What is atherosclerosis occlusive disease? With the change of dietary structure of our countrymen, the increase of fat-containing food intake and the prolongation of per capita life expectancy, atherosclerosis has become the most common disease among middle-aged and old-aged people, and the incidence rate of the disease is as high as 79.9% among people over 60 years of age in our country. Atherosclerotic occlusive disease is systemic atherosclerosis in the limb local performance, mainly manifested as atherosclerotic plaques in the arterial intima, the middle layer of tissue degeneration or calcification, the lumen can be secondary to thrombosis, destroying the arterial wall, and ultimately narrow the lumen, or even completely occluded, so that the affected limb occurs in the acute or chronic ischemic symptoms, and in severe cases, it can cause necrosis of the limb. What causes atherosclerotic occlusive disease? What kind of people are prone to atherosclerotic occlusive disease? The cause of the disease is still unknown, and it may be a combination of factors that lead to the onset of the disease. This disease is closely related to hyperlipidemia, low-density lipoprotein can promote arterial atherosclerosis, hypertension, hyperlipidemia and immune complex, can damage the arterial endothelium, and then cause lipoprotein infiltration, platelet adhesion, smooth muscle cell proliferation, lipid deposition and other lesions. Factors related to the pathogenesis of this disease, including hypertension, diabetes, smoking, obesity and so on. Therefore, “nine high and one low” high blood fat, high blood sugar, high uric acid, high body weight, high blood pressure, high blood viscosity, high age, high mental stress, high smoking and less exercise of middle-aged and old people, is atherosclerosis occlusive disease of high-risk factors, the disease occurs more often in patients over 50 years of age. The human body begins to have lipid deposition in the arteries after about thirty years of age, and after middle age, one should pay attention to the atherosclerosis of one’s arterial vessels, and go to the hospital regularly to have the arterial vessels examined every year. What are the typical manifestations of atherosclerotic occlusive disease of the lower limbs? Clinical symptoms of atherosclerotic occlusive disease are mainly caused by insufficient local blood supply to the limbs due to arterial stenosis or occlusion Regardless of how extensive the occlusive lesion is, as long as the development of the lesion is slow, and effective collateral circulation can be established, the clinic can be free of obvious symptoms; on the contrary, the typical clinical symptoms appear in the early stage. Lower limb atherosclerotic occlusive disease can be clinically divided into four stages according to the degree of development: the first stage (mild complaint period): feeling of the affected limb skin temperature decrease, fear of cold, or mild numbness, easy to fatigue after the activity, easy to foot`s and not easy to control, thinning of the skin, lack of nutrients, hair reduction, easy to fall off; the second stage (intermittent claudication period): the patient walks, due to ischemia and hypoxia, the calf muscle The second stage (intermittent claudication period): when patients walk, due to ischemia and hypoxia, calf muscle spasm, pain and fatigue, need to stop and rest for a few moments, and wait for symptoms to improve in order to continue to walk, so that the symptoms are repeated; the third stage (resting pain period): when lower limb ischemia is aggravated, the lateral branch of the compensation of the serious lack of lower limb muscles and nerves appear ischemic pain, the most common manifestation of patients who can hardly sleep at night, sitting with their knees in the arms, the calf is drooping, can not be uplifted, or else aggravate the ischemia, the patient mental and somatic people feel the ischemia, the period The patient’s spirit and body feel great pain; The fourth stage (tissue necrosis period): ischemic limbs appear tissue necrosis, skin temperature is obviously lowered, ulcers appear at the end of limbs, toes show dark purple necrosis, and gradually upward to the foot, ankle and even calf, toxins enter the body through the blood, systemic poisoning occurs, and serious threat to life. Is there a clinical staging of lower extremity atherosclerosis occlusive disease? What is its significance for treatment? In 2000, the Pan-Atlantic Interventional Society (PAS) classified TASC A, B, C, and D according to the length and type of arterial stenosis/occlusion from mild to severe, which is a guideline for the choice of treatment. type A suggests the first choice of endovascular treatment, type D suggests the first choice of traditional surgical treatment, and type B and type C, due to the lack of sufficient evidence-based medicine, do not have a clear recommendation on the first choice of treatment. Type B and type C, due to insufficient evidence-based medical support, do not have a clear recommendation for preferred management, but the usual management principle is that endovascular treatment is more often recommended for type B patients, while traditional surgical treatment is more often recommended for type C patients. What are the risks of atherosclerosis? Atherosclerosis affects the arteries and blood vessels throughout the body to a certain extent, so we call it a systemic disease. If left untreated, atherosclerosis can affect the cardiovascular system, which can be fatal. In the case of intermittent claudication, which seems to be a benign disease process, i.e. the disease can be stabilized for several years, about 1-3% of patients with peripheral vascular disease experience a worsening of the disease from year to year. This means that even after 10 years, only 10-30% of people will have worsening disease. This is why we do not perform surgical treatment on all patients with arterial stenosis. However, some of the factors that can cause the lesions to worsen should be treated first. These include smoking, lack of exercise, hyperlipidemia, uncontrolled diabetes and high blood pressure. Patients with intermittent claudication who do not take medical advice usually have progressive disease and may be at risk of amputation. What can be done to prevent atherosclerotic occlusive disease? To change the bad habits of life, quit smoking, prohibit high-fat indigestible and stimulating food, eat a light diet, eat more fruits and vegetables, legumes. People suffering from hypertension, hyperlipidemia and diabetes should actively treat the primary disease. Closely monitor the condition and do not take it lightly. Obese patients should reduce their weight. Appropriate exercise can increase collateral circulation, but should not move heavy objects. Keep the affected limbs warm Keep the feet dry and clean Cut the toenails correctly Wear appropriate shoes and socks Avoid injury. What tests should be done for arteriosclerotic occlusive disease? As we age, many diseases can cause pain and discomfort in the legs, so it is important to investigate the cause. A number of tests performed on an outpatient basis can often help us to identify whether your symptoms are due to disease of the arteries, can help us to further characterize the site of the narrowing or blockage, and can be critical in choosing further treatment. Common tests are: 1, general examination: the package of live lipid determination, such as cholinesterase, triglyceride, lipoprotein electrophoresis, etc., routine examination of electrocardiography and echocardiography can understand the cardiac function of the situation, to confirm the presence of coronary atherosclerosis and lead to myocardial ischemia; funduscopic examination can be observed directly with or without atherosclerosis of fundus arteriosus and determine the degree of sclerosis and the rate of progression, and then clarify the degree of ischemia of the head, X-ray radiographs X-ray film can find arterial calcification shadow, in the abdominal aorta or lower limb arteries show irregular calcification spots distribution, in the diagnosis has special value. 2. Segmental arterial blood pressure measurement of the extremities: a non-invasive test, applying a Doppler ultrasound stethoscope to check the arterial blood pressure of the extremities. It is often necessary to check the condition of the lower limbs in both static and dynamic states to distinguish whether intermittent claudication is caused by arterial obstructive disease, and the distance of claudication can be measured according to the dynamic examination in order to decide the treatment. 3.Color ultrasound Doppler examination is a non-invasive examination method widely used in recent years, which is simple and easy to carry out, and can better show local arterial lesions, such as lumen morphology, intima-media sclerosis plaques, blood flow status, etc. There are also continuous scanning ultrasound angiograms available at present. Currently, continuous scanning ultrasound angiography is also available to visualize the entire arterial course and lesions. Color ultrasound Doppler is also a commonly used method for postoperative monitoring of graft vessels. However, this method requires experienced examiners to obtain satisfactory results, and it is difficult to show the vessels in certain deep areas. 4. Arteriography and digital subtraction angiography are the most accurate examination methods and one of the most important means of diagnosing vascular diseases, which is of great value in diagnosing arterial occlusive diseases. Arteriography can not only clearly show the morphology of arteries and identify the site of arterial blockage, but also provide detailed information about the distal vessels of the blockage site and the establishment of collateral circulation, which can help to determine the surgical treatment plan and estimate the prognosis of the operation. However, it is an interventional method, and the use of contrast media may be limited in patients with renal insufficiency. Therefore, this method is mostly used for patients who need surgery or percutaneous intervention. 5.CT Angiography (CTA) or Magnetic Resonance Angiography (MRA) CTA or MRA is an examination that needs to be performed on a large-scale instrument in the CT room or MRI room, which is a safe and quick examination. However, a small amount of contrast agent usually needs to be injected into a peripheral vein during the examination, but it should be performed with caution in the case of more serious renal insufficiency. Although examinations such as color Doppler ultrasound can provide us with a lot of useful information about the lesion, CTA or MRA can obtain more precise information and images of the arterial lesion site and distal arteries before further treatment. How should atherosclerotic occlusive disease be treated? It can be categorized into non-surgical and surgical therapies: non-surgical therapies include dietary control, appropriate exercise, smoking cessation, warmth preservation; application of lipid-lowering drugs, vasodilators and traditional Chinese medicines; antiplatelet aggregation, limb negative pressure therapy, etc. to promote the establishment of collateral circulation. Non-surgical therapy can only slow down the progress of lower limb atherosclerosis occlusion, and cannot fundamentally solve the narrowing and occlusion of lower limb atherosclerosis occlusion. Surgical therapy: according to the lesion site, degree, scope and collateral circulation, arterial bypass surgery, endarterectomy, omentum transplantation or venous arterialization surgery can be chosen to increase the blood supply of the affected limbs. Patients should choose individualized treatment modalities at different stages of their disease development, so it is essential to choose a vascular surgeon who specializes in treating patients on an individual basis. Is there any other way to treat atherosclerotic occlusion of the lower limbs? Endovascular treatment refers to the opening of narrowed and blocked arteries from the vascular lumen under X-ray surveillance without surgery or general anesthesia, and is therefore called endovascular treatment, or interventional treatment, which is equivalent to bypass surgery in the vascular lumen. This method has the advantages of being minimally invasive, simple to operate, effective and repeatable. It includes endovascular stenting, endovascular sclerotic plaque rotational dissection and ultrasound and laser endovascular angioplasty. Among them, endovascular stenting is an international and domestic mature technology. Is endoluminal minimally invasive treatment effective? What is the difference between it and traditional surgery? After summarizing and analyzing cases at home and abroad, the success rate of endoluminal stenting for lower limb atherosclerotic occlusion is higher than 90% on average, and the complication rate is lower than 10%. After the first restenosis of lower limb arteriosclerosis occlusion, the patency rate of one year after re-treatment is 80-98%, and the patency rate of five years reaches 45-80%. Because of opening the stenosis from the blood vessel, the stenting is much less invasive than bypass surgery, and the patency rate in the early and mid-term is also higher, so that it provides a whole set of safe and reliable treatment methods for many patients with lower limb arteriosclerosis occlusion. The traditional surgical method is a more mature method. Traditional surgical methods are more mature methods, its limitation is that the risk is relatively large, and because these surgical methods often require general anesthesia, so they are not suitable for lower limb atherosclerosis occlusion combined with serious cardiovascular and cerebrovascular diseases, diabetes mellitus patients. Is it necessary to continue taking medication after endoluminal therapy, and if so, how should it be regulated? According to the current treatment experience, the stent is placed in the lumen of the blood vessel to improve the blood supply of the affected limb, but the cause of the disease has not been removed, and the endothelial hyperplasia may lead to restenosis in the long term. In addition, the stent belongs to the metal foreign body, which may induce thrombosis, so patients who have received endoluminal therapy should take oral anticoagulant, antiplatelet drugs and lipid-lowering drugs for a long period of time after the procedure, and go to the hospital regularly to check the blood viscosity level every month. Postoperatively, strict control of blood pressure (metoprolol tartrate tablets 12.5 mg orally 2/day, isosorbide mononitrate 40 mg orally 1/day, nifedipine extended-release tablets 40 mg orally 2/day, adjusted in time according to the situation of blood pressure), and statin lipid-regulating drugs 1 tablet once/day for at least six months to one year. Cholesterol should be reduced to <4.68 mmol/L; LDL cholesterol <2.6 mmol/L, fasting blood glucose should be kept at 4.4-6.7 mmol/L, and regular internal medicine outpatient review should be conducted, and it is recommended to check the blood pressure, blood lipids and blood glucose every 1-3 months. Oral antiplatelet and microcirculation improvement drugs, commonly used drugs include: aspirin 100mg, 1 time/day, long-term oral. Clopidogrel (Bolivir) 75 mg, 1 time/day, oral medication for at least 1 month for patients with normal stent implantation, and at least 9 months for patients with drug-coated stent. Regularly review the coagulation function to adjust the dosage of oral medication to avoid overdose that may lead to bleeding Do I need to go to the hospital for regular checkups after endoluminal therapy? The purpose of regular review is to observe the efficacy of the postoperative treatment and to detect and deal with new symptoms and emerging diseases as early as possible. Outpatient follow-up should be arranged half a month, 1 month, 2 months, 6 months, 1 year after discharge from the hospital, and every 6 months thereafter. In case of any special or emergency situation, contact the surgeon or the outpatient or emergency physician at any time, so as to provide appropriate diagnosis and treatment as soon as possible. Postoperative restenosis usually occurs 3-6 months after surgery, so arterial ultrasound or CT angiography can be performed at this time to assess stent patency and to check for endothelial proliferation if necessary. What are the precautions after discharge? The following 3 aspects should be noted after discharge: 1. Exercise: Treadmill exercise and walking are the most effective exercises for claudication. Exercise intensity: Walking speed should be set at the speed that induces painful claudication symptoms in 3 to 5 minutes, walk under this load until moderate pain symptoms occur, then stand or sit down and rest to relieve symptoms, and then continue the above walking. Exercise duration: The exercise-rest-exercise process should be repeated during each exercise session. Initially walk for a total of 35 minutes, then add 5 minutes to each session until you have completed a total of 50 minutes of walking, and continue at this intensity and duration. Exercise frequency: 3 to 5 times a week. 2.Life habits and risk factors control: quit smoking, alcohol, low-salt and low-fat diet, control low-density lipoprotein (LDL) below 100mg/dl, control blood glucose, so that glycated hemoglobin is below 7%, control blood pressure below 140/90mmhg, or if combined with diabetes mellitus or renal disease should be controlled blood pressure below 130/80mmhg. 3.After discharge from the hospital, it is necessary to take long-term oral antiplatelet and microcirculation improvement drugs, and regularly review the blood coagulation indexes, adjust the dosage of oral medication to avoid overdose leading to bleeding.