Lower extremity atherosclerotic occlusive disease is a chronic arterial occlusive disease caused by atherosclerotic lesions, mainly affecting large and medium-sized arteries such as the lower abdominal aorta, iliac artery, femoral artery, and N artery. The lower extremity becomes ischemic due to luminal narrowing and occlusion caused by atherosclerotic plaque, arterial middle layer degeneration and secondary thrombosis. The main clinical manifestations are coldness, numbness, pain, intermittent claudication, loss of arterial pulsation, nutritional disorders of limb tissues, and ulceration or gangrene of toes or feet. 1Q: My father, 58 years old, developed soreness, heaviness and weakness in both lower limbs after walking two years ago. In the last six months, he has experienced stiffness in his legs after walking about 200 meters, and he needs to rest for a while before he can continue walking. Is this lower extremity atherosclerosis occlusive disease? Do you need to treat it? A: According to your father’s symptoms and ultrasound results, he was diagnosed with lower extremity atherosclerosis occlusive disease. This is a common disease in the elderly, with a prevalence rate of 17% among people aged 55-70 in Europe and the United States. In the arteries of the lower extremities, the continuous expansion of atheromatous material and secondary thrombosis can cause narrowing and occlusion of the arterial lumen, resulting in chronic or acute ischemic symptoms in the extremities, mostly in the lower abdominal aorta, iliac artery and femoral N artery. The earliest symptoms of the disease are coldness, numbness and intermittent claudication of the affected limb. As the disease progresses, the ischemia of the affected limb worsens, resulting in pale toe, foot or lower leg complexion, decreased temperature, decreased sensation, thinning of the skin, muscle atrophy, thickened and deformed toenails, and thinning of the bone in a quiet state. Under severe ischemia, toe, foot or lower leg ulcers and gangrene can occur, which can only lead to amputation or even death. In order to avoid further aggravation and deterioration, your father should be treated as soon as possible. 2Q: My father, 60 years old, always said that his legs were numb and pain in his calves appeared after walking, which could be relieved after rest and continued walking, with intermittent pain. He went to the orthopedic department of our county hospital and was diagnosed with lumbar disc herniation. After traction and medication, there was no significant improvement. Subsequently, an ultrasound was done and it was said that there was intimal thickening and partial luminal stenosis in the arteries of both lower limbs, and the doctor said it was vasculitis. What exactly is this disease and how should it be treated? A: Your father’s diagnosis should be lower extremity atherosclerosis occlusive disease, which is very similar to neurogenic claudication. Lumbar spinal stenosis, disc prolapse, sciatica and polyneuritis can also show lumbar pain, hip, hip and thigh muscle pain and weakness, which is similar to the symptoms caused by lower extremity atherosclerosis occlusive disease. However, the pain of neurogenic claudication is tingling sensation, weakness, limb inflexibility, and numbness, often appearing after exercise, and the range of claudication varies, with symptoms when standing, often requiring sitting or changing position to relieve; whereas the sensation of ischemic claudication is muscle fatigue and tightness, with the walking range basically the same each time it develops, with no symptoms when standing, and can be relieved by stopping walking. Now there is a phenomenon that the lower extremity arteriosclerosis occlusion, varicose veins, phlebitis, deep vein thrombosis and many other vascular surgery diseases collectively referred to as “vasculitis”, which is a misconception. In fact, “vasculitis” is one of the vascular surgical diseases, the full name is “thrombo-occlusive vasculitis”. It is a disease that occurs in young and strong men with a history of smoking, mainly invading the small arteries in the lower extremities and causing coldness, numbness, pain during exercise, pain at rest, pale skin, weak or absent arterial fluctuations, and muscle atrophy for a long time, rather than the general term for a series of diseases of the blood vessels of the lower extremities. 3Q: I am 63 years old, retired and at home. I was diagnosed with lower limb atherosclerosis occlusive disease a year ago. How should I treat it? Can I maintain the status quo without treatment? What are the consequences of not treating it? A: If you have been diagnosed with lower extremity atherosclerosis, you should get treatment as soon as possible to avoid aggravation and deterioration of symptoms. The treatment of lower extremity atherosclerosis occlusive disease should be based on the patient’s condition. Mainly: 1. Improve lifestyle habits: actively treat primary diseases such as hypertension, hyperlipidemia, diabetes, etc. Eat more low salt, low sugar, high fiber and plant foods containing unsaturated fatty acids, such as bean fruits and vegetables. 2, quit smoking: smokers are 9 times more likely to have intermittent claudication than non-smokers, and almost 90% of patients with intermittent claudication are smokers. Therefore, quitting smoking is an effective measure to reduce the incidence. 3, physical therapy: patients should have moderate physical exercise, such as walking, jogging is very good, which can relax the spirit and relieve tension; through physical therapy, manipulation massage to make the skin temperature is also a better complementary therapy, whether exercise or physical therapy, the important thing is that they all help the establishment of collateral circulation and improve ischemia. 4.Lipid-lowering drugs, antihypertensive drugs, vasodilators, antiplatelet drugs and anticoagulant drugs can be applied under the guidance of vascular surgeons. If there is arterial thrombosis, thrombolytic drugs can be used. The main role of the currently applied drugs is to control the continued development of the disease, improve the collateral circulation of the affected limb, relieve pain and promote ulcer healing. 5, surgery: for intermittent claudication gradually aggravated, affecting work and even life can not take care of themselves, or due to limb ischemia caused by resting pain, tissue necrosis patients, surgical treatment is required, these patients if not timely surgery, eventually inevitable amputation. In patients in whom local tissue gangrene has occurred, postoperative healing of the wound can be promoted. Surgical treatment consists mainly of surgery and endoluminal arterioplasty. Patients treated surgically must have access to imaging data and a thorough evaluation of the status of the vessels before determining the surgical plan. 4Q: My mother is 67 years old and retired. The elderly have hypertension and coronary heart disease, and I read in the newspaper that arteries throughout the body can become ischemic due to sclerosis, so that there is no ischemia in the blood vessels of the lower extremities, what can be done to prevent it? A: Lower extremity atherosclerosis occlusive disease often coexists with hypertension, coronary heart disease, cerebral infarction, diabetes, which requires multi-level, multi-faceted prevention. First of all, we should quit smoking and limit alcohol; low-fat and low-sugar light diet, eat more fresh vegetables, fruits and other vitamin-rich foods. Regular and moderate living. Secondly, appropriate fitness exercise to avoid obesity, regular exercise, equal to let the blood vessels do gymnastics, can enhance the elasticity and prevent aging. Further good at adjusting their emotions, to avoid long-term depression and tension. You should also regularly go to the hospital to perform a formal comprehensive physical examination, to be able to early detection of hypertension, diabetes and other lower limb atherosclerosis occlusion of the original disease. When you find yourself suffering from these diseases, it is necessary to take drugs to lower blood pressure and blood sugar under the guidance of a doctor to avoid the susceptibility factors of lower limb atherosclerosis and occlusion. 5Q: My father is 70 years old and has a history of hypertension, heart disease, and cerebral infarction, and was later diagnosed with lower extremity atherosclerosis occlusive disease. How should I choose? A: The treatment of lower extremity atherosclerosis is generally divided into medication, open surgery and endoluminal arterioplasty. Among them, open surgery is divided into endovascular debridement and artificial vascular bypass diversion. Endovascular debridement: The endothelium is surgically removed, which means the atherosclerotic plaque is removed and the occlusion is lifted, and an artificial vascular patch can be added to repair it. Artificial vascular bypass diversion: It is the most commonly used surgical procedure for those who have a long segmental stenosis or occlusion of the artery and whose input and output tract arteries are basically patent. The procedure involves bypassing the blocked vessels at both ends with artificial or autologous vessels, through which blood is reperfused to the distal limb. The artificial vessels are made of polytetrafluoroethylene or polyester, and are a very effective treatment method. The drawbacks of surgical procedures are that they are more invasive, complicated by anesthesia, and cannot be tolerated by elderly, frail, or patients with combined diseases of other organs. However, because of the exact postoperative revascularization and better postoperative results, surgical procedures should also be performed in patients with better general condition and complete occlusion of long segments of arteries. The main indications for endoluminal arterioplasty are balloon dilation and stenting, which are widely used for stenotic lesions in short segments of arteries. A stent made of nickel-titanium memory alloy is placed in the lesion to prevent restenosis or even occlusion due to thrombosis, intimal hyperplasia and elastic retraction after balloon vasodilation. The doctor develops specific treatment based on the patient’s symptoms and the exact imaging data. 6Q: What are the causes of lower extremity atherosclerosis occlusive disease? What tests should be done? Can medication completely cure it? A: The cause of atherosclerosis is not well understood, but most scholars believe that it is multi-source. It occurs mostly in patients over the age of 50, but it is also found in those under 50. According to the epidemiological findings of the American Heart Association the main risk factors for atherosclerosis are hypertension, hypercholesterolemia and smoking. Non-invasive color ultrasound scans can be performed if there are clinical signs of bilateral lower extremities, and the degree of stenosis can be determined in conjunction with changes in blood flow velocity. Magnetic resonance angiography and arteriography can show the anatomical pattern of the peripheral arteries, which is essential to develop an appropriate surgical plan. Arteriosclerotic occlusion is an organic lesion, and no drug has yet been able to completely penetrate the platelet obstruction of the diseased artery. The main role of the currently used drugs is to control the progression of the disease, improve the collateral circulation of the affected limb, relieve pain and promote ulcer healing.