Patient: Description of condition (onset, main symptoms, hospital visited, etc.): male, 70 years old, suffering from atherosclerosis occlusive disease of both lower limbs for one year, hypertension and diabetes for 9 years, cerebral infarction for 9 years, blood pressure is normal after taking antihypertensive drugs, blood sugar is normal after using insulin, left upper limb and left lower limb movement is moderately limited, limping current symptoms: pain in the left foot and ankle above 10 centimeters for one year, aggravated for more than 2 months, especially In the past year, the lower extremity arteries have been operated four times, nine stents and four balloons have been put in, but the pain in the left lower extremity has not been relieved and worsened, and there is no new treatment plan in the above hospitals. The results of the adjuvant treatment are as follows: for your reference 1. blood and urine routine clotting time is normal 2. liver and kidney function is normal 3. electrocardiogram: left atrial enlargement, left ventricular diastole, hypofunction, aortic root widening with aortic valve calcification 4. ultrasound: 2011.04.04 4. color ultrasound: 2011.04 bilateral carotid plaque formation, bilateral carotid intima thickening, left internal carotid artery stenosis 5. CT: December 2010 post-operative bilateral lower extremity ASO change left artery stent patency, lower end intima thickening, right femoral artery local near occlusion 2011.03 post-operative bilateral lower extremity ASO post-operative stent intima slightly hyperplasia, to the femoral N artery shift at In April 2011, the three branches of the coronary artery had multiple luminal stenosis >50%. I hope to get your advice on what to do now and where the hospital can treat such a disease, because doctors say there is nothing to do? Doctor: Hello, from your description, we found that you went to the best hospitals in Shanghai for lower limb artery treatment, but the pain is still there, so the condition is really complicated. Here I would like to ask you to add some information about the patient: 1. What are the changes in temperature and skin color of the left foot and left ankle joint? (You can compare with the right foot.) 2. Is the pain very clear and limited in extent, or is it the whole lower leg? Is there any swelling in the vicinity of the pain, such as the knee or ankle joint? Has the vein been checked? Patient: Thank you very much for your busy reply, the answer is as follows: 1. the temperature is low and purple-red, the left thumb has not healed for 1 month after accidentally breaking it 2. the pain is clear and limited, 10 cm down from the ankle to the top of the foot, without any swelling 3. The index of the artery of the left calf is 0.41, the vein has not been checked because the hospitals in Shanghai now reply that there is no way, but the pain is so bad that I can’t sleep at night, and it is quite painful, originally Shanghai said that the leg can be amputated, but now it says that it can’t, because there is diabetes, so the family is very anxious. Please reply again, thank you very much! Doctor: From these 3 points, it should be said that the diagnosis of lower limb atherosclerosis occlusive disease is undoubted. The arterial index of the left calf is 0.41, which is called the “ankle-brachial index”, and is the ratio of the systolic pressure of the arteries in the lower and upper limbs. 0.41 is already severe ischemia. Interventional therapy is an important method for treating diabetic foot, which can effectively open the arteries above the ankle joint, but it cannot solve the peripheral circulation ischemia caused by long-term diabetes, and the pain is still severe after interventional therapy, which means that the blood supply to the lower part of the lower leg up to the foot is very poor and cannot be opened by interventional methods, so there are several options: 1. If the surgery is successful, the wound healing can be ensured even if some tissues need to be surgically removed. 2. Direct amputation: It is the fastest way to relieve pain, provided that the plane of amputation has sufficient blood supply to ensure the incision healing. Both procedures require that the patient has no contraindications to surgery, such as severe cardiopulmonary insufficiency, hepatic and renal insufficiency, etc., otherwise the risk of surgery is too great. It is possible that the patient’s multi-branch coronary artery disease was one of the reasons that prevented the surgery from being performed. 3. Various pain relief treatments: including painkillers, analgesic pumps, nerve blocks, ozone therapy and so on, as well as symptomatic supportive treatments such as controlling infection and activating blood circulation until the pain can be relieved after complete necrosis of ischemic tissue. However, this process may be long, and the intermediate or combined infection, or necrotic toxin triggered liver and kidney failure, etc., can cause life-threatening.