Forty-year-old boss Zhang’s business is successful, busy every day with various social engagements. One day in the sauna, he suddenly shouted: ” Oops, how can I have blisters on my toes? The water was so hot, how come this foot didn’t feel warm”. Boss Zhang vigorously pinched his left foot, obviously tingling. The new situation makes the boss feel bad, the next day rushed to take the time to go to the hospital to see a doctor. The doctor looked at Mr. Zhang’s foot and said, “Your foot has a more serious problem, medically called gangrene, caused by ischemia, when did the discomfort begin?” . Boss Zhang recalled carefully, “I do not remember particularly well, it seems that six months ago I felt a little pain in my left foot, walking without strength, walking more pain is obvious. But because the business is too busy, the pain will eat painkillers to cope with the past. Then I got used to it and never paid any attention to it.” . “Do you smoke a lot?” “About two packs a day” “According to your situation, your foot should be arterial ischemic lesions, such as arteriosclerosis occlusive evidence or vasculitis, etc. caused by the need for further examination in hospital to confirm the diagnosis, it is likely to be amputated.” Boss Zhang was immediately dumbfounded at hearing this. After hospitalization, a series of tests confirmed that the gangrene of Zhang boss’s left foot is caused by vasculitis, and finally the left foot had to be amputated. How can vasculitis be so terrible, what exactly is it a disease Vasculitis is called thrombo-occlusive vasculitis, also known as Buerger’s disease. It is a chronic vascular occlusive disease characterized by segmental, non-suppurative inflammation of small and medium-sized arteries and intra-arterial thrombosis, which causes lack of adequate blood supply to the tissues on the distal side of the occlusion, mostly in the lower extremities. The etiology of vasculitis is still unclear, smoking is a clear causative factor, hormonal disorders, infections, and neuromodulation disorders are also possible causes. There are more theories that support the idea that vasculitis is an autoimmune disease, which is why hormones are used clinically to control symptoms. Pain is usually the most prominent symptom of vasculitis, and it gradually worsens as the disease progresses. At first, the pain can be reduced or disappeared after rest, but it worsens after walking, and the patient has to stop and rest for a while after walking a certain distance because of the pain, which is often referred to as “intermittent claudication”. After that, the pain cannot be relieved even after resting, and it is more obvious at night, and some patients have trouble sleeping at night with their knees and feet flexed. At this point, even morphine-based painkillers can’t help. However, not all patients experience such an obvious process of pain aggravation. Because the inflammation of vasculitis can affect the sensory function of the nerves in the lower limbs, and ischemia further decreases the sensation of the nerves. Zhang boss is such a typical example, at first he did feel a foot pain, but he took painkillers every day, the pain was not obvious, and later the nerve function was impaired, the pain naturally reduced. Chilliness and abnormal sensation are also common symptoms of vasculitis: because of ischemia, the temperature of the body surface of the lower extremities drops, and the patient feels chilled and afraid of cold. After nerve damage, not only does it affect the pain sensation, but abnormal sensations such as pins and needles and burning often occur. Another common symptom is skin color change: the skin turns white after arterial ischemia; some patients have thinning skin due to reduced tone of superficial blood vessels, and also flushing or bruising. How to detect vasculitis early Most vasculitis progresses slowly, with periodic episodes and sometimes insidious symptoms. An early symptom is a feeling of extra coldness in the lower extremities and a whitening of the skin, which is more noticeable in the winter. This is when patients should go to the hospital to find out what is causing the disease, or if it is simply physiological. As the climate warms in the summer, the feeling of cold feet usually improves, and it is easy for patients to neglect and delay the diagnosis at this time. How to confirm the diagnosis of vasculitis The commonly used clinical examination methods include the following: (1) photoelectric volumetric tracing: check the blood supply to the end artery of the affected limb, you can generally understand the location and extent of the lesion, with the characteristics of cheap, simple, non-invasive, repeatable examination. (2) Ultrasonography: The commonly used ultrasound is color duplex ultrasound, which has similar characteristics as photoelectric volumetric tracing, but has a higher accuracy rate. (3) Angiography (DSA) examination: is the gold standard for the diagnosis of vasculitis, and the results of angiography are the basis for differentiation from other diseases causing vascular occlusion. However, this test is more expensive and has some risk and trauma. (4) MRI or CT and other vascular reconstruction examinations: the examination results are similar to DSA, and the trauma and cost are relatively small. In addition, patients are mostly young and strong males, often with a history of heavy smoking, and vasculitis can be diagnosed when there are positive results of the above tests along with clinical manifestations of ischemia. How to treat vasculitis Once diagnosed with vasculitis, what to do? Is it an incurable disease and very scary? In fact, vasculitis is not all terrible, some can be cured, some also have very good treatment effect, can relieve pain, reduce symptoms, usually should start from the following aspects: 1, quit smoking The importance of quitting smoking is no matter how stressed is not too much, this is the first step in the treatment of vasculitis, but also the most important one. It is also the most important measure to avoid relapse. It can be said that if you want legs, you don’t want smoke, and if you have smoke, you don’t have legs. Passive smoking is equally harmful and should be avoided as much as possible. 2, medication Medication is still the main method of treating vasculitis. Commonly used drugs include Chinese and Western medicine two types. The more recognized Chinese medicines are Danshen and Shengve injection. Western medicine is currently more certain is Kaishi (prostaglandin a vasodilator). Ambulac and Norbostat are two new drugs that have recently been used in clinical practice and have good effects. Sometimes hormones are also needed to control acute attacks. 3, surgical treatment (1) arterial reconstruction: multiple stenosis is a distinctive feature of vasculitis, which makes it difficult to solve the problem surgically, and it is impossible to bridge between each stenosis. The percentage of patients able to undergo surgical treatment is very small. (2) Sympathectomy: This procedure is still an effective treatment for this disease, which can release vasospasm and promote the formation of collateral circulation to a certain extent. (4) Stem cell transplantation: At present, there have been reports of the application of stem cell transplantation for the treatment of vasculitis at home and abroad. There is a certain degree of short-term efficacy, but the specific mechanism is still unclear, and there is also a lack of long-term clinical validation. Patients should pay special attention to the problem Be careful with your hot water bag: Vasculitis is prone to develop in winter, because the winter cold, easy to cause vasoconstriction, and after the beginning of spring as the weather warms up, the blood vessels expand, and the symptoms are reduced. In the winter onset, patients mostly like to use hot water bags to warm up to improve pain and coldness. However, there is a very paradoxical problem here: proper insulation does improve the above symptoms, however, the simple local temperature increase increases the metabolism and oxygen consumption of the tissues at the lesion, but the total blood flow is not likely to increase, and in fact the degree of tissue hypoxia is aggravated. Because the nerve damage is significantly reduced sensation, some patients even put hot water bags directly on the legs for a long time without any discomfort, the result is scalded local skin and tissue, resulting in ulcers. To add insult to injury, the more ischemic the tissue is, the poorer the ability to repair and the poorer the ability to resist infection. So the ulcer expands, gradually infected, and does not heal over time …… Similarly, avoiding accidental injury to the lower extremities is also something that this part of the patient should pay special attention to, wearing fewer and thinner clothes in the summer, more attention should be paid to safety. Usually choose shoes should be loose and soft, pay attention to warmth and moisture. Pay attention to hygiene: Patients with vasculitis should wash their feet with warm water every day, toenails should not be too long, foot odor and other diseases should be treated early. Buerger’s exercise is an appropriate and effective exercise method: the patient lies on his back, elevate the affected limb 45 degrees for 1-2 seconds, sit up and hang the foot on the edge of the bed for 2-5 seconds, and Move the foot and toes more than 10 times, then lie on the back again for 2 seconds. This procedure is practiced 5-6 times, several times a day. Walking is also a good exercise method, patients can walk a certain distance according to their own situation, and then stop to rest for a while after the slight pain in the leg, and then continue to walk until the next pain appears, you can walk 6-8 round trips a day, day by day to increase the distance of walking, long-term persistence, can effectively increase the endurance. For patients without ulcers, both methods can be carried out. And when ulcers appear, Buerger’s exercise is more appropriate. Light diet Ensure nutrition: There are no special contraindications in the diet of patients with vasculitis, but it is not advisable to eat spicy, cold and other foods, you can eat more lean meat, eggs, soy products, fresh vegetables and fruits to ensure adequate nutrition and vitamin supplementation, which is especially important to promote ulcer healing. It is also very important to maintain a happy mood, emotional optimism and proactive cooperation with treatment. Generally, vasculitis takes about 5 years to develop to the final stage of gangrene. If diagnosed early and actively cooperate with treatment, most patients are able to save their limbs. Although Mr. Zhang’s unfortunate experience is related to the characteristics of his own disease, much also depends on the lack of early diagnosis and treatment. Remember the saying, possible vasculitis comrades, quit smoking is the first priority.