What is lower limb arteriosclerosis occlusive disease?
The arteries in the human body are like an oil pipeline, arterial blood flows in the arteries every moment, which is like crude oil in the human body. The heart is like an oil pump, which continuously delivers energy to various tissues and organs through different pipelines, and the pipelines leading to the lower limbs mainly include the thoracic aorta, abdominal aorta, iliac artery, femoral artery, N artery and arteries of the lower legs.
Lower extremity atherosclerosis occlusive disease refers to the formation of atherosclerotic plaque on the inner wall of the artery. As the plaque continues to grow, the lumen gradually narrows, the patency of the pipeline is affected, the blood flow to the lower extremity is reduced, and when the narrowing reaches a certain level or even completely blocked, the blood flow supplying the lower extremity cannot meet the needs, and the symptoms of lower extremity ischemia will appear.
Is lower extremity arteriosclerosis occlusive disease common?
Lower extremity atherosclerosis occlusive disease belongs to the category of vascular surgery, which is a very common disease. In China, with the improvement of people’s living standard, the change of diet structure, and the aging of the population, the number of cases diagnosed with lower extremity atherosclerosis occlusive disease has a tendency to increase year by year. There are currently about 20 million patients in China, and it is estimated that the number will continue to increase by about 600,000 each year. The disease is more common in Europe and the United States, with literature reporting 3-10% of people under the age of 70 and 15-20% of people over the age of 70. The majority of patients with the disease are men, mostly in the older age group.
Third, what causes atherosclerosis of the lower extremities?
The occurrence of lower extremity atherosclerosis-occlusive disease is closely related to lifestyle. The diet structure is not healthy enough, sweet tooth, high saturated fat food such as red meat, excessive salt intake, lack of exercise, overweight is prone to diabetes, hypertension or hyperlipidemia. Diabetes, smoking, hypertension and hyperlipidemia are the four major killers of lower extremity arterial disease.
Diabetes can increase the onset of lower extremity atherosclerotic occlusive disease by 3-5 times, and, in patients with combined diabetes, the lesions are often much more severe than in other patients. Smoking is a recognized killer of human health, and smoking can also cause arterial constriction, contribute to arterial narrowing, accelerate the formation of atherosclerosis, aggravate limb ischemia, and is one of the main risk factors for lower extremity atherosclerosis. Long-term hypertension can cause vascular damage and easily form plaque causing stenosis. High blood lipids cause increased blood viscosity, which is also prone to vascular stenosis and leads to lower extremity atherosclerotic occlusive disease.
The environment is also closely related to the occurrence of lower extremity atherosclerotic occlusive disease. Cold and wet environments are prone to develop, so the incidence is higher in the north. Cold weather and vasoconstriction can also lead to aggravation of the original lesion, so patients with lower extremity atherosclerosis often experience worsening symptoms in winter.
Fourth, what are the symptoms of lower extremity atherosclerosis occlusive disease?
The early stage of lower limb atherosclerosis is often characterized by coldness, numbness, and leg muscle spasms, commonly known as “cramps”, and because these early symptoms are not typical, they are easily confused with other diseases, so they are often mistaken for calcium deficiency in the elderly or lumbar spondylosis, resulting in misdiagnosis and mistreatment, which delays their condition. Therefore, patients who have these symptoms should be reminded to go to the vascular surgery department of a regular hospital to confirm the diagnosis through scientific examination means.
If the lesion continues to develop, symptoms of claudication may occur. Doctors call the claudication caused by this disease “intermittent claudication”, characterized by pain in the lower extremities after walking about hundreds to tens of meters, usually manifested as soreness in the calf muscles, but also pain in other parts of the lower extremities, the patient is forced to stop and rest for a period of time to relieve the pain, and can continue to walk, and continue to move pain can The pain can recur with continued activity. As the lesion worsens, the distance over which the pain appears becomes shorter and shorter, from several hundred meters to finally a dozen meters or even a few meters, requiring prompt treatment.
If the symptoms of claudication are not treated and the lesion continues to deteriorate, “resting pain” will appear, and the patient will still have pain in the lower limbs even when not exercising, especially at night when sleeping, making it difficult for the patient to sleep and eat and nervousness. At this stage, the patient must be treated actively, otherwise the disease will enter an advanced stage.
After entering the advanced stage, even a little break in the foot is very difficult to heal, the lower limbs gradually appear necrosis, and eventually can only amputate the necrotic limb, and even life-threatening in serious cases.
Five, leg pain is all have lower limb atherosclerotic occlusive disease?
So, are all patients with claudication and leg pain suffering from lower extremity atherosclerotic occlusive disease? Lumbar spine diseases can cause leg pain and claudication. The pain of lumbar spine disease is radiating pain from the lower back to the buttocks, the back of the thigh, the outer calf up to the foot, and is usually relieved by sitting down or squatting to rest. In addition, osteoporosis and arthritis can manifest as lower limb pain. Therefore, elderly people with limb pain without obvious cause should undergo vascular examination to avoid misdiagnosis.
There is a phenomenon in life that many vascular surgical diseases such as lower limb arteriosclerosis occlusion, varicose veins, phlebitis, deep vein thrombosis are collectively called “vasculitis”, which is also a misconception. In fact, “vasculitis” is one of the vascular surgery diseases, the full name is “thrombo-occlusive vasculitis”, which occurs in young and middle-aged men with a history of smoking. “The symptoms of vasculitis are similar to those of lower extremity atherosclerosis occlusive disease, but they are not the same disease, and the treatment is different, so the vascular surgery department in a regular hospital should make a clear diagnosis and treat the symptoms.
Is lower extremity arteriosclerosis occlusive disease dangerous?
Many people think that lower limb atherosclerosis occlusive disease is “old cold leg”, it is quite common, wear warm, or in small clinics to grab some medicine, prescribe some painkillers, paste a plaster, survive the winter will be fine. However, from the development of the symptoms of lower extremity atherosclerosis occlusive disease can be seen, this disease has a considerable risk, if not timely to the regular hospital, will seriously affect the quality of life, there is a risk of amputation or even death.
We understand the danger of this disease through a set of data: the 5-year mortality rate of all patients with lower limb atherosclerosis-occlusive disease is 10-15%, the 5-year mortality rate of patients with “intermittent claudication” is 30%, and the 5-year mortality rate of patients with “resting pain” and ulcer gangrene is as high as 70%. The 5-year mortality rate is as high as 70%, and the 1-year amputation rate of patients with severe disease is 30%.
How do I know I have lower extremity arteriosclerosis occlusive disease?
Lower extremity atherosclerosis is so dangerous that it is important to seek medical attention as soon as possible. However, since the early symptoms of the disease are not typical enough, patients must not self-diagnose and self-medicate, as this will delay the disease on the one hand, and abuse of drugs will also cause harm to the body. Patients should go to a regular hospital with a vascular surgery specialty to confirm the diagnosis through scientific tests. For example, arterial pressure measurement, lower extremity artery ultrasound, CTA, magnetic resonance imaging (MRI), etc. These tests can help determine whether there is arterial stenosis or occlusion in the limbs. If necessary, the doctor will also recommend an arteriogram, which injects a contrast agent into the blood vessels to show the location and extent of the lesions in the blood vessels under radiation, using X-rays to accurately show the location and extent of the lesions.
What are the treatments for lower extremity atherosclerosis occlusive disease?
Once the lower extremity atherosclerosis occlusive disease is diagnosed, treatment should be started as early as possible to avoid deterioration of the disease. The treatment includes general conventional treatment, medication, endovenous intervention and surgery, and the vascular surgeon will choose different treatment methods according to the severity of the patient’s condition.
General treatment includes: quit smoking, which can significantly delay the continued aggravation of the disease; arrange the diet reasonably, eat more low salt, low sugar, high fiber and plant foods containing unsaturated fatty acids, such as beans, fruits and vegetables; carry out appropriate walking exercise, adhere to several times a day for 60 min, can increase the formation of lateral branch circulation of the affected limb, improve ischemia, and introduce an exercise method for patients who have difficulty walking The patient should be able to walk, i.e. elevate the affected limb for 1-2 min, droop for 2-3 min, lie down for 2-3 min, rotate the foot, flex and extend, and exercise repeatedly for 20-30 min; pay attention to foot care, keep the foot warm and avoid limb injury. General treatment also includes active treatment of diabetes, hypertension, hyperlipidemia and other diseases that induce atherosclerosis in the lower limbs.
In addition to taking glucose-lowering drugs, antihypertensive drugs and lipid-lowering drugs on time to control blood sugar, blood pressure and blood lipids, for patients with severe claudication symptoms, vascular surgeons will also prescribe artery-dilating drugs, antiplatelet drugs or anticoagulant drugs, and if necessary, painkillers, which mainly serve to control the continued development of the disease, improve limb ischemia, relieve pain and promote ulcer healing.
Most of the patients’ conditions can be effectively controlled by general treatment and medication. Only some patients with severe disease, such as severe claudication that affects quality of life, “resting pain”, or even gangrenous limb ulcers, require endoluminal and surgical treatment.
Endoluminal treatment, also known as interventional surgery, refers to the selection of relatively superficial blood vessels without lesions, such as the artery at the root of the thigh and the artery at the elbow, etc. A small eye is pierced with a special puncture needle, and some special guidewires and catheters are inserted through this puncture eye to reach the diseased vessel under X-ray surveillance, and the narrowed artery is dilated with a special balloon, and then the stenosis is supported with a special metal stent to achieve the treatment. The goal is to treat the stenosis with a special metal stent. Endoluminal treatment is not an open surgery, and only a puncture hole is left in the body after the treatment, causing no harm to any tissues outside the blood vessels, resulting in less trauma, less pain and faster recovery for the patient.
However, endoluminal therapy may not be suitable for all patients, and some patients with more severe lesions still require open surgery to unblock the narrowed area, sometimes requiring the use of autologous or artificial blood vessels to “bridge” the blood through the newly created “bridge” to the distal vessel of the lesion. The new “bridge” is used to re-route blood to the distal vessel of the lesion.
After surgery, medication is still needed to consolidate the postoperative effect and delay the recurrence of the disease, whether it is endoluminal treatment or open surgery.
What can be done to prevent lower extremity atherosclerosis?
Prevention-oriented, scientific and healthy lifestyle and good habits can greatly reduce the risk of disease onset: (1) quit smoking; (2) low salt, low fat, low sugar light diet, eat more fresh vegetables, fruits and other vitamin-rich food; (3) appropriate fitness exercise can control weight, which is equivalent to regular gymnastics for blood vessels, can enhance elasticity and prevent aging; (4) good at adjusting emotions. Avoid long-term mental tension and depression; (5) pay attention to warmth, but do not use warm water bags to warm the feet or hot water soaking feet, some patients may be due to reduced skin sensation, insensitive to heat and burns.
Regularly go to the hospital to perform a formal and comprehensive physical examination, to be able to early detection of hypertension, diabetes, hyperlipidemia and other predisposing factors of lower limb atherosclerosis occlusion. When you find yourself suffering from these diseases, it is necessary to take drugs to lower blood pressure, blood sugar or blood lipids under the guidance of a doctor to avoid the susceptibility factors of lower limb atherosclerosis occlusion.
Finally, we remind our elderly friends that if they experience discomfort in the lower limbs, they should not be shy about seeking medical advice, but should go to a regular hospital with vascular surgery as soon as possible to identify the cause. Otherwise, the early stage of lower limb atherosclerosis, which could be improved and stabilized by conservative treatment or simple surgical solutions, will develop into serious “resting pain” or even ulcer gangrene, which will not only increase the treatment cost but also delay the best time for treatment.