What is atherosclerosis-occlusive disease?
With the change of national diet structure, the increase of fatty food intake and the increase of per capita life expectancy, atherosclerosis has become the most common disease among middle-aged and elderly people in China, with the incidence rate of 79.9% among people over 60 years old in China. Atherosclerotic occlusive disease is a local manifestation of systemic atherosclerosis in the limbs, mainly manifested as atherosclerotic plaques in the intima, degeneration or calcification of the middle layer of tissue, the lumen can be followed by thrombosis, destruction of the arterial wall, and eventually narrowing of the lumen, or even complete occlusion, causing acute or chronic ischemic symptoms in the affected limbs, which can cause limb necrosis in severe cases.
What are the causes of atherosclerotic occlusive disease? What kind of people are prone to develop atherosclerotic occlusive disease?
The cause of the disease is still unknown, and a combination of factors may contribute to its onset. The disease is closely related to hyperlipidemia. Low-density lipoprotein can promote atherosclerosis of arteries, and hypertension, hyperlipidemia and immune complex can damage the intima of arteries and subsequently cause lesions such as lipoprotein infiltration, platelet adhesion, smooth muscle cell proliferation and lipid deposition. Factors related to the development of this disease include hypertension, diabetes, smoking, obesity, etc. Therefore, middle-aged and elderly people with “nine highs and one low” – high blood lipids, high blood sugar, high uric acid, high body weight, high blood pressure, high blood viscosity, high age, high mental stress, high smoking addiction and low exercise – are at high risk for atherosclerosis and occlusive disease, which mostly occurs in patients over 50 years of age. The human body begins to have lipid deposits in the arteries after about thirty years of age, and after middle age, one should pay attention to the atherosclerosis of one’s arteries and have regular annual hospital examinations of the arteries.
What are the typical manifestations of atherosclerotic occlusive disease of the lower extremities?
The clinical symptoms of atherosclerotic occlusive disease are mainly due to the local blood supply deficiency in the limbs caused by arterial stenosis or occlusion. Regardless of how extensive the occlusive lesion is, as long as the lesion develops slowly and an effective collateral circulation can be established, there will be no obvious clinical symptoms; on the contrary, typical clinical manifestations appear early. Lower extremity atherosclerotic occlusive disease can be clinically divided into four stages according to the degree of development.
The first stage (mild complaint period): feeling of reduced skin temperature, coldness, or mild numbness of the affected limb, easy fatigue after activity, easy occurrence of foot`s and not easy to control, thinning of the skin, lack of nutrition, hair reduction, easy loss;
The second stage (intermittent claudication): patients walking, due to ischemia and hypoxia, calf muscle spasm, pain and fatigue, the need to stop and rest for a moment, and so the symptoms have improved to continue walking, so the symptoms repeated;
The third stage (resting pain period): when the lower limb ischemia is aggravated, the lateral branch compensation is seriously insufficient, the lower limb muscles and nerves appear ischemic pain, the most common manifestation is that the patient has difficulty sleeping all night, sitting with knees, lower leg drooping, cannot lift up, otherwise aggravate the ischemia, during this period, the patient feels great mental and physical pain;
Stage 4 (tissue necrosis phase): tissue necrosis occurs in the ischemic limb, skin temperature decreases significantly, ulcers appear at the end of the limb, toes show dark purple necrosis performance, and gradually develop upward to the foot, ankle and even calf, toxins enter the body through the blood, systemic poisoning occurs, and serious threats to life.
What is the harm of atherosclerosis to human body?
Atherosclerosis affects the arteries of the whole body to a certain extent, so we call it a systemic disease. If left untreated, atherosclerosis may affect the heart and brain vessels, which can lead to fatal consequences. As for intermittent claudication, it seems to be a benign disease process, which means that the disease can be stable for several years, and about 1-3% of patients with peripheral vascular disease experience a deterioration of the disease from year to year. This means that even after 10 years, only 10-30% of patients will have deterioration. This is why we do not treat all patients with arterial stenosis surgically. However, there are a number of factors that can cause the lesion to worsen that should be treated first. These factors include smoking, lack of exercise, hyperlipidemia, uncontrolled diabetes and hypertension. Patients with intermittent claudication who do not take medical advice usually have progressive disease and are at risk of amputation.
What can be done to prevent atherosclerotic occlusive disease?
To change bad habits, quit smoking, abstain from high-fat indigestible and stimulating foods, eat a light diet, and eat more fruits and vegetables and legumes. Those who suffer from hypertension, hyperlipidemia, diabetes should actively treat the original disease. Obese patients should reduce their weight and exercise appropriately to increase collateral circulation, but not to move heavy objects. The affected limbs should be kept warm, the feet should be kept dry and clean, toenails should be cut correctly, and appropriate shoes and socks should be worn to 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 explore the cause. A number of tests in the clinic can often help us identify whether your symptoms are due to disease of the arteries, and can help us further identify the site of arterial narrowing or blockage, and can be critical in choosing further treatment. Common tests are.
1, general examination: package live lipid determination, such as cholestasis, triglycerides, lipoprotein electrophoresis, etc., routine examination of electrocardiogram and echocardiography can understand the heart function, confirm the presence of coronary artery atherosclerosis and myocardial ischemia; fundus examination can directly observe the presence of fundus arteriosclerosis, and determine the degree of hardening and the rate of progress, and then clarify the degree of head ischemia, X-ray plain film can be found to have arterial X-rays can reveal arterial calcification shadows and irregular calcified spots in the abdominal aorta or lower limb arteries, which are of special value in diagnosis.
2.Segmental arterial blood pressure measurement of the extremities: a non-invasive examination method that applies a Doppler ultrasound stethoscope to check the arterial blood pressure of the extremities. It is often necessary to examine the lower extremities 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 to decide the treatment.
Color ultrasound Doppler examination is a widely used non-invasive examination method in recent years, which is simple and easy to perform and can better show local arterial lesions, such as lumen pattern, intimal sclerosis plaque and blood flow status. At present, there is also continuous scanning ultrasound angiography to show the entire arterial pathway and lesions. Color ultrasound Doppler is also commonly used for postoperative follow-up monitoring of graft vessels, but this method requires experienced examiners to obtain satisfactory results, and it is difficult to show vessels in certain deep areas.
4.Arteriography and digital subtraction angiography are the most accurate examination methods and one of the most important means to diagnose vascular diseases. Arteriography not only clearly shows the morphology of the artery and the site of arterial obstruction, but also provides detailed information about the distal vessels of the obstruction and the establishment of collateral circulation, which can help to determine the surgical treatment plan and estimate the prognosis of the procedure. However, it is an interventional method, especially in patients with renal insufficiency, and the use of contrast agents may be limited. Therefore, this method is mostly used for patients who need surgical or percutaneous intervention.
5.CT angiography (CTA) or magnetic resonance angiography (MRA)
CTA or MRA is a safe and quick test that needs to be performed on a large instrument in a CT room or MRI room, but the test usually requires a small amount of contrast agent to be injected into a peripheral vein, but should be performed with caution if there is severe renal insufficiency. Although tests such as color Doppler ultrasound can provide us with a lot of useful information about the lesion, CTA or MRA can provide more accurate information and images of the arterial lesion site and distal arteries before further treatment.
How should atherosclerotic occlusive disease be treated?
It can be divided into non-surgical and surgical therapies.
Non-surgical therapy includes diet control, proper exercise, avoiding smoking, keeping warm; application of lipid-lowering drugs, vasodilators and Chinese medicine; anti-platelet aggregation, negative pressure therapy of the limbs to promote the establishment of collateral circulation, etc. Non-surgical therapy can only delay the progress of the disease process of lower limb atherosclerosis occlusion, but cannot fundamentally solve the narrowing and occlusion of the blood vessels of lower limb atherosclerosis occlusion.
Surgical treatment: According to the location, degree, scope and collateral circulation of the lesion, arterial bypass surgery, arterial endothelial debridement, omental transplantation or venous arterialization surgery can be used to increase the blood supply to the affected limb.
Patients should choose individualized treatment modalities at different stages of disease development, so it is essential to choose a vascular surgeon to treat patients individually.
Are there other ways to treat lower extremity atherosclerosis?
Endovascular treatment refers to the opening of narrowed and blocked arteries from the lumen of blood vessels under X-ray surveillance without surgical incision or general anesthesia, and is therefore called endovascular treatment, or interventional treatment, which is equivalent to bypass surgery in the lumen of blood vessels. This method has the advantages of being minimally invasive, simple to perform, effective and repeatable. It includes endovascular stenting, endovascular sclerotic plaque spinning and ultrasound and laser endovascular angioplasty. Among them, endoluminal stenting is a relatively mature technology in China and abroad.
Is endoluminal minimally invasive treatment effective? What is the difference between it and traditional surgical methods?
The success rate of endoluminal stenting for lower extremity atherosclerosis is higher than 90% on average, and the complications are lower than 10%, according to the summary analysis of domestic and foreign cases. The patency rate is 80-98% in one year and 70-91% in five years after the first restenosis of lower extremity arteriosclerosis occlusion. Because the stenosis is opened from inside the blood vessel, it is far less invasive than bypass surgery, and the patency rate is higher in the early and middle stages, thus providing a set of safe and reliable treatment methods for many patients with lower extremity arteriosclerosis occlusion.
Traditional surgical methods are more mature methods, but their limitations are relatively high risks, and because these surgical methods often require general anesthesia, they are not suitable for patients with lower extremity atherosclerosis occlusive disease combined with severe cardiovascular and cerebrovascular disorders and diabetes mellitus.
Do I need to continue taking medication after endoluminal therapy and if so, how should I take it?
As far as the current treatment experience is concerned, the stent is placed in the lumen of the blood vessel to improve the blood supply to the affected limb, but the cause of the disease is not removed, and the intimal hyperplasia may lead to long-term restenosis, in addition, the stent is a metal foreign body, which may induce thrombosis.
Strict postoperative blood pressure control (metoprolol tartrate tablets 12.5mg orally 2/day, isosorbide mononitrate 40mg orally 1/day, nifedipine extended-release tablets 40mg orally 2/day, adjusted promptly according to blood pressure) and statin lipid-regulating drugs 1 tablet once/day for at least six months to one year. Cholesterol down to <4.68 mmol/L; LDL cholesterol <2.6 mmol/L, fasting blood glucose maintained at 4.4-6.7 mmol/L, regular internal medicine outpatient review, blood pressure, lipid and blood glucose check recommended every 1-3 months. Oral antiplatelet and microcirculatory drugs, commonly used drugs are: aspirin 100mg, 1 time/day, long-term oral. Clopidogrel (Bolivar) 75 mg, 1 time/day, oral medication for at least 1 month in patients with implanted common stents; at least 9 months in patients with drug-coated stents. Regularly review coagulation function to adjust the dosage of oral medication to avoid bleeding due to overdose
Do I need to go to the hospital for regular checkups after endoluminal therapy?
The purpose of regular checkups is to observe the efficacy of the treatment and to detect and treat new symptoms and emerging diseases as early as possible. In case of special or emergency situations, the surgeon or emergency physician should be contacted at any time for early and appropriate treatment. Postoperative restenosis occurs 3-6 months after surgery, so arterial ultrasound and CT angiography can be performed at this time if necessary to assess stent patency and to check for endothelial hyperplasia.
What are the precautions to be taken after discharge from the hospital?
The following 3 aspects should be noted after discharge.
1, sports exercise: treadmill exercise and walking are the most effective exercises for the treatment of claudication. Exercise intensity: walking speed should be set at 3 to 5 minutes that is the speed when painful claudication symptoms are induced, walk under this load until moderate painful symptoms are produced, then stand or sit down to rest so that the symptoms are relieved, and then continue the above walking. Exercise duration: The exercise – rest – exercise process should be repeated during each exercise session. The initial exercise should be a total of 35 minutes of walking, followed by an increase of 5 minutes per exercise until a total of 50 minutes of walking is completed, and continue with this intensity and duration of exercise. Exercise frequency: 3 to 5 times per week.
2.Living habits and risk factors control: quit smoking and alcohol, low salt and low fat diet, control low density lipoprotein (LDL) below 100mg/dl, control blood sugar, make glycated hemoglobin below 7%, control blood pressure below 140/90mmhg, if combined with diabetes or kidney disease, blood pressure should be controlled below 130/80mmHg.
3. Long-term oral antiplatelet and microcirculatory improvement drugs are needed after discharge, and blood coagulation indexes should be rechecked regularly to adjust the dosage of oral drugs to avoid bleeding caused by overdose.
Support Us
If the above content has been helpful to you, please click the share button to share the article or website. This is the greatest support for us.
Discussion
Share your experience, or seek help from fellow patients.
