1.What is peripheral vascular disease? When it comes to vascular diseases, we are most familiar with cardiovascular and cerebrovascular diseases, such as coronary heart disease, cerebral infarction, cerebral thrombosis and other diseases; what is peripheral vascular disease? Generally speaking, they are vascular diseases other than cardiovascular and cerebrovascular diseases; in general, they can be divided into two categories: one is arterial diseases, and the most common ones are arteriosclerotic occlusive disease of the limbs, diabetic limb vasculopathy, diabetic foot, arterial embolism of the limbs, arterial thrombosis, carotid artery sclerosis or occlusion, renal artery stenosis or occlusion, aortitis, thrombo-occlusive vasculitis, etc. These are These are diseases caused by partial or complete blockage of arterial vessels and can be collectively referred to as limb ischemic diseases; there are also aneurysmal dilatation diseases, commonly known as abdominal aortic aneurysm, thoracic aortic aneurysm, aortic coarctation and aneurysm of the limb. Another major category of peripheral vascular diseases is venous diseases, commonly including varicose veins of lower limbs, thrombotic superficial phlebitis, lower limb deep vein valve insufficiency, lower limb deep vein thrombosis, etc. These diseases are mainly due to incomplete closure of lower limb venous valves, blood reflux, or venous thrombosis blocking blood vessels, resulting in poor venous blood flow back to the lower limbs, which can be collectively referred to as venous reflux disorders. In addition to these two major categories of peripheral vascular diseases, some inflammatory diseases of the skin vessels and lymphedema of the limbs also belong to the category of peripheral vascular treatment. 2.What tests are needed for peripheral vascular disease? To diagnose whether it is peripheral vascular disease, the most basic test is two tests: one is the familiar ultrasound examination, through color Doppler vascular ultrasound examination, we can make a preliminary judgment on most vascular diseases; the other test is to use a special non-destructive examination instrument for peripheral vascular, which can perform segmental pressure measurement, waveform tracing and blood flow sound analysis on the arteries of the limbs, and at the same time, the blood flow waveform of the toes can be The blood flow waveform of the toes can be traced to determine whether there is stenosis in the arteries of the limbs and the degree of stenosis; the veins of the limbs can be analyzed by the sound of blood flow to determine whether the venous blood flow is smooth, whether there is reflux and the degree of reflux. If the condition is more serious, surgical treatment should be considered, such as severe arterial stenosis occlusion, thoracoabdominal aortic aneurysm and other conditions, further imaging examinations are required, mainly including arterial CT and contrast examinations. 3.What are the symptoms of lower extremity arterial occlusion? According to the degree of arterial occlusion, the symptoms are different, generally divided into three stages, the early stage is mainly cold limbs, walking weakness, occasional numbness; the middle stage is mainly intermittent claudication, can be accompanied by cold feet and fear of cold or numbness of toes after walking, physical examination can see toe nail thickening, slow growth, dry skin, sweat hair loss, foot skin temperature cool, dorsal foot or posterior tibial artery pulsation is weakened; severe stage intermittent claudication The distance is obviously shortened, generally less than 100 meters, the foot is cold and afraid of cold obviously, can be accompanied by toe pain, examination can be seen toe color purple, skin temperature cold, dorsal foot, posterior tibial artery pulsation is weak or can not be felt, late stage can appear toe black necrosis, pain is intense, can not walk, some patients therefore amputation. 4.What is intermittent claudication? Intermittent claudication is a condition in which the lower limbs, especially the lower legs, become sore and tired or sore after walking for a certain distance and cannot continue to walk, so it is necessary to slow down or rest for a few minutes and continue to walk after the symptoms are relieved, but the above symptoms appear again after walking to about the same distance and can be relieved after resting for a few minutes as well, and this walking condition is called intermittent claudication. 5.What are the common diseases that cause intermittent claudication? There are two most common diseases that cause intermittent claudication, one is arteriosclerotic stenosis or occlusion of the lower extremities, which, in addition to intermittent claudication, is accompanied by coldness and fear of coldness in the extremities and weakening or disappearance of the posterior tibial artery pulsation in the dorsum of the foot; the other common disease that causes intermittent claudication is disc herniation or spinal stenosis, which is also accompanied by coldness and fear of coldness in the extremities, but unlike intermittent claudication caused by arterial occlusion, lumbar spine lesions are mostly associated with However, unlike intermittent claudication caused by arterial occlusion, lumbar spine lesions mostly have numbness and lumbar discomfort, while the dorsalis pedis or posterior tibial artery pulsation is normal. 6.What is vasculitis? For peripheral vascular disease, the people are most familiar with “vasculitis”. People generally occur in the leg and foot parts, redness, swelling, pain, ulceration as the main manifestation of the disease is collectively referred to as “vasculitis”; in fact, the above symptoms as the main manifestation of vascular disease contains a variety of diseases, such as thrombotic superficial phlebitis, arteriosclerosis occlusion caused by gangrene of the toes, diabetic foot, venous ulcers, etc.;. Specialists say vasculitis, generally refers to thrombo-occlusive vasculitis, the onset of young men as the most common, is an immune vasculitis disease, related to smoking, cold, male hormones and other factors, the diseased vessels to the calf in the small arteries, vascular ultrasound examination shows the arterial intima thickening lumen narrowing, occlusion or thrombosis, the main manifestations of early toe cold and fear of cold, intermittent claudication is the main The further development of the disease can appear bruised and swollen toes, pain, serious stage will appear toe ulceration, difficult to heal, severe pain, etc. 7.What are the surgical treatments for lower extremity atherosclerosis occlusion? Most people have probably heard of coronary heart disease. If the coronary artery is severely narrowed or completely occluded, it can be treated by surgical bypass or stent placement. Similarly, if a lower extremity artery is severely stenosed or occluded, it can be treated in the same way. At present, the most commonly used method is “stenting”, which is called “endovascular intervention” and is a minimally invasive treatment that generally does not require an incision. With the progress of medical science and technology and the continuous improvement of medical equipment and instruments, the means of endovascular treatment have become more and more abundant and the scope of treatment has become more and more extensive, so that some patients with ischemic arterial occlusion who were previously complicated and difficult to treat have been saved. At present, we are able to independently carry out various endovascular procedures (interventional treatment), including Straub thrombus aspiration, atherosclerosis Turbohawk plaque spinotomy, aneurysm sandwich surgery, etc., which represent the current advanced level, becoming one of the few hospitals in China to master this technology and taking a leading position in China. 8.What are the causes of varicose veins in the lower limbs? The primary varicose veins are divided into primary and secondary, which means there are no obvious triggering factors, and congenital weakness of vein wall, reduced elasticity and poor venous valve structure are the main causes of the disease, which are related to heredity; secondary triggering factors are heavy physical labor, prolonged standing, injury and cold, history of phlebitis, and increased abdominal pressure caused by various reasons such as female pregnancy. Due to valve insufficiency, the venous blood reflux in the lower extremities, the venous pressure in the lower extremities increases, because the superficial veins are located in the superficial subcutaneous layer and lack of muscle and connective tissue protection around them, the venous hypertension can cause the veins to grow and thicken over time, and varicose veins appear. In the early stage of the disease, there is no obvious discomfort, but with the gradual aggravation of superficial varicose veins, there is a feeling of soreness and heaviness in the lower limbs, and the longer course of the disease can appear skin nutritional changes, including skin pigmentation, eczema or ulcers, and pain can appear with superficial phlebitis. 9.What are the complications of varicose veins? Simple varicose veins usually have no special discomfort, only the blood vessels in the legs will protrude like earthworms when standing, and then recover as usual after lying down or elevating the legs, and often no attention is paid to the diagnosis and treatment; as the disease slowly develops, the protruding blood vessels will become more and more obvious and the scope will gradually expand, and then the discomfort symptoms of the legs will appear, which we call the complications of varicose veins, and the common ones are leg swelling, characterized by light in the morning and heavy in the evening. The most serious complications are ulcers, mostly at the inner and outer ankles, which are characterized by repeated ulcers and do not heal easily, commonly known as “old rotten legs”, which seriously affect the quality of life and should be taken seriously. The prevention and treatment of varicose veins should be taken seriously. 10.What is the role of venous valves? As we all know, venous blood flows back upward from the distal end of the limb and eventually returns to the heart, if there is no valve, the venous blood may reflux due to the influence of gravity and cannot return to the heart normally, therefore, the function of the venous valve is to prevent venous blood from reflux, structurally speaking, the venous valve is paired, just like a one-way valve, which can only open upward in one direction under normal circumstances to ensure that the blood flows back upward from below. If the valve is relaxed or closed by some factors, it will cause the blood to reflux and accumulate in the blood vessels, which is one of the main causes of some lower limb vein diseases. 11.How to treat varicose veins? Early mild to moderate varicose veins in the lower extremities can be maintained for a long period of time without development after reasonable changes in lifestyle habits and appropriate conservative treatment, which can be up to 30 years or more. The measures taken are to reduce the long-term standing and long-term sitting posture, to elevate the lower limbs appropriately when lying down or sitting down, to carry out walking exercises appropriately in order to increase the role of calf muscle pump; to wear medical decompression stockings when standing or sitting for a long time in order to help lower limb venous reflux and to avoid injury and cold to the affected limbs, and to use drugs to promote venous reflux appropriately. However, with the slow development of the disease to a certain stage, there will be complications such as sunken and swollen legs, itchy skin, dermatitis and eczema, pigmentation, superficial phlebitis and even ulcers, which seriously affect the quality of life, therefore, varicose veins still need to be actively treated. If the varicose veins combined with leg swelling and discomfort, light in the morning and heavy in the evening, you can first conservative treatment, currently commonly used drugs are horse chestnut seed extract and other vasoactive drugs and blood-boosting and dampness-eliminating herbs, which can improve the symptoms and relieve the condition; but once there is phlebitis, dermatitis and even ulcers, it means the condition is more serious, then we should actively consider surgery, there are many ways of surgery, according to each person’s The disease is selected; if surgery is not accepted or the body cannot tolerate surgery for other disease reasons, only conservative treatment can be sought, then Chinese herbal medicine has certain advantages and characteristics for the treatment of these complications. 12., What are the surgical methods for varicose veins? Only those who have severe simple varicose veins in lower limbs with corresponding complications should consider surgery, such as severe tortuous vein masses in inner thighs after long-term development; long years of varicose veins, resulting in soreness or heaviness in lower limbs after prolonged walking, which affects the quality of life; varicose vein masses bleed frequently and it is not easy to stop bleeding and healing; varicose veins cause changes in skin properties of lower limbs, such as eczema, bruising The varicose veins cause changes in the skin properties of the lower limbs, such as eczema, bruising dermatitis, ulcers, etc., which are still ineffective after active conservative treatment. Currently, the following surgical methods are commonly used: 1 traditional high ligation combined with trunk stripping of large and small saphenous veins, stripping of varicose vein masses and traffic branch ligation 2 high ligation combined with endovenous laser electrocoagulation, stripping of varicose vein masses and traffic branch ligation 3 high ligation, trunk stripping combined with transilluminated direct vision spinotomy 4 transilluminated direct vision spinotomy combined with laser or radiofrequency ablation. There is no single method that is perfect for treating varicose veins, and any of the surgical methods has a certain recurrence rate. It is important to emphasize that most patients with varicose veins also have deep vein valve insufficiency in the lower extremities, and often have edema in the lower extremities in addition to superficial varicose veins, which is not suitable for superficial varicose vein surgery alone and requires deep vein valve repair. 13.What is diabetic foot? Diabetic foot is one of the serious complications of diabetes mellitus, which usually occurs after 5-10 years of diabetes mellitus. The main symptoms are cold and cold feet, numbness of toes, and loss of pain and temperature sensation in the early stage, further development of the disease can appear walking weakness or intermittent limp, serious stage of the foot can be due to minor trauma, scratching, skin abrasions and other serious infections, manifested as redness, swelling, heat and pain, etc., the rapid development of the disease can appear in a short period of time foot ulceration, many patients therefore amputation. The main reason for the occurrence of diabetic foot is the long-term poor control of blood sugar, resulting in microcirculatory disorders of the foot and nerve damage, therefore, diabetic patients must control blood sugar, once the symptoms of the foot, to promptly seek medical advice. 14.Which diseases are easy to be accompanied by lower limb edema? From the perspective of vascular surgery, most of the lower limb edema is caused by lower limb venous reflux disorders or lymphatic reflux disorders. The most common disease is lower extremity venous valve closure insufficiency, we know the lower extremity venous blood from the distal extremity back to the heart, that is, from the bottom up, how to ensure that the blood from the bottom up backflow and not by the influence of gravity downward flow or reflux? Under normal circumstances, the valve is open in one direction and can only be opened upward to ensure the return of blood from the bottom to the top; if the valve is not closed properly due to various congenital or acquired factors, it will lead to blood reflux, so that blood will accumulate in the blood vessels causing venous hypertension and lower limb edema. Lower limb venous thrombosis is also a common disease that causes lower limb edema, characterized by sudden onset, unilateral limb, mostly seen in the elderly, it is necessary to emphasize that there are several cases that are prone to venous thrombosis, one is the patient who has difficulty moving or is bedridden for a long time due to cardiovascular disease, the other is the tumor patient, and also the patient after major surgery, especially lower limb orthopedic surgery, once these patients have lower limb edema, they should Once these patients develop lower limb edema, they should pay high attention to the possibility of lower limb venous thrombosis. In addition, once lower limb edema occurs in people who travel long distance by car or airplane, the possibility of lower limb vein thrombosis should be considered and timely medical treatment should be sought. The most serious complication of lower extremity deep vein thrombosis and pulmonary embolism is pulmonary embolism, which usually occurs in the acute stage of deep vein thrombosis, because in the early stage of thrombosis, the thrombus is mud-like and unstable, and it will be partially dislodged under limb movement and extrusion, and the dislodged embolus will flow with the blood flow toward the heart, and eventually block the pulmonary artery, causing pulmonary circulation obstruction; large area Severe pulmonary embolism will show symptoms such as “chest pain, coughing blood and difficulty in breathing”, which will lead to respiratory and circulatory failure and endanger the life, therefore, it is necessary to seek medical treatment as soon as possible for lower limb deep vein thrombosis, do not easily massage and squeeze the swollen limbs, and stay in bed without walking activities. 16.How to prevent the recurrence of lower limb deep vein thrombosis? Anticoagulation therapy is the most basic treatment to prevent the recurrence of DVT, especially for the central type and mixed type of DVT, which should be administered regularly for 3-6 months, and according to the rechecking result of thrombus recanalization, some patients need to prolong the anticoagulation therapy, and patients with pulmonary embolism need long-term anticoagulation therapy; the commonly used anticoagulation drugs are low molecular heparin for subcutaneous injection and oral warfarin sodium tablets. Oral warfarin sodium tablets anticoagulation therapy requires regular rechecking of coagulation indexes with the aim of preventing bleeding complications caused by drug overdose. In addition to anticoagulation therapy, active treatment of chronic diseases such as diabetes and hyperlipidemia, dialectical treatment of blood circulation in Chinese medicine, wearing antithrombotic elastic stockings, avoiding prolonged sitting and standing, and proper exercise are all effective measures to prevent recurrence of lower extremity DVT. 17.What are the sequelae of lower limb deep vein thrombosis? After the formation of lower limb DVT, it will often cause the destruction of deep vein valve or part of the thrombus remains in the blood vessel, which will result in poor venous blood return to the lower limb, especially when standing or sitting, blood will accumulate in the lower leg, and leg swelling will appear, which will be relieved when lying down or elevating the affected limb. Therefore, it is necessary to actively treat the leg swelling after deep vein thrombosis to avoid or delay the occurrence of sequelae. 18.How to prevent and treat the sequelae of deep vein thrombosis? To prevent and treat the sequelae of deep vein thrombosis, comprehensive treatment measures should be taken, firstly, regular anticoagulation therapy should be taken to prevent the recurrence of thrombosis, and vascular ultrasound should be reviewed regularly to understand the residual situation of deep vein thrombosis and valve function; if the sequelae is mainly leg swelling, vasoactive drugs can be taken for a long time, currently the common one is horse chestnut seed extract, such as Mai Zhi Ling, etc., and suitable antithrombotic elastic stockings should be worn at the same time. Chinese herbal medicine has certain advantages and characteristics for the treatment of deep vein thrombosis sequelae, especially for severe edema, dermatitis, pigmentation and ulceration, taking dialectical treatment of strengthening spleen and benefiting qi, activating blood and dispelling dampness, detoxifying and generating muscle, etc., which can well relieve the condition. 19.What is the function of medical elastic stockings? Wearing medical elastic socks is one of the methods to prevent and control varicose veins of lower limbs, venous insufficiency of lower limbs, deep vein thrombosis and other diseases. Because these socks are designed and manufactured mainly for the above diseases, the weaving method is different from ordinary socks, generally in the ankle area is more finely woven, and gradually sparse upward, so that the pressure is high in the ankle area, and gradually decreases upward, producing a pressure gradient from the bottom to the top, which can promote venous blood flow back upward, reduce blood stagnation, and lower venous pressure. Generally, these socks are divided into nursing type and treatment type, with long and medium socks, and the pressure is divided into primary, secondary and tertiary pressure (some are classified according to primary, secondary and advanced pressure), therefore, according to the condition and the thickness of the legs, the elastic socks of the right type, size and length, and pressure should be chosen, so that they can be worn comfortably and effectively. 20, lower extremity venous reflux disorders and “old rotten leg” Lower extremity venous reflux disorders generally refer to varicose veins, lower extremity venous valve insufficiency, lower extremity deep vein thrombosis, iliac vein compression syndrome, inferior vena cava syndrome and other diseases, these diseases have a common pathological basis, that is, the lower extremity venous blood return is not smooth, blood stagnation in the vascular The long-term venous hypertension will cause leg swelling, gradually appear skin pigmentation, dermatitis eczema, on this basis if trauma, scratching and other factors lead to skin breakage, untimely treatment will cause infection and the formation of ulcers, this ulcer is characterized by irregular trauma, dark red surrounding tissue, exudate, smell foul, pain is obvious, ulcers are not easy to heal. It is commonly known as “old rotten leg” and is called “polyposis” in Chinese medicine; Chinese medicine has certain characteristics and advantages in the treatment of polyposis. In the acute stage of the disease, it is generally believed that the disease is caused by dampness and heat, and in the chronic stage, it is caused by qi deficiency, blood stasis and dampness.