Atherosclerosis is a systemic disease that occurs in middle-aged and elderly patients. Atherosclerosis can also occur in the arteries of the lower extremities, just like “scale growing in water pipes”, which can cause blockage of water pipes when it grows to a certain extent, and the development of atherosclerosis can cause severe narrowing and complete blockage of blood vessels.
Figure 1 Normal intra-abdominal segment of lower limb artery (iliac artery).
Figure 2 Atherosclerosis causes occlusion of the entire left iliac artery.
Figure 3 Normal thigh segment of the lower extremity artery (femoral artery).
Figure 4 Arteriosclerosis leading to gross wall, multiple limited significant stenosis and complete occlusion of the femoral artery.
Figure 5 Normal lower extremity artery of the lower leg segment with three normal branches, namely the anterior tibial, posterior tibial and peroneal arteries.
Figure 6 Atherosclerosis causing full occlusion of two of the three main arteries of the lower leg (posterior tibial and peroneal arteries) and long segment occlusion of the remaining one (anterior tibial artery).
Atherosclerotic occlusion in the lower extremity can lead to severe ischemia in the lower extremity, with early manifestations of intermittent claudication, i.e., pain and weakness in the lower extremity after walking a few hundred meters, and inability to continue walking, and the ability to continue walking only after a few moments of leisure, accompanied by coldness and pale skin color in the affected extremity. The blackened necrosis or ulceration starting from the distal end (toe) is accompanied by continuous severe pain, which is unbearable and seriously affects sleep. If the blood vessels are not effectively unblocked in time, amputation is eventually required. Atherosclerotic occlusion of the lower extremity is the most common cause of limb loss in middle-aged and elderly patients.
Figure 7 Toe necrosis caused by atherosclerotic occlusion of the lower extremity.
Figure 8 Chronic ulceration of the lateral foot caused by atherosclerotic occlusion of the lower extremity.
Figure 9 Total foot necrosis caused by atherosclerotic occlusion of the lower extremity.
Currently, pharmacological treatment of atherosclerotic occlusion of the lower extremities can only be used as an adjunctive treatment with limited efficacy and cannot open the occluded vessels. The most effective treatment measures include surgical treatment and interventional treatment. The main surgical treatment is artificial vessel bypass surgery, in which the two ends of the artificial vessel are connected to the relatively normal vessels at the distal and proximal ends of the occluded segment, so that blood flow is supplied to the distal part of the lower extremity through the artificial vessel. However, not all types of lower extremity atherosclerotic occlusions are suitable for surgical treatment, and surgical treatment is more traumatic, and for elderly patients of advanced age and with a variety of medical diseases, they cannot tolerate surgical treatment, and some surgical treatments have been replaced by interventional treatments.
Interventional therapy, also known as endoluminal therapy, i.e. balloon dilation and stent implantation, is usually performed by puncturing in the groin (root of thigh) or elbow fossa, through which catheters and guidewires can treat lesions of blood vessels throughout the body and open blood vessels from within the lumen. Interventional treatment fundamentally solves the blockage of blood vessels, with immediate effect and no surgical incision, minimal trauma and quick recovery. With the improvement and widespread development of interventional technology, interventional treatment is suitable for almost all types of lower extremity atherosclerotic occlusions. Because interventional treatment is less traumatic and has faster recovery, it is generally tolerated by elderly patients with a variety of medical diseases such as hypertension, diabetes mellitus, and coronary artery disease, and has now replaced some surgical treatments as the treatment of choice for patients with lower extremity atherosclerotic occlusions.
Figure 10 Patient 1 with limited severe stenosis of the femoral artery due to atherosclerosis.
Figure 12 The same patient, stenotic segment dilated by application of balloon during intervention.
Figure 13 The same patient, the stenotic segment has completely disappeared after stenting.
Figure 14 Patient 2, multiple sclerotic stenosis and complete occlusion of the femoral artery (lower limb artery thigh segment).
Figure 15 In the same patient, the occluded segment of the femoral artery was opened and the stenoses disappeared completely after intervention (balloon dilation and stent implantation).
Figure 16 Patient 3 with sclerotic occlusion and multiple segmental stenosis in long segment of femoral artery.
Figure 17 In the same patient, the occluded segment was completely opened and the stenoses disappeared after intervention.
Figure 18 Patient 4, two of the three main arteries of the lower leg (posterior tibial and peroneal arteries) were completely occluded, and the remaining one (anterior tibial artery) was occluded in a long segment.
Figure 19 In the same patient, the occluded segment of the anterior tibial artery was completely opened after intervention (balloon dilation).
Figure 20 Patient 5 with sclerotic occlusion of the entire left iliac artery (intra-abdominal segment of the lower extremity artery).
Figure 21 The same patient, the catheter has successfully passed through the occluded segment of the left iliac artery during the intervention.
Figure 22 The same patient with complete opening of the left iliac artery after stenting.