What is thrombo-occlusive vasculitis?
Thrombo-occlusive vasculitis is an inflammatory and chronic occlusive disease involving blood vessels that mainly affects the extremities, especially the small and medium-sized arteries and veins of the lower extremities. Rarely, it occurs in the blood vessels of the brain, heart and digestive tract. The disease occurs in all parts of China, but is more common in areas north of the Yellow River; abroad, it occurs mostly in Asian regions, and is rare in Europe and the United States. In 1908, Buerger reported the pathological changes of this disease, so it is also called Buerger’s disease.
What is the cause of thrombo-occlusive vasculitis?
The cause of this disease is still not fully understood, but is generally thought to be due to a combination of factors. Smoking, cold, humidity, malnutrition, and sex hormone abnormalities have been considered major factors in the development of the disease, with smoking being particularly associated with the onset of the disease. In the last decade or so, immune factors have received attention. Through the observation of humoral immunity, cellular immunity and immunopathology of this disease, many scholars believe that this disease is an autoimmune disease.
What are the manifestations of thrombo-occlusive vasculitis? How is it diagnosed?
The disease has an insidious onset and a slow pathological progression, with periodic episodes that often take several years to become severe. The evolution of the disease can be divided into three stages according to the degree of limb ischemia.
The first stage (local ischemic stage) is the primary stage of the lesion. The main manifestations are numbness, coldness, coldness, soreness, easy fatigue, heaviness and mild intermittent claudication of the affected limb. The latter is a typical sign of this stage. When the patient walks 1 to 2 miles, the calf or foot muscles become distended or throbbing, and if he continues to walk, the pain worsens and he is finally forced to stop walking. After rest, the pain is immediately relieved. The symptoms reappear after walking again and are called intermittent claudication. As the condition progresses, the walking distance is gradually reduced. This is due to the increased oxygen demand of the muscles after walking. On examination, the skin temperature of the affected limb is reduced, the skin color is paler, and the dorsalis pedis artery or (and) the posterior tibial artery pulses are weakened. Wandering thrombophlebitis is often present.
Stage II (dystrophic phase) The symptoms of numbness, coldness, coldness and soreness of the affected limb are aggravated, intermittent claudication becomes increasingly obvious, walking distance is shortened, rest time is prolonged, and pain becomes persistent. The pain does not stop even when the limb is at rest, which is called resting pain. It is more obvious at night. The skin temperature of the affected limb decreases significantly, the skin color becomes paler, or purple spots and flushing appear, the skin is dry, and the sweat hair is lost. Toe (finger) nail thickening and deformation, calf muscle atrophy, dorsalis pedis artery and posterior tibial artery pulsation disappear, N artery and femoral artery pulsation may also be weakened.
In the third stage (tissue necrosis stage), in addition to the above-mentioned symptoms continue to worsen, the affected limb is severely ischemic, and the resting pain is even more aggravated, the pain is severe and persistent, the patient sits on his knees and holds his feet day and night, and does not sleep at night. Patients are unable to sleep steadily at night. If local infection is complicated, fever, chills, irritability and other symptoms of systemic toxemia may appear. Ischemia of the extremity tissue is more severe, producing ulcers or gangrene. Most of the gangrene is dry, with the toe (finger) end dried and blackened, and may extend to the proximal end. After the necrotic tissue is shed, a long-lasting ulcer is formed. If secondary infection develops, the gangrene is wet. According to the extent of gangrene, it can be divided into three grades: grade I, gangrene is limited to the toe (finger); grade II, gangrene extends to the toe (metacarpal) joint and (metacarpal); grade III, gangrene extends to the heel, ankle joint or above the ankle joint.
The above staging is to identify the severity of the disease and the different stages of the disease process, so that the corresponding and effective treatment can be mastered. However, the staging is not static. If the lesion develops, the symptoms can be aggravated. If timely treatment is provided, the lateral branch circulation is established and the local blood supply is improved, the symptoms can be relieved and the disease can improve, and the stage and level can be changed.
The diagnosis of thrombo-occlusive vasculitis mainly relies on clinical and cannot rely on laboratory test results to confirm the diagnosis. The first manifestation of thrombo-occlusive vasculitis is mostly below 40 years of age, and the typical complaints of patients are coldness, numbness, and pain due to impaired circulation in the hands and feet, and patients often already have gangrene of the extremities. Angiography can confirm the diagnosis of patients with clinically suspected thrombo-occlusive vasculitis.
What diseases can be complicated by thrombo-occlusive vasculitis?
Thrombo-occlusive vasculitis can be complicated by ischemic pathological changes in nerve, muscle, bone and other tissues. If local infection is complicated, systemic toxemia such as fever, chills, and irritability may occur. Ischemia of the extremity tissue is more severe, producing ulcers or gangrene, mostly dry gangrene or, if secondary to infection, wet gangrene. Toxins or other toxins produced by bacteria enter the blood circulation and produce systemic toxic symptoms called toxemia.
Should I be bedridden if I have thrombo-occlusive vasculitis?
Patients with thrombo-occlusive vasculitis need to strengthen their exercise to promote better establishment of collateral circulation and thus improve blood supply to the affected limbs. Burgh exercise method can be tried, that is, the patient lies flat, first elevate the affected limb more than 45 degrees, maintain 1-2 minutes, then dip in the bedside for 2-3 minutes, then place the horizontal position for 2 minutes, and make foot rotation, extension and flexion activities. Repeat the above exercise for 20 minutes, several times a day.
Do all patients with thrombo-occlusive vasculitis have to have their limbs amputated?
Thrombo-occlusive vasculitis is a chronic ischemic lesion that progresses slowly, with periodic episodes, and often takes several years to become severe, so strengthening functional exercise and active treatment can have a better outcome, and statistics show that the 5-year amputation rate for patients with thrombo-occlusive vasculitis is 20-30%, but the life expectancy is similar to that of the normal population.
How can thrombo-occlusive vasculitis be prevented?
Do not smoke, do not drink alcohol, be in a relaxed mood, live, study and work with full passion and energy, and pay attention to body warmth in the cold season, especially the extremities. Diet and living in moderation, the discovery of the early stage of the disease patients should go to the hospital in time to diagnose, and actively treat. Do early detection and early treatment.
How to treat thrombo-occlusive vasculitis?
The aim of treatment is to relieve resting pain, promote ulcer healing and avoid and reduce amputation. The most important measure is strict control of nicotine inhalation, and complete weaning from nicotine inhalation can bring the disease into quiescence. Cold and trauma should be prevented, as well as overheating to avoid an increase in tissue oxygen demand. Conservative treatment includes the use of antiplatelet, anticoagulant, steroid and immunosuppressive drugs, and hyperbaric oxygen therapy to increase oxygen supply to the limb. The use of thrombolytic drugs is controversial and should only be considered in the early stages of the disease. Surgical treatments include: lumbar sympathectomy, endothrombectomy, bypass diversion, staged arteriovenous diversion, and amputation.
Are there any other less invasive methods to treat thrombo-occlusive vasculitis?
The treatment of lower extremity atherosclerosis is gradually moving toward minimally invasive surgery – percutaneous endovascular surgery, gene therapy, and autologous peripheral blood stem cell transplantation – with encouraging prospects that these minimally invasive procedures may gradually replace conventional surgery.
What are the precautions after discharge from hospital?
1, sports exercise: treadmill exercise and walking are the most effective exercises to treat claudication. Exercise intensity: walking speed should be set at 3 to 5 minutes that is when the painful claudication symptoms are induced, walk under this load until moderate painful symptoms are produced, then stand or sit down to rest so that the symptoms are relieved, and then continue the above walking. Exercise duration: The exercise – rest – exercise process should be repeated during each exercise session. The initial exercise requires a total of 35 minutes of walking, followed by an increase of 5 minutes per exercise until a total of 50 minutes of walking is completed, and the exercise continues at this intensity and duration. Exercise frequency: 3 to 5 times per week.
2.Living habits and risk factors control: quit smoking and alcohol, low salt and low fat diet, control low density lipoprotein (LDL) below 100mg/dl, control blood sugar, make glycated hemoglobin below 7%, control blood pressure below 140/90mmhg, if combined with diabetes or kidney disease, blood pressure should be controlled below 130/80mmHg.
3. Long-term oral antiplatelet and microcirculatory improvement drugs are needed after discharge, and blood coagulation indexes should be rechecked regularly to adjust the dosage of oral drugs to avoid bleeding caused by overdose.