Several questions about arteriosclerosis occlusive disease
Q: Why does my leg appear cold, numb, painful, ulcerated long-term treatment does not get better?
A: Lower limb “cold, numb, painful and rotten” is often a manifestation of lower limb ischemia. Many patients suffering from lower limb atherosclerosis occlusive disease and thrombo-occlusive vasculitis cannot be diagnosed for a long time, and they turn to orthopedics, neurology and rehabilitation physiotherapy departments for medical treatment, but because they do not receive targeted treatment, their conditions often persist.
Q: What is lower extremity atherosclerosis occlusive disease?
A: Atherosclerosis is the most common disease in the elderly, with a prevalence rate of 79.9% in people over 60 years old and almost 100% in people over 70 years old. The development of atherosclerosis causes blood vessel narrowing and thrombosis, resulting in acute or chronic ischemia of the limbs and internal organs, such as cerebral infarction and myocardial infarction, and those occurring in the lower limbs are called atherosclerotic occlusive disease.
Q: Who is prone to atherosclerosis-occlusive disease?
A: Atherosclerosis-occlusive disease usually occurs in middle-aged and elderly people over 50 years old, and is significantly more common in men than in women. The incidence is higher if you have diabetes, hypertension, hyperlipidemia, coronary artery disease, carotid atherosclerosis, and cerebral atherosclerosis. Long-term smoking is a clear risk factor.
Q: My toes have been a little numb, cold, and sometimes tingling lately, is this a precursor to stroke?
A: This is an early manifestation of atherosclerotic occlusive disease, and further development will result in intermittent claudication. Diagnosis needs to be differentiated from lumbar spine lesions and cerebrovascular lesions.
Q: Why do I experience leg swelling, fatigue and pain after walking for a while, and then get better after I stop and rest for a while, and then again after walking for a while?
A: This is a typical symptom of “intermittent claudication” in atherosclerosis occlusive disease, which is a manifestation of early ischemia and should be treated promptly. At the same time, it should be distinguished from venous insufficiency of the lower limbs.
Q: My feet are cold and painful in winter, is it okay to soak them in hot water?
A: Atherosclerosis occlusive disease leads to lower limb ischemia, the feet will be cold and painful, but should not be soaked in hot water or hot compresses. Because of the temporary increase in foot temperature, local metabolism will also increase, tissue oxygen consumption increases, but the blood supply can not effectively increase. Thus, local heating will only aggravate tissue hypoxia, and in some cases lead to aggravation of the lesion. Of course, proper warmth should also be provided to avoid aggravating ischemia due to vascular spasm caused by cold.
Q: My feet rotten for 8 months, take medicine to fight, surgical change of medicine are not effective, why?
A: There are many causes of lower limb ulcers, among which vascular diseases account for a large proportion. If vascular disease, such as arteriosclerosis occlusive disease, is not treated, it is difficult to heal lower limb ulcers.
Q: I have chronic leg pain, and I have been treated for “low back pain” in orthopedics without improvement, is it because of arteriosclerosis?
A: Orthopedic diseases such as sciatica, herniated discs and spinal stenosis can also cause numbness, pain and intermittent claudication in the limbs, but these patients often neglect to have vascular examinations. Knowledge of vascular medicine is not yet widespread, and there is a lack of specialized physicians in China, so patients cannot easily get timely diagnosis and treatment. Even in the United States, less than 15% of patients with intermittent claudication of the lower extremities know they need to go to a vascular unit.
Q: I have been diagnosed with vasculitis in several hospitals, and when I saw a vascular specialist I was told it was not vasculitis but atherosclerosis, why?
A: Thrombo-occlusive vasculitis and atherosclerotic occlusive disease are both chronic ischemic diseases of the lower extremities with similar clinical manifestations, with vasculitis often affecting small and medium-sized arteries and atherosclerotic occlusive disease often affecting large and medium-sized arteries. The age marker for differentiating the two diseases is 45 years, with patients with thrombo-occlusive vasculitis younger than 45 years and atherosclerotic occlusive disease often older than 50 years, both nationally and internationally. The former is associated with smoking and gender (male) and the latter with diabetes, hypertension, hyperlipidemia, coronary heart disease, and smoking. In addition, non-specialists often refer to lesions involving blood vessels as “vasculitis”.
Q: Now I have severe pain in my feet at night, but it gets better when I sit up, sometimes I can’t sleep all night, why is that?
A: This is “resting pain”, indicating severe ischemia of the limb, with a tendency of limb necrosis. Patients often wake up in pain during sleep, mainly the toes or the front part of the foot is in severe pain, after sitting up, the ischemia is temporarily relieved because the heart position is in high position and the perfusion pressure of the lower limb increases. Therefore, patients often “sit with their knees in their arms”.
Q: How to confirm the diagnosis of atherosclerotic occlusive disease?
A: The initial diagnosis can be made by understanding the clinical symptoms (cold and numb limbs, intermittent claudication, chronic ulcers, resting pain, gangrene, etc.) and by touching the arteries of the lower limbs (femoral artery, N artery, dorsalis pedis artery, posterior tibial artery). Arterial color ultrasound, CT angiography, magnetic resonance angiography, and arteriography can make a definitive diagnosis.
Q: My father’s toes are painful, broken and infected, and he has been on antibiotics for a long time but still does not get better, why is this?
A: Patients with lower extremity atherosclerosis occlusive disease have insufficient blood supply to the foot, poor local tissue repair ability, and low local concentration of antibacterial drugs, which results in poor infection control. If not combined with vascular related treatment, their ulcers and infections are difficult to cure.
Q: I am a patient with arteriosclerosis occlusive disease, some doctors say that I don’t need surgery and can be cured by taking interventional treatment, is it so?
A: Endovascular treatment (intervention) is a minimally invasive procedure performed under X-ray through arterial puncture, and is one of the main techniques in vascular medicine. The purpose of both endovascular treatment (intervention) and arterial bypass surgery is to treat ischemia in the lower extremities, and the choice is mainly made by the vascular surgeon according to different situations. At present, the effectiveness of endovascular treatment of lower extremity atherosclerosis occlusive disease is improving, and the treatment can be repeated several times if necessary.
Q: Which patients with atherosclerosis-occlusive disease have to have their limbs amputated?
A: Patients with atherosclerosis-occlusive disease do not seek medical treatment in a timely manner and are often at an advanced stage when they visit the vascular department.
1, gangrene with severe infection
2, extensive occlusion of blood vessels, gangrene with severe resting pain
3, drug ineffective or diversion surgery failed, and the disease progressed.
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