Disease Name (English) thromboangiitis obliterans拚音XUESHUANBISAIXINGMAIGUANYAN Alias Western Medical Disease Classification Code Circulatory System Diseases, Peripheral Vascular Disease, Chinese Medicine Disease Classification Code Western Medical Disease Name Definition Thrombo-occlusive vasculitis is a chronic and segmental vascular disease that is dominated by embolism of small and medium-sized arteries in the limbs . Companion veins are often involved. It is more common in China. The cause of Western medicine is not well understood, but it is generally believed that smoking is one of the main causes, and cold and humidity are important triggers for the development of this disease.
It is more common in young and strong men, but the incidence in women is only 2%-5%, which may be related to sex hormones. In addition, fungal infection, trauma and malnutrition may also be factors in the development of the disease. The high rate of HLA-JI positivity in the patient’s serum may have a genetic component. The positive rate of anti-arterial antibodies in patients was found to be as high as 44.1-56%, with a significantly higher positive rate of antigens such as HLA-A and B5 and higher IgM values, suggesting that it may be an autoimmune disease.
TCM etiology Season Region Population Prevalence is in young and strong males, with female incidence of only 2-5%. Intensity and transmission Incidence Pathogenesis TCM pathology The pathology mainly invades the small and medium-sized arteries of the limbs, and the arteries of the lower limbs are involved in about 80% of cases, and both lower limbs often develop successively. Arteriography reveals occlusion below the N artery and its bifurcation in 70%-75% of cases. The upper extremities are less frequently affected alone, but mostly the ulnar, radial and metacarpal arteries are involved.
The arterial lesions are often segmental, with the proximal end and the arteries between the two occluded segments being mostly normal. It can be divided into two phases: acute and chronic. In the acute phase, endothelial cell proliferation is seen, with new thrombi in the lumen, surrounded by giant cells, and inflammatory cell infiltration throughout the artery. In the chronic phase, thrombus mechanization and recanalization may occur, the inner elastic lamina of the artery is often wavy and contracted, there is fibrous tissue proliferation in and around the artery, and the accompanying veins and nerves may be involved.
Coexistence of acute and chronic phase lesions may be seen in recurrent cases. In severe cases, there is extensive thrombosis within the tiny arteries and veins. Fibrinoid degeneration characterized by metaplasia may also be found in the middle layers of the arteries. In patients with acute progression and advanced disease, the blood is often hypercoagulable due to increased adrenal medullary hyperplasia and hormone secretion, which is detrimental to disease progression. Pathophysiology Chinese medicine diagnostic criteria Western medicine diagnostic criteria Thromboembolic vasculitis diagnostic criteria:
1, this disease occurs almost exclusively in men aged 20 to 40 years.
2, patients mostly have progressive intermittent claudication of the lower limbs and chronic ischemic symptoms (numbness, coldness, pain, pallor, bruising) and other manifestations.
3, 40% to 50% have a history and signs of superficial migratory superficial phlebitis episodes, and the pulsation of small arteries in the affected limbs is weakened or disappeared.
4, the patient has a history of smoking, most of them have a history of cold and damp (moisture).
5.Arteriogram and impedance flowmeter, ultrasound Doppler and other examinations are needed.
6.Identify arteriosclerotic occlusive disease of the limbs, cardiogenic and aortic vascular embolism, traumatic vasospasm, vascular nerve dysfunction, diabetic gangrene, venous thrombosis and post-thrombophlebitis syndrome, thoracic outlet syndrome, periarteritis nodosa, multiple aortitis, nodular vasculitis, allergic vasculitis, erythematous limb pain, scleroderma, Raynaud’s syndrome, oculo-oral genital syndrome, dermatomyositis, lipofuscinosis, lupus erythematosus, shoulder and neck syndrome, spinal stenosis, gluteal epicutaneous nerve injury syndrome, lumbar disc herniation, peripheral neuritis, sciatica, etc.
Western medicine diagnosis is based on clinical features, combined with skin temperature measurement, positive limb position test and blood volume tracer and other instrumental tests to confirm the diagnosis. The majority of patients have a history of smoking and a history of migrating superficial phlebitis in about 50% of cases. The vast majority of patients have intermittent claudication, which is clinically divided into three phases.
① local ischemic phase: the affected foot is obviously cold, numb, pale or cyanotic skin, reduced skin temperature, and diminished or absent peripheral arterial pulsation.
②Dystrophic phase: the above symptoms are aggravated with muscle atrophy, skin and toenail dystrophy, often with perineural infection and focal ulcers.
③Necrosis stage: The lesion continues to deteriorate and extremity necrosis occurs. The necrosis is limited to the toe (finger) as primary necrosis; over the toe-plantar joint as secondary necrosis; near the ankle joint or ankle as tertiary necrosis. From the stage of nutritional disorder, there are walking (limping) pain and resting pain, especially in the stage of necrosis, the resting pain is so intense that the patient often sits on his knees and has difficulty sleeping day and night. If the necrotic infection is severe, the patient is debilitated and often has toxic symptoms.
Physical examination Electrical diagnosis Imaging diagnosis Laboratory diagnosis Blood Urine Stool Cerebrospinal fluid Other diagnosis Immunology Histological test Western medicine differential diagnosis In the diagnosis should be distinguished from atherosclerotic occlusive disease, arterial thromboembolism, Raynaud’s disease, etc. Chinese medicine class evidence differentiation Efficacy assessment criteria (a) recent efficacy
1. Clinical cure.
①The clinical symptoms basically disappear;
② complete healing of limb trauma;
③Limb peripheral blood circulation disorder and impedance hemogram improved significantly;
④Walking speed of 100-120m/min, and can continue to walk about 1500m or more without discomfort.
2.Significantly effective.
①Significant improvement of clinical symptoms.
②Limb trauma healing or close to healing.
③Limb peripheral blood circulation disorder and hemogram are improved.
④Walking speed of 100-120m/min, those who can walk continuously for about 500m or more.
3.Progress.
①Clinical symptoms are reduced.
②Limb trauma is close to healing or shrinking.
③Limbs with slightly improved peripheral blood circulation and hemogram.
④Walking speed of 100~120m/min, able to walk about 300m.
4. Ineffective (including deterioration): No progress in symptoms and signs after 1 course of treatment (2 months) or the condition continues to worsen.
(II) Long-term efficacy (more than 1 year): The follow-up targets were mainly those who were clinically cured and significantly effective in the recent efficacy.
Excellent.
①Can walk continuously for more than 2500m (walking speed 100-120m/min);
②Able to perform normal work. including general physical labor.
③No conscious symptoms in general.
Good.
①Can walk continuously for 500~1000m (walking speed 100~120m/min);
②Ability to perform general non-manual work;
③After work, there are still mild clinical symptoms when the weather changes and cold;
Poor: Ischemic symptoms are more obvious, sometimes there is rupture, and even ulcer necrosis occurs, and the limb is amputated after continued treatment is ineffective. Prognosis Complications Western medicine treatment The basic principle of treatment is to prevent the progress of the lesion, promote the formation of collateral circulation and improve the ischemic state of the limb. Warmth, prevention of infection, avoidance of trauma, and lifelong smoking cessation are important measures to prevent and treat this disease. Commonly used vasodilators include tolazoline, phentolamine, phencyclidine, niacin, vasodilator, and the Chinese herbal medicine Danshen.
Dextran 40 intravenous drip also has a good effect on early and recovery cases. Lumbar sympathectomy can be considered for cases in which Chinese and Western medicine are ineffective or have poor results. If arteriography confirms segmental arteries, endovascular debridement, autologous venous diversion or other revascularization procedures can be performed. In cases of toe end necrosis, the necrotic tissues should be removed in one stage or in stages under the control of local infection and improvement of limb ischemia, and if necessary, amputation should be performed.
Hyperbaric oxygen therapy and various acupuncture therapies also have certain pain-relieving effects. The main treatment rules for each type of cases are to warm the channels and disperse cold for the Yin-Cold type, to clear the channels and channels for the Qi-Stagnation-Blood Stasis type, to clear heat and dampness for the Warm-Heat type, to clear heat and detoxify for the Poison-Heat type, and to nourish Qi and Blood for the Qi-Blood deficiency type.
Chinese medicine, acupuncture, acupressure, massage, combined Chinese and Western medicine treatment, care, rehabilitation of vasculitis, in the early course of the disease traditionally made Buerger’s gymnastics, that is, in the supine position the affected limb elevated 2-3min, while making resistance ankle flexion and extension exercises, then let the affected limb outside the edge of the bed droop 3-5min, and then flat on the bed 2-3min Then let the affected limb sag off the edge of the bed for 3-5 min, then lay flat on the bed for 2-3 min, and so on for 3-10 times. Recently, endurance exercises such as walking and resistance cycling are also used, intermittently, in order not to aggravate the pain, so as to promote the development of collateral circulation and revascularization. Warm mineral baths or radiant heat therapy can also be performed in the early stages. For late cases, heat therapy can be applied to the proximal healthy limb, and ultrashort wave therapy can be used for necrotic and ulcerated areas.