlusions of the lower extremities. Statistical studies have found that there is also a relationship between smoking and the occurrence and development of atherosclerotic occlusion. Fourth, the diagnosis of lower extremity arteriosclerosis The diagnosis of lower extremity arteriosclerotic occlusive disease is not difficult. Generally speaking, the patient has chronic ischemic symptoms in the lower extremities, and the age of onset is above 45 years. The lesions mainly involve large and medium-sized arteries such as: lower abdominal aorta, iliac artery, femoral artery, etc., resulting in weakening or loss of pulsation of femoral artery, N artery, dorsalis pedis artery, and performing X-ray plain film may show arteries with patchy calcification. The ankle/brachial index can be less than 1 in non-invasive vascular examinations, or less than 0.5 in severe cases. Based on the above symptoms and examination, the diagnosis can be made. Arteriography may show multiple elongated and twisted arteries with diffuse irregular lumen narrowing or segmental occlusion. Patients may have hypertension, hyperlipidemia, hyperglycemia, coronary artery disease, stroke, etc., which may also help in the diagnosis. However, the absence of arterial calcification and normal lipids on X-ray does not definitely exclude the presence of atherosclerotic occlusion. In the process of diagnosing atherosclerotic occlusive disease of the lower extremities, it is necessary to differentiate from a number of diseases. The first is thrombo-occlusive vasculitis, which differs from lower extremity atherosclerotic occlusive disease in that thrombo-occlusive vasculitis is most often seen in young and middle-aged men, and patients generally do not have a history of hypertension, diabetes, or coronary artery disease. The disease is a chronic, periodically increasing inflammatory obstructive disease of small to medium-sized arteries and veins throughout the body, mainly involving the arteries of the lower extremities such as the dorsalis pedis, posterior tibial artery, N artery or femoral artery. About 40% of patients have recurrent wandering superficial thrombophlebitis in the lower leg and foot during the early or onset of the disease, and more than 90% of patients have a history of smoking; the second disease that needs to be identified is polyarteritis major. The second disease that needs to be differentiated is polyarteritis. This disease is mostly seen in young women and mainly affects 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 and lower extremities or kidneys. Clinical manifestations include memory loss, headache, vertigo, fainting, coldness, numbness, soreness, weakness, and intermittent claudication in the affected limbs, but without resting pain and gangrene in the lower limbs, which are generally easier to distinguish from arteriosclerotic occlusive disease of the lower limbs; the third is periarteritis nodosa. This disease may have symptoms of pain in the lower extremities when walking, often with scattered purple spots on the skin, ischemia or necrosis, fever, malaise, weight loss, increased erythrocyte sedimentation rate, and other signs and symptoms, and is often accompanied by lesions of internal organs, but rarely causes larger arterial occlusion or loss of arterial pulsation. A biopsy is required to confirm the diagnosis of this disease; the fourth is idiopathic arterial thrombosis. This disease is rare clinically and is often complicated by other diseases such as collagenous diseases (systemic lupus erythematosus, periarteritis nodosa, rheumatoid arthritis, etc.) and erythrocytosis, and can also occur after surgery or arterial injury. The onset is acute and can cause gangrene of the limb; the fifth is acute lower extremity arterial embolism. The disease can occur in patients of any age and has a rapid onset, with sudden onset of pain, pallor, coldness, numbness, impaired movement, and weakened or absent arterial pulses in the affected limb. It is most often seen in patients with heart disease (e.g., atrial fibrillation, heart valve disease, etc.), where the emboli mostly form in the heart and dislodge into the arteries of the lower extremities. Based on the absence of previous intermittent claudication and resting pain and the rapid onset, it is easier to distinguish from lower extremity atherosclerotic occlusive disease. In conclusion, lower extremity atherosclerosis is often a local manifestation of systemic atherosclerosis, so 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 thrombo-occlusive vasculitis, etc. If accompanied by diabetes, the prognosis is also worse. V. Treatment of lower extremity arteriosclerosis For the treatment of lower extremity arteriosclerosis, vasodilators can be used in the early stage, which are intended to promote the formation of more collateral circulation, and some herbal medicines can also be used as an adjunct to relieve the symptoms. It should be reminded that in clinical practice, there are many patients who have lost valuable time for surgery due to their focus on TCM treatment and their limbs have become necrotic and finally had to be amputated. This should not be taken lightly! Atherosclerotic occlusion is an organic lesion and there is no drug that can restore elasticity and recanalization of diseased arteries. The main role of the drugs currently used is to stop the continued development of the disease, improve the lateral circulation of the affected limb, relieve pain and promote ulcer healing, and avoid amputation. Patients with high blood lipid levels that do not decrease after dietary control can be treated with lipid-lowering drugs. Currently, the following drugs are commonly used: inositol nicotinate (a mild peripheral vasodilator that also has a cholesterol-lowering effect. 0.2~0.4g 3 times daily or 100mg 1~2 times daily by intramuscular injection); Vitamin C: It has been reported that larger doses of vitamin C have cholesterol-lowering effects. (3 times daily, 0.5g each time;) Atomine: the effect of lowering blood lipids is more certain, but it has damage to the liver, so attention should be paid to checking liver function when applying. 1 to 2 pills 3 times a day; Pulse: 2 capsules 3 times a day. About 40 to 50% of patients with arteriosclerotic occlusion are accompanied by hypertension, which often poses a certain risk to surgery, so hypertension should be treated at the same time. Commonly used antihypertensive drugs include compound antihypertensive tablets, reserpine, etc. If renal artery stenosis is considered, try mercaptomethoproline, which is an anti-renin drug, 25mg three times a day, and the dose can be adjusted according to the hypotensive situation. In addition, there are vasodilator drugs such as dibazol, nifedipine, tolazurin and niacin. They can release vasospasm and promote collateral circulation, thus improving blood supply to the affected limb. At the same time, herbal preparations such as compound danshen and mao dongqing have the effect of activating blood circulation and resolving blood stasis, which are effective for this disease. Compound Salvia injection 20ml can be put into 500ml 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. It has a certain effect on improving microcirculation and promoting collateral circulation, which is one of the commonly used drugs for the treatment of atherosclerosis occlusive disease. However, if the symptoms are severe, surgical treatment should be taken. Patients with intermittent claudication and severe narrowing of the arteries in the lower extremities (diameter less than 50% of the normal diameter) confirmed by arteriography need surgical treatment. Surgery is also indicated when there is severe resting pain or toe ulceration and gangrene, but the results are often unsatisfactory. 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 then placing one or more stents for support. This procedure is less invasive and allows some elderly people who have been lost to surgery in the past due to poor health conditions to regain the opportunity for successful surgery. If transarterial balloon dilation and installation of an intra-arterial stent fails, vascular bypass surgery must be performed so that the limb can be saved in a timely manner. It is worth reminding that some patients do not get attention because intermittent claudication appears only after walking longer distances; 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. Because lower extremity atherosclerosis 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 interventional balloon dilation, placement of an internal stent, or an artificial vessel (or autologous saphenous vein) for arterial bypass grafting, and a bypass (or bridge) anastomosis at the proximal and distal ends of the occluded artery. If the arterial output tract is narrowed or occluded, that is, the occluded segment of the artery is occluded for the entire distance, conventional arterial bypass grafting often leads to failure. Currently, methods such as lumbar sympathectomy, venous arterialization (that is, surgical transformation of the vein accompanying the diseased artery into an artery), and hematopoietic stem cell transplantation are mostly used to improve the arterial blood supply to the ischemic limb. According to my own experience and that of domestic and foreign countries, most of the above methods have certain efficacy. Prevention of atherosclerosis of the lower extremities We should treasure the two legs that play an important role in supporting human life. 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, we should pay attention to the lower extremity atherosclerotic occlusive disease prevention before it happens. First of all, those who suffer from hypertension, hyperlipidemia and diabetes should actively treat the original disease. Closely monitor the condition and do not take it lightly. Obese patients should reduce their body weight; secondly, diet should be reasonably regulated to prevent lipid metabolism disorders and high blood cholesterol. After middle age, 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. To 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 appropriately, but the pace of walking should not be too fast to avoid the onset of ischemic symptoms. Heavy objects should not be moved. The affected limbs should be insulated, and when the feet become cold, you should not use warm water bags to warm the feet or soak them in hot water, because this will aggravate the ischemia of the lower limbs and make the condition worse. The patient’s feet should be kept dry and clean, toenails should be cut regularly, and appropriate shoes and socks should be worn to avoid injury.