What is vasculitis? Vasculitis, known as thromboembolic vasculitis, is a kind of inflammatory and chronic occlusive disease involving blood vessels, which mainly attacks the limbs, especially the middle and small arteries and veins of the lower limbs. Rarely occurs in the brain, heart, digestive tract and other places of the blood vessels. There are morbidity in all parts of our country, but to the north of the Yellow River is common; in foreign countries, it occurs in Asian regions, Europe and the United States are rare. The majority of patients are male, occurring in young adults. 1908, Buerger reported the pathological changes of this disease, so it is also known as Buerger’s disease. What is the cause of Thromboembolic Vasculitis? The real cause of the disease is not clear, but several factors related to the onset of the disease have been found: (1) Smoking: the pathogenesis of smoking and the disease is also not clear, but there is a very clear relationship with the onset of the disease. Clinically, it is found that after the patient quits smoking, the symptoms can be improved and the condition can be easily stabilized, but if the patient smokes again, the symptoms can be aggravated again. This may be due to the fact that smoking can cause vasoconstriction. (2) Sex hormones: most patients with this disease are male; and the age of onset is young and middle-aged, considering androgen-related. (3) Geographic distribution and cold: may be related to the cold can induce vasospasm. (4) Immunology: some studies have shown that vasculitis is an autoimmune disease under the repeated effects of tobacco allergy and other factors. (5) Trauma: a few patients have a history of lower limb injury before the onset of the disease, such as pressure injuries, strenuous exercise, long-distance walking, etc. The onset of the disease may be related to vascular injury. (6) Increased blood coagulability: the whole blood viscosity and plasma degree of such patients are increased, and the electrophoresis time of red blood cells is slowed down. What are the main clinical symptoms of Thromboembolic vasculitis? How is it diagnosed? Thromboembolic vasculitis is mainly caused by obstruction of small arteries in the limbs, resulting in reduced blood flow and ischemia of the limbs. The main symptoms are: (1) pain, early mainly intermittent claudication, that is, when the patient walks a certain distance (50-500 meters) after feeling calf or foot muscle distension or throbbing, if you continue to straighten the line, then the pain is aggravated, and finally forced to stop. After a few moments of rest, the pain is relieved, and the pain returns after walking again. In the late stage of the disease is further aggravated, the patient can often appear resting pain. This kind of pain is very intense and persistent, especially at night. The patient sits day and night with knees bent and feet clasped, and stays awake all night. Wandering thrombophlebitis: About 40% of patients have recurrent wandering thrombophlebitis in the lower leg or foot before or during the onset of the disease. It is often in the form of red streaks and nodules, accompanied by mild pain. (2) Limb nutritional disorders Long-term ischemia of the limbs causes limb nutritional disorders, which mainly manifests slow growth of toenails, thickening and deformation, dry skin, flushed or purplish color, loss of sweat hair, and muscle atrophy of the calf or foot. In the late stage, there may be ulcer or gangrene of limbs. And most of them are dry gangrene. Gangrene can be divided into three levels: Grade I: gangrene is limited to the toe (finger); Grade II: gangrene extends to the toe-metatarsal (phalangeal) joints and the metatarsal (palm); Grade III: gangrene extends to the heel of the foot and the ankle joint or above; according to the severity of the clinical manifestations, the course of the disease can be divided into three phases: Phase I localized ischemia: the disease belongs to the early stage. It includes intermittent claudication and wandering thrombosed superficial phlebitis. The second stage of nutritional disorders is the progressive stage: mainly resting pain and muscle atrophy. The third stage of tissue necrosis: it is the late stage. It is mainly ulcers and gangrene in distal limbs. Diagnostic points: (1) Male young adults are common, with 20~40 years old most, female is rare. Patients are mostly addicted to smoking. (2) At the beginning, it is often unilateral lower limb, later it can involve the opposite lower limb, and when it is serious, the upper limb can also be involved. (3) Clinical manifestations of chronic arterial ischemia in the lower limbs. Symptoms mostly start from the end of the limb and may develop to the calf or forearm in a short period of time. The affected limb is pale after elevation and flushed or petechial purple after lowering. Compression of the skin of the toe (finger) end or the toe (finger) nail with the finger results in a slow recovery time of the local skin or nail bed capillaries. The dorsalis pedis or/and posterior tibial artery and national artery pulsations of the affected limb are weakened or absent. A few superficial femoral arteries are also involved. (4) History or clinical manifestations of wandering thrombosed superficial phlebitis in the lower extremities. (5) The condition may alternate between cyclic stabilization and episodes of recurrence, with gradual deterioration of the circulation in the extremities and the occurrence of gangrene. (6) There is no history of hypertension, hyperlipidemia, atherosclerosis or diabetes mellitus. Treatment of Thromboembolic Vasculitis (1) General therapy: ① Quit smoking, prevent cold, damp, and keep the affected limbs warm, but should not apply hot compresses or heat therapy. ② Foot exercises. (2) Drug therapy: ① herbal medicine; ② vasodilator drugs; ③ anti-infection; ④ supportive therapy. ⑤ Hormone (3) Hyperbaric oxygen therapy (4) Surgery: ① Lumbar sympathetic ganglionectomy; ② Arterial thrombus endarterectomy; ③ Arterial bypass grafting; ④ Greater omentum grafting; ⑤ Surgery for distal vein arterialization of the limb.