I. What is atherosclerosis occlusive disease? With the change of national diet structure, the increase of fatty food intake and the increase of per capita life expectancy, atherosclerosis has become the most common disease among middle-aged and elderly people in China, with the incidence rate of 79.9% among people over 60 years old in China. Atherosclerotic occlusive disease is a local manifestation of systemic atherosclerosis in the limbs, mainly manifested as atherosclerotic plaques in the intima, degeneration or calcification of the middle layer of tissue, and the formation of secondary thrombus in the lumen of blood vessels, which can destroy the arterial wall and eventually narrow the lumen or even completely occlude it, causing acute or chronic ischemic symptoms in the affected limbs, which can cause limb necrosis in severe cases. Second, what causes atherosclerotic occlusive disease? What kind of people are prone to atherosclerotic occlusive disease? The cause of the disease is still unknown and is the result of a combination of factors. (The disease is closely related to hyperlipidemia, low-density lipoprotein can promote atherosclerosis of arteries, hypertension, hyperlipidemia and immune complex, all of which can damage the intima of arteries and subsequently cause lesions such as lipoprotein infiltration, platelet adhesion, smooth muscle cell proliferation and lipid deposition). Factors associated with the development of this disease include hypertension, diabetes, smoking, obesity, etc. Therefore, middle-aged and elderly people with “nine highs and one low” – high blood lipids, high blood sugar, high uric acid, high body weight, high blood pressure, high blood viscosity, high age, high mental stress, high smoking addiction and low exercise – are at high risk for atherosclerosis-occlusive disease. The disease mostly occurs in patients over the age of 50. The human body begins to have lipid deposits in the arteries after about thirty years of age, and after middle age, one should pay attention to the atherosclerosis of one’s arteries and have regular annual hospital checkups of the arteries. What are the typical manifestations of lower limb atherosclerotic occlusive disease? The clinical symptoms of atherosclerotic occlusive disease are mainly due to the local blood supply deficiency in the limbs caused by arterial stenosis or occlusion. No matter how extensive the occlusive lesion is, as long as the lesion develops slowly and an effective collateral circulation can be established, there will be no obvious clinical symptoms; on the contrary, the typical clinical manifestations will appear in the early stage. Lower extremity atherosclerosis occlusive disease can be clinically divided into four stages according to the degree of development: Stage 1 (mild complaint period): feeling of reduced skin temperature, coldness, or mild numbness of the affected extremity, easy fatigue after activity, thinning of the skin, lack of nutrition, hair reduction and easy loss; Stage 2 (intermittent claudication period): when the patient walks, due to ischemia and hypoxia, the calf muscles produce spasm, pain and fatigue, and weakness. The third phase (resting pain phase): when the ischemia of the lower extremity is aggravated, the lateral branch compensation is seriously insufficient, and ischemic pain occurs in the muscles and nerves of the lower extremity, the most common manifestation of which is that the patient has difficulty sleeping all night, sits on his knees, sags his calves, and cannot lift them up, otherwise the ischemia is aggravated. The fourth stage (tissue necrosis phase): tissue necrosis occurs in the ischemic limb, the skin temperature decreases significantly, ulcers appear at the end of the limb, the toes show dark purple necrosis performance, and gradually develop upward to the foot, ankle and even calf, toxins enter the body through the blood, systemic poisoning occurs, and serious threats to life. 4. How to diagnose arteriosclerotic occlusive disease? What tests should be done? Men, over 50 years old, with chronic ischemic symptoms of lower or upper limbs and weakened or absent arterial pulsation; accompanied by hypertension, hyperlipidemia, diabetes mellitus and/or clinical manifestations of atherosclerosis in other internal organs such as brain, heart and kidney; X-ray film showing patchy calcified shadows in the arterial wall should suspect the possibility of this disease. Common examinations include: 1. General examination: including the examination of the major arteries of the body, such as the carotid, brachial, radial, femoral, N, foot and arm, and posterior tibial arteries. Lipid determination, such as cholestasis, triglyceride, lipoprotein electrophoresis, etc., electrocardiogram and echocardiography can understand the cardiac function and confirm the presence of myocardial ischemia caused by coronary atherosclerosis; fundus examination can directly observe the presence of fundus arteriosclerosis and indirectly determine the degree of head ischemia, and X-ray plain film can find the shadow of arterial calcification. 2.Segmental arterial blood pressure measurement of the extremities: It is a non-invasive examination method, applying a Doppler ultrasound stethoscope to check the arterial blood pressure of the extremities. It is often necessary to examine the lower limbs in both static and dynamic states to distinguish whether intermittent claudication is caused by arterial obstructive disease, and the distance of claudication can be measured according to the dynamic examination to decide the treatment. Color ultrasound Doppler examination is a non-invasive examination method widely used in recent years, which is simple and easy to perform and can better show the local arterial lesions, such as lumen morphology, intimal sclerotic plaque, blood flow status, etc. Color ultrasound Doppler is also a common method for postoperative follow-up monitoring of the grafted vessels, but it is necessary to rely on a professional ultrasonographer to obtain satisfactory results. 4. CT angiography (CTA) or magnetic resonance angiography (MRA) CTA or MRA is a safe and quick test that needs to be performed on a large instrument in a CT room or MRI room, but it usually requires a small amount of contrast agent to be injected into the surrounding veins. CTA or MRA can be used to obtain more accurate information and images of the arterial lesions and distal arteries before further treatment. 5.Arteriography and digital subtraction angiography are the most accurate examination methods and one of the most important means to diagnose vascular diseases. (Arteriography not only clearly shows the morphology of the artery and identifies the site of arterial obstruction, but also provides detailed information about the distal vessels of the obstructed area and the establishment of collateral circulation, which helps to determine the surgical treatment plan and estimate the prognosis of the operation. However, it is an interventional method, especially in patients with renal insufficiency, and the use of contrast agents may be limited. (Therefore, this method is mostly used in patients requiring surgical or percutaneous intervention). How should atherosclerotic occlusive disease be treated? Non-surgical therapy can be divided into non-surgical therapy and surgical therapy: 1, non-surgical therapy: including diet control, appropriate exercise, avoid smoking, warmth; application of lipid-lowering drugs, vasodilators and traditional Chinese medicine; anti-platelet aggregation, negative pressure therapy of the limbs to promote the establishment of collateral circulation, non-surgical therapy can only delay the progression of lower limb arteriosclerosis occlusion, can not fundamentally solve the narrowing and occlusion of the lower limb arteriosclerosis vessels. 2.Surgical therapy: According to the location, degree, scope and collateral circulation of the lesion, arterial bypass surgery, arterial endothelial debridement, omental transplantation or venous arterialization surgery can be used to increase blood supply to the affected limb. Patients should choose individualized treatment modalities at different stages of disease development. Endovascular treatment refers to the opening of narrowed and blocked arteries from the lumen under X-ray surveillance without surgical incision or general anesthesia, and is therefore called endovascular treatment. This method has the advantages of being minimally invasive, simple to perform, effective and repeatable. It includes balloon dilation, endoluminal stenting, endoluminal sclerotic plaque spinning and ultrasound and laser endoluminal angioplasty. How to prevent atherosclerotic occlusive disease? To change bad habits, quit smoking, prohibit high-fat indigestible and stimulating food, eat a light diet, eat more fruits and vegetables, beans. Those who suffer from hypertension, hyperlipidemia and diabetes should actively treat the original disease. Obese patients should reduce weight, and appropriate exercise can increase the lateral branch circulation. Pay attention to heat preservation of the affected limbs, keep the feet dry and clean, cut toenails correctly and promptly, but do not cut them too close to the skin; do not wear shoes or socks that are too tight, and do not walk barefoot; avoid injury. Avoid applying drugs that constrict blood vessels. The affected limb should be protected from cold, but not baked hot or in the sun; do not sit with legs crossed, keep the skin of the affected limb clean and dry.