Overview
Arterial disease is a general term for diseases that occur in the arteries. Organic (inflammation, stenosis or occlusion) or functional (arterial spasm) diseases of the arteries give rise to ischemic clinical manifestations, and the course of the disease can be progressive with serious consequences. According to the time of onset of the disease, it can be divided into acute and chronic; according to the nature of the lesion, it can be divided into steno-occlusive and dilatational diseases (aneurysms).
Causes
1. Atherosclerosis: it can occur in the whole arterial system.
2. Diabetes mellitus: it can cause inactivation of endothelial cell function in micro arteries and lead to thrombosis in microvessels. In addition, diabetic patients’ ability to resist infection decreases, and the release of inflammatory factors can exacerbate local ischemia.
3. Smoking: it can destroy the arterial endothelium and promote local inflammatory response, thus activating the intravascular coagulation mechanism, leading to vasospasm and intravascular thrombosis.
4. Hypertension.
5. Heart disease
Symptoms
1. Arteriosclerosis obliterans
Early symptoms are coldness and pallor of the affected limbs, followed by intermittent claudication. If the lesion is confined to the main-skeletal artery, the pain is in the buttocks and femur, which may be accompanied by yang plankton; if the femoral-popliteal artery is involved, the pain is in the calf muscle group. In the advanced stage, the affected limb has a marked decrease in skin temperature, pale or cyanotic color, resting pain, and ischemic gangrene or ulceration of the distal limb. Early chronic ischemia causes trophic changes in the skin and its attachments, sensory abnormalities, and muscle atrophy. The femoral, popliteal, posterior tibial and dorsalis pedis arterial pulses of the affected limb are weakened or cannot be detected.
2. Arterial embolism
The clinical manifestations of acute arterial embolism can be summarized as the 5P signs, i.e. pain, abnormal sensation, paresthesia, pulselessness and pallor.
3. Raynaud’s syndrome
Typical symptoms are the sequential appearance of pallor, cyanosis and flushing. Pallor occurs due to intense arterial spasm, resulting in a temporary cessation of capillary perfusion.
Examination
Since the syndrome is a systemic disease, a detailed examination should be conducted, including lipid determination, function and vascular examination of the heart, brain, kidney, lungs and other organs, and funduscopic examination.
1. Color Doppler ultrasound
Color Doppler ultrasound can provide information about the diameter of blood vessels, the speed of blood flow, and whether there are blood clots in the vessels.
2.CT Angiography and Magnetic Resonance Angiography
Through computerized three-dimensional reconstruction, a three-dimensional model of limb arteries can be simulated and constructed.
Diagnosis
A diagnosis of arterial disease can be initially established based on clinical symptoms and signs. Combined with laboratory tests, the diagnosis can be confirmed by ruling out other diseases.
Treatment
1. Non-surgical treatment
For patients with aneurysms, except for those who are difficult to tolerate surgery, in principle, surgery is feasible. Non-surgical treatment for patients with lower limb atherosclerotic occlusive disease includes lifestyle changes, functional exercises and medication.
(1) Lifestyle changes Smoking cessation, low-salt and low-fat diet.
(2) Functional exercise Walking is the mainstay, with rest until the onset of ischemic symptoms and resumption of walking when symptoms improve.
(3) Medications Regularly take antihypertensive, hypoglycemic, and hypolipidemic medications to control blood pressure, blood sugar, and blood lipids.
2. Surgery
Surgery can be divided into two types: open surgery and endoluminal surgery.