Atherosclerosis-occlusive disease (ASO) treatment
Atherosclerotic occlusive disease is a disease in which the atheromatous material in the arteries of the limbs is expanding and secondary to thrombosis, causing narrowing and occlusion of the arterial walls, resulting in chronic or acute ischemic symptoms in the limbs. The obstructive disease of blood vessels throughout the body caused by atherosclerosis is collectively referred to as atherosclerotic occlusive disease (ASO). Customarily, stenosis and occlusion of coronary arteries occurring in the heart are classified as cardiovascular medicine and surgery, while stenosis and occlusion of cranial arteries are classified as neurological medicine and surgery, and atherosclerotic occlusive disease in other areas is classified as peripheral vascular disease. The incidence is higher in Western countries, with more lower limbs than upper limbs, about 10%. With the aging of our population and the change of dietary structure and other factors, atherosclerotic occlusive disease of the limbs has now become a common peripheral vascular occlusive disease in middle and old age.
Atherosclerotic occlusive disease pathology, causes and symptoms
The pathology of arteriosclerosis-occlusive disease is a chronic degenerative proliferative lesion of arteries. It is the disease with the highest mortality and disability rate in the world. In China, the incidence rate of over 60 years old is as high as 79.9%, and the incidence rate in autopsy: 77.3% for 50-60 years old, 87% for 61-70 years old, and almost 100% for over 70 years old, therefore, how to prevent or control atherosclerosis has become one of the most important topics in the medical field.
What factors are associated with arteriosclerotic occlusive disease? According to domestic and foreign research, the following factors are related to.
1, gender: more men than women, (6:1), more pronounced below 50 years of age, and gradually approaching after 50 years of age.
2, age: often occurs in middle and old age, (over 45 years old).
3, smoking: associated with long-term heavy smoking.
4, obesity and hyperlipidemia: one of the important factors of atherosclerosis.
5, hypertension: the resulting vascular damage is one of the important initiating factors of atherosclerosis.
6, diabetes: can accelerate the process of atherosclerosis occlusion, while there are diabetic microangiopathy to make the condition more complicated; 7 and: dietary habits, mental tension, genetic factors, etc.
Atherosclerotic occlusive disease occurring in the limbs is a manifestation of systemic atherosclerosis and is a slowly progressive arterial disease. It often appears as symptoms of chronic limb ischemia: such as sleepy and heavy lower limbs after exertion, discomfort, coldness under the knees, numbness in the lower legs, or the feet change from sweaty to sweatless, toes, back of the feet and even lower legs lose sweat hair, toenails become thick, dry and black, etc. Typical lower limb atherosclerotic occlusive disease can be divided into three stages from mild to severe: (1) intermittent claudication; (2) resting pain; (3) ischemic tissue necrosis.
Patients who sit still and do not show symptoms of intermittent claudication when the lower limbs are inactive but are accompanied by loss of pulse can be classified as stage 0, the asymptomatic stage. Symptomatic stage: Initially, the foot feels cold and the skin temperature decreases. As the disease worsens, the above symptoms become more obvious, and the characteristic symptoms – intermittent claudication, resting pain, and even waking up in pain during sleep, or sitting on the knees and having trouble sleeping at night – appear. In severe cases, the skin of the affected foot is pale or cyanotic, and in severe cases, the toes are blackened and ulcerated, and the pulsations of the dorsalis pedis artery, posterior tibial artery, N artery and femoral artery of the lower limbs are weakened or disappeared.
Treatment of arteriosclerotic occlusive disease
There are two major types of treatment: surgical and non-surgical, each with its own advantages and disadvantages.
1, surgical treatment is effective, as long as there are good indications, surgical treatment should be considered, but only one third of patients are suitable for surgical treatment, and surgical treatment can be selectively small, can not be repeatedly applied, it is difficult to treat after restenosis or embolism, the long-term efficacy is reduced, which is mainly vascular restenosis or embolism, the healing is poor.
2, non-surgical treatment in addition to Western medicine, such as anticoagulation, thrombolysis, depolymerization, fibrous dilation and lipid lowering therapy, Chinese medicine is a major feature of the treatment of peripheral vascular disease in China, saving the limbs of countless patients and accumulating many successful experiences.
3.In recent years, the role of interventional treatment has been paid more and more attention, it is less invasive and can play a similar effect to surgery, such as “balloon catheter expansion”, “stent placement”, “plaque ablation”, etc., which has good effect on limited lesions.
However, even with multiple treatments, the disease has a 5% amputation rate and mortality rate due to the following reasons
1. treatment is too late, and the best treatment opportunity is lost when it is transferred to an experienced peripheral vascular specialist.
2, the disease is difficult to treat, especially in advanced patients, there is no 100% cure rate at home and abroad, so early treatment is very important.
3. the occurrence of life-threatening complications due to serious complications
4, because of the long treatment time of the disease, some patients “see the difference” can not adhere to treatment.
5, can not be adjusted according to the doctor’s requirements: such as patients still a lot of smoking, some patients massage the affected limb caused by extensive necrosis, some patients wash their feet with hot water caused by extensive necrosis of the affected foot, etc., so, timely and regular treatment, serious regular care is also very important.