Acute lower extremity ischemia

Introduction Common diseases of lower extremity arterial ischemia include arteriosclerotic occlusive disease, thromboangiitis obliterans, vasculitis, arterial injury, arterial distress and aneurysmal cystic disease, of which the former two are the most common. With the improvement of people's living standards and the aging of the population, the incidence of arteriosclerosis has increased year by year. In addition, most of these patients are accompanied by diabetes, which makes the arterial ischemia of the lower extremities progress faster and the condition is more complicated. In addition, due to the increase in the number of smokers, the younger and more feminine of smokers, the incidence of thromboangiitis obliterans is also on the rise, and the number of female patients is also significantly higher than before.

Cause

In China, the main cause of lower limb arterial ischemia is arteriosclerosis and thromboangiitis obliterans (also known as Berg disease). With the improvement of people's living standards and the aging of the population, the incidence of arteriosclerosis has increased year by year. In addition, most of these patients are accompanied by diabetes, which makes the arterial ischemia of the lower extremities progress faster and the condition is more complicated. In addition, due to the increase in the number of smokers, the younger and more feminine of smokers, the incidence of thromboangiitis obliterans is also on the rise, and the number of female patients is also significantly higher than before.

an examination

Related inspection

Cardiovascular electrocardiogram

Lower extremity arterial ischemia can be divided into three phases: early, middle and late. In the early stage of ischemia, the main manifestations are the cold, numbness and acupuncture of the affected limb. During the examination, there may be a plaque-like change in the back of the foot. The toe tip and the toenail are obviously thickened and pale, and the skin temperature of the affected limb is lowered. The dorsal artery pulsation weakens or even disappears. It is followed by difficulty in walking, that is, the patient's walking speed is slowed down, the walking distance is shortened, and limp is present. The patient usually walks within 100 meters and feels numbness and pain in the affected limb. He must stop for a while before continuing to walk. Therefore, this symptom is also called "intermittent claudication", and this period can also be called "intermittent claudication".

If the disease develops further, it will enter the mid-term. On the basis of the above-mentioned symptoms gradually increasing, the main feature of the mid-term is pain. The patient is painful while walking, and also pains during rest, and the more the night is quiet, the more severe the pain, so this period is also called the resting pain period. The late stage is also called "necrosis period", which is mainly manifested by the blackening and necrosis of the toe, the external hemorrhoids, the heel and other peripheral parts, and the infection occurs on the basis of necrosis, forming ulceration. The patient was unable to sleep all night and the pain was unbearable.

Color ultrasound, arterial angiography, etc. should be performed before surgery. Using advanced digital visualization angiography and angioscopy, we can find that lower extremity arterial ischemia is mainly caused by occlusion of the lower extremity main artery. The cause of occlusion can be either atherosclerotic plaque, thickening of the vessel wall, and blockage of the blood clot. The occluded part can occur in the lower part of the abdominal aorta, or in the femoral artery, radial artery, and the like. The higher the site where arterial occlusion occurs, the larger the area of ischemia; the lower the site where occlusion occurs, the earlier the ischemic symptoms appear.

Differential diagnosis

In the diagnosis of this disease, special attention must also be paid to the following questions in order to distinguish it from several diseases:

1. Intermittent claudication must be distinguished from claudication (such as neurogenic claudication) caused by non-vascular lower extremity pain.

2. For patients with acute lower extremity ischemia such as sudden lower extremity chills, numbness and rest pain, the history of claudication is the main basis for the identification of arterial thrombosis and arterial embolism.

3, age and location is the identification of this disease and aortitis and thromboangiitis obliterans, aortic inflammation occurs in young women, mainly invading the aorta and its main branches; thromboangiitis obliterans more common in smoking Young and middle-aged men, mainly involving the small and medium arteries and veins of the limbs. Often complicated by thrombophlebitis, slow progression, no arterial wall calcification, no diabetes, high blood pressure, high blood lipids.

4, Raynaud's disease (levy): occurs in young women, often due to cold or emotional changes to stimulate the typical change of finger skin color, mostly bilateral symmetry. A small number of patients can occur in the lower limbs or limbs. During the non-onset period, the finger (toe) is of normal color.

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