Do you experience weakness, tenderness, swelling and pain in your limbs after walking, forcing you to rest for several minutes before you can continue your journey? Or worse, do you have persistent leg pain, often lying on your knees at night, unable to sleep at night? Or worse, do you have hyperpigmentation, ulcers, cyanosis, toe necrosis in your lower extremities? If you have any of these symptoms, you are probably suffering from “lower limb ischemic disease”. What is “ischemic disease of the lower extremities”? Lower limb ischemic diseases include ischemic symptoms in the distal limb caused by relative or absolute shortage of blood supply to the lower limb due to poor blood flow caused by arterial stenosis, occlusion, thrombosis or embolism, and in severe cases, necrosis of the limb may occur; at the same time, it also includes distal limb stasis, swelling and metabolic disorders caused by venous return obstruction, and in severe cases, necrosis of the distal limb may still occur. Therefore, lower extremity ischemic diseases have both arterial disease factors causing limb ischemia and venous disease factors causing limb stasis. Arterial ischemic disease recognition and scope Patients with arterial ischemic disease mainly present with intermittent or persistent leg pain, decreased skin temperature, pallor, reduced or even inaccessible arterial fluctuations, numbness, and limited motion. Pain may be relieved by dropping and resting the limb, and appears or worsens with elevation of the limb or increased walking distance. Vascular ultrasound and 3D reconstruction of lower extremity vessels can clarify the site, cause, and severity of arterial disease. Arterial ischemic diseases involve the following categories: 1. Lower limb atherosclerosis occlusive disease Lower limb atherosclerosis occlusive disease mainly affects middle-aged and elderly people, often with a background of hypertension, hyperlipidemia, diabetes mellitus and other diseases, with smoking and other risk factors, lower limb pain and other ischemic symptoms are gradually aggravated, from intermittent claudication to persistent resting pain, limb ischemic necrosis development. 2, thrombo-occlusive vasculitis thrombo-occlusive vasculitis occurs in young and middle-aged people, with a long history of smoking, while there is a family tendency to gather, sensitive to nicotine reaction, this part of the disease in the 1980s and before common, now gradually reduced, the main performance of lower limb ischemia often combined with thrombotic superficial phlebitis. 3. Acute arterial embolism Acute arterial embolism of lower extremity can lead to acute ischemia of the limb, and the lateral circulation can not be established in time, and irreversible necrosis of the limb distal to the embolism can occur in 6-8 hours, and the typical manifestation of arterial ischemia mentioned above is present at the beginning of the disease, and the prognosis of the disease depends on the early and late consultation and timely treatment, and early embolization and thrombolysis is the principle of treating acute arterial embolism, but the effect of embolization is limited and can easily lead to thrombosis in more than 6-8 hours. However, if the onset of the disease is more than 6-8 hours, the effect of embolization is limited, and it will easily lead to myopathic nephrotic syndrome, and the mortality and amputation rate will be increased. 4. Raynaud’s syndrome is triggered by emotion, nervousness, cold stimulation, etc., and appears as pale, painful, inaccessible pulse, numbness, paralysis and other manifestations of the extremity. 5, arteriovenous fistula arteriovenous fistula because there is an abnormal blood vessel between the artery and vein direct access, resulting in arterial blood through the fistula directly back into the vein, resulting in the artery distal limb blood supply is insufficient, causing ischemic symptoms, severe cases can cause distal limb necrosis. 6, diabetic foot Diabetic foot is a diabetic patient due to long-term unsatisfactory blood sugar control, involving small and medium-sized blood vessels in the limbs, sclerosis, occlusion, resulting in inadequate blood supply to the limbs, limb pain, pigmentation, ulcers, and even gangrene. Therefore, diabetic foot and arteriosclerosis occlusion are related and different. It is more difficult to treat than the latter because it involves smaller and medium-sized blood vessels. Venous ischemic disease identification and scope Venous ischemic disease manifests as gradually increasing intermittent limb heaviness, tenderness, weakness, developing into persistent limb pain, aggravated by drooping and moving limbs, relatively reduced by elevation and resting limbs, increased skin temperature of the affected limb compared with the contralateral limb, thickening of the limb compared with the contralateral limb, bruising, hyperpigmentation, ulceration or gangrene may appear. 1. Deep vein thrombosis and sequelae Deep vein thrombosis refers to the abnormal coagulation of blood in deep vein, which occurs in the lower limbs, and there is no exact statistical data on the incidence in China. million. If the acute stage of DVT is not diagnosed and treated in time, some patients may be forced to amputate their limbs due to severe swelling and necrosis of lower limbs; some patients may suffer from pulmonary embolism caused by dislodged thrombus, and about 100,000 people die from pulmonary embolism in the United States every year. In addition, most of those who fail to timely and correctly deal with the problem cannot avoid the occurrence of chronic thrombosis sequelae, resulting in long-term intermittent or persistent leg pain due to lower limb stasis, which affects life and work ability and can cause disability in serious cases. 2.Superficial varicose veins of lower limbs (moderate to severe) See the last issue of Sanjiang Weekly for details. 3. Thrombotic superficial phlebitis Thrombotic superficial phlebitis is common in the clinic, which can cause significant discomfort and functional limitation of the lower limbs, although it is a benign self-limiting disease, it can recur and persist for a long time, and it is reported in the literature that about 11% of the cases of thrombotic superficial phlebitis, the thrombus spreads leading to deep vein thrombosis. The manifestation is pain along the vein with striated structures or nodules, often combined with a perivenous inflammatory response that causes redness of the involved veins.