The patient, Zhang, was diagnosed with lumbar disc herniation and treated at a local hospital for long-term back and leg pain, and after a period of time, his symptoms did not improve and he underwent lumbar spine surgery at the local hospital. After the surgery, the symptoms not only did not improve, but also developed into cold and severe pain in the affected limb, which prevented him from sleeping all night, and ulcers and black gangrene in the toes. The patient came to our vascular surgery department, and through ultrasound, CTA and DSA angiography, we found that the patient’s iliac artery on one side was completely occluded, leading to severe ischemia in the lower limbs. Especially, many middle-aged and elderly people do not pay attention to the soreness of legs and feet after walking, and they think it is normal when they are old, so it is often ignored or treated as general back and leg pain or calcium deficiency and misdiagnosed for a long time. Therefore, it is necessary to raise awareness of the symptoms of this disease. The disease is characterized by an insidious early onset, early manifestations of the patient walking for a distance after the calf muscle soreness, then if the patient sits down for a moment, the soreness can be relieved or disappear, but again walking a certain distance after the pain will be aggravated, which is the so-called “intermittent claudication”. This is due to the increased need for oxygen in the muscles of the lower limbs when walking, but due to insufficient blood supply from arterial stenosis, anaerobic metabolism occurs, and the metabolites generated such as lactic acid stimulate the nerves and cause soreness in the affected limbs, especially the calf muscles. As the arterial stenosis becomes more severe, the distance the patient can walk becomes shorter, until eventually the ability to walk is lost. At the later stage of the disease, the artery may even be occluded, and then the limb is in a state of extreme ischemia even at rest, resulting in severe pain in the nerve endings, called “resting pain”, especially at night and in winter and spring when the temperature is low. At the same time, the skin and muscle tissues gradually lose their vitality due to ischemia, resulting in ulceration or black gangrene of the affected foot, especially the toe, and the recurrent infection of the necrotic area is often uncontrollable with general drugs, resulting in the so-called “old rotten foot”, and a considerable number of patients have to undergo amputation, which seriously affects the quality of life. So is there any way to detect arterial disease early? First of all, people can make a preliminary self-diagnosis against the early symptoms of the disease: if there is often pain in the calf stomach after walking a few hundred meters, or cold feet, then you should look at the color of the skin of your feet when you get up early and sleep late, the color of the skin of the feet is often white or purple when the lower limbs are ischemic, and you can also feel the temperature of the feet, if the diseased feet will be cold. And can feel the dorsalis pedis artery has no pulsation, if the artery pulsation is normal, can be ruled out, if the dorsalis pedis artery pulsation is very weak or disappeared, the possibility of suffering from this disease is very high, then you should go to the hospital for a systematic and comprehensive vascular specialist examination. At present, the commonly used examination methods mainly include lower extremity artery ultrasound, lower extremity artery CT angiography (CTA), lower extremity artery magnetic resonance angiography (MRA) and lower extremity artery digital subtraction angiography (DSA), etc. To prevent and treat lower limb arteriosclerosis, we should pay attention to good habits, such as giving up smoking and other bad habits, abstaining from high-fat indigestible and stimulating foods, eating a light diet, and eating more fruits and vegetables and legumes. Diabetes, hypertension and hyperlipidemia should also be actively treated. Patients diagnosed with this disease should not walk too fast to avoid the onset of ischemic symptoms, but appropriate walking exercises can be used to enhance the tolerance of lower limb tissues to ischemia, and to promote the formation and opening of collateral vessels around the occluded artery, which can play a role in alleviating the disease. Lower limb atherosclerosis occlusive disease such as cold feet should pay attention to insulation, but can not use hot water bags to warm the feet or soak feet with hot water, because this will aggravate the lower limb ischemia, making the condition worse. In addition, patients can also take some vasodilator drugs under the guidance of doctors to improve the blood circulation of the affected limbs. For patients diagnosed with lower limb atherosclerosis and occlusive disease, treatment such as improving lifestyle habits, lowering blood pressure and lipids and antiplatelet aggregation as prescribed by internal medicine can slow down the progress of lower limb atherosclerosis and occlusive disease, but cannot fundamentally eliminate the narrowing and occlusion of existing lower limb arteries. Patients should still go to a vascular surgeon as soon as possible, and the main treatment method is to reconstruct the blood supply of the affected limb through surgery. Surgical procedures for lower extremity atherosclerosis include endovascular stripping, artificial vessel replacement, bypass reconstruction, and other traditional procedures, as well as endoluminal revascularization. In contrast, traditional surgery is very traumatic and risky, especially not suitable for patients with lower extremity atherosclerosis occlusive disease combined with serious cardiovascular and cerebrovascular disorders and diabetes mellitus. In contrast, endoluminal intervention in the arteries of the lower extremities has the advantages of being minimally invasive, simple, effective and repeatable, and is the direction of development in the diagnosis and treatment of vascular diseases. The procedure only requires a rice-sized incision at the root of the thigh, and the catheter, balloon and stent are inserted into the diseased artery to complete balloon dilation and stent placement in the narrowed or occluded artery.
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