Q: What does “intermittent claudication” mean?
”Intermittent claudication” refers to the condition of arterial occlusion or stenosis of the lower extremities, in which the patient experiences pain and soreness in the buttocks and lower legs after walking a certain distance, forcing the patient to stop and rest for a few moments before the pain is relieved, and then the symptoms recur after walking a certain distance, especially in winter, when vasoconstriction is more likely to occur at low temperatures.
Q: What diseases can cause “intermittent claudication”?
A: Any disease that causes arterial occlusion or stenosis in the lower extremities can manifest as “intermittent claudication” in the early stages. Common diseases include: lower extremity arteriosclerosis occlusive disease, thrombotic occlusive vasculitis, diabetic foot (ischemic), etc.
Q: Are there any serious consequences of “intermittent claudication”?
A: “Intermittent claudication” is an early clinical manifestation of insufficient arterial blood supply to the lower extremities. If not given enough attention at this stage, it can lead from “intermittent claudication” to “resting pain” and, in severe cases, gangrene of the lower limbs. Resting pain” means that the patient has progressively more severe pain even without walking, especially at night. Gangrene” refers to signs of necrosis such as darkening of the skin and impairment of movement in the terminal areas of the patient’s main limbs.
Q: Can “intermittent claudication” lead to amputation?
A: “Intermittent claudication” has two regression results: in the first case, after certain treatment to eliminate the disease factors, the walking distance is extended and the disease is controlled. In the second case, the disease continues to progress due to lack of timely and proper treatment or ineffective treatment, with the possible end result of amputation.
Q: Who is prone to “intermittent claudication”?
A: The four major factors that cause atherosclerosis are also the main factors that cause “intermittent claudication”: smoking, hypertension, diabetes, and hyperlipidemia. Other factors include: obesity, advanced age, etc.
Q: In which age group does “intermittent claudication” tend to occur?
A: If it is “intermittent claudication” caused by atherosclerosis-occlusive disease, the age of prevalence is generally between 65 and 75 years old. If the “intermittent claudication” is caused by thrombo-occlusive vascular disease, the age of prevalence is around 30-40 years old.
Q: Why should we pay special attention to “intermittent claudication”?
A: There are three main reasons: (1) “intermittent claudication” is a prelude to ischemic necrosis of the arteries in the lower extremities. (2), in the “intermittent claudication” stage for the correct treatment effect is often the best, amputation rate is very low. (3) “Intermittent claudication” often reflects the patient’s cardiovascular and cerebrovascular pathology at the same time.
Q: What tests should be done at the hospital when “intermittent claudication” occurs?
A: Since spinal stenosis, venous blockage and other diseases can also cause similar claudication, it is important to make a clear diagnosis. For patients who are suspected of having “intermittent claudication”, an examination of the arterial system is always required. The procedure is generally as follows: vascular surgery visit → check lower extremity arterial pulsation → ABI measurement → lower extremity arterial ultrasound → CT or MRI arteriography → DSA imaging.
Q: Is it necessary to perform cannulation angiography for “intermittent claudication”?
A: In the past, arteriography using a femoral artery cannula was considered the “gold standard”, but in recent years, with the advent of 64-row spiral CT, there has been a historic change in the diagnosis of lower extremity arterial disease. It takes only 10 seconds and costs only about 1/3 of the cost of conventional arteriography.
Q: How do you define “intermittent claudication” due to arterial ischemia?
A: In order to distinguish it from other similar claudication, it is important to understand several characteristics of “intermittent claudication”: 1) the distance walked is relatively fixed each time; 2) the pain must appear after walking a certain distance; 3) the pain appears mainly in the calf muscles, and in some patients in the buttocks; 4) the pain is relieved after a few moments of rest.
Q: Is there a less invasive way to treat “intermittent claudication” if medication is less effective?
A: The current development of interventional technology has enabled the treatment of intermittent claudication to avoid some of the complications of traditional surgery. Balloon dilation or stenting of the lesion is performed by introducing special equipment through vascular puncture.
Q: Can interventional treatment be used if there is occlusion of small vessels in the lower extremities with extensive vascular lesions?
A: In the past, both traditional surgery and interventional treatment had a prerequisite that the distal end of the lesion should be kept in a good patency, called “outflow tract”. However, many cases encountered in clinical practice have narrowed or occluded the distal “outflow tract” vessels due to the long duration of the disease, and there were no effective means for such patients in the past, so the amputation rate was high. In recent years, the emergence of the “Deep Balloon” technique has solved the problem of treating distal vascular lesions below the knee.
Q: What are the characteristics of the vascular lesions below the knee?
A: Vascular lesions represented by ischemic diabetic foot are often characterized by extensive stenosis or occlusion of arteries below the knee. Long segmental occlusion is one of its characteristics, with poor collateral circulation and severe calcification.
Q: Why is Deep Balloon Technology able to solve the vascular lesions below the knee?
A: “Deep balloon technology” uses equipment specifically designed for small vascular lesions below the knee, such as “Deep guidewire” and “Deep balloon”, which can pass well through the lesion The treatment is performed through the vascular segment. “In addition to its small diameter, the Deep Balloon also has good compliance and does not cause medical damage to the blood vessels while dilating the lesion.
Q: Is it necessary to implant a stent after balloon dilation of the infrapopliteal vascular lesion?
A: Generally speaking, it is not necessary to implant a stent after “Deep Balloon” dilatation of infrapopliteal vascular lesions, but in cases such as significant retraction after balloon dilatation or the formation of entrapment during treatment, it is necessary to implant a special stent called “Deep Stent”. “It is the smallest caliber self-expanding stent in the market, which is specially used for the treatment of infrapopliteal artery lesions.