More than a month ago, Zhang Quan (pseudonym), 40 years old, felt a little pain in his left foot, which gradually worsened, and after he was treated with a poultice in the province, the pain not only did not get better, but the color of his toes slowly turned black. After several turns, Zhang Quan came to the Vascular Surgery Department of the Fifth People's Hospital of Chengdu, where the doctor diagnosed thromboangiitis obliterans and required surgical treatment, and the surgical method was a vascular bypass technique that was rarely used and had a large difficulty coefficient in China, and re-established a vascular channel. The reporter learned that one of the triggers of this disease is smoking, and Zhang Quan's smoking age has been more than 20 years, with an average of at least 1 pack a day!
The course of the disease is fast: the toes go from pain to necrosis in just 1 month!
Zhang Quanquan is a native of Chongqing, usually doing odd jobs in Chengdu, and usually has no entertainment activities. His only hobby is to treat himself with a cigarette outside of work, and "a cigarette after a meal to pass the living immortal" has always been his mantra.
One day more than a month ago, he was in another province. At that time, I was resting, and suddenly felt a tingling pain in my left foot, at first I didn't pay much attention, but then I couldn't help it, so I went to the clinic to apply some medicine, prescribed some earth to eat and got better.
However, after 1 week, the foot pain recurred, the pain was significantly aggravated, and the dressing and earthwork did not see obvious results. This situation lasted for another week, and Zhang Quan found that the color of his toes began to turn black. Zhang Quan insisted on applying medicine and eating earthen recipes, but he didn't expect that his toes had turned completely black little by little, "It was a month before and after." ”
During this period, the left foot can only be slightly relieved by sagging, so Zhang Quan has almost sat and rested for 1 month, unable to lie flat. The long-term sitting posture caused his right foot to appear blood return disorders and cause swelling.
Zhang Quan came to the Vascular Surgery Department of Chengdu Fifth People's Hospital for treatment after going to many hospitals, and Yao Zuoyi, deputy chief physician who received him, recalled that Zhang Quan's mental state was not good at that time, and he looked much older than his actual age. At that time, Zhang Quan's left foot three, four and five toes had been necrotic, the tip of the thumb was necrotic, and the only remaining second toe began to be bruised and oozed a yellowish liquid, which was judged by the entire incidence combined with imaging and blood examination indicators as "thromboangiitis obliterans".
Surgical skill: Bridge in small blood vessels in the foot Is rare in China
Zhang Quan must undergo surgery, which is undoubted, without vascular repair surgery, his foot will continue to die instep and ankle. However, Zhang Quan's surgical methods, vascular surgery, were also fully discussed.
According to common sense, doctors may first recommend minimally invasive interventional surgery to Zhang Quan because the trauma is small and the recovery is fast. However, this procedure does more harm than good for Zhang Quan, one is because Zhang Quan's vascular occlusion site is special, the popliteal artery located at the knee joint and the three main branches of the knee artery under the knee joint to the ankle are completely occluded; the second is that the nature of the lesion is special, because of the occlusion caused by vasculitis. Regardless of the nature of the lesion and the location of the lesion, the interventional method is used, and the long-term patency rate of postoperative re-passage of blood vessels is low, and the vascular occlusion may occur again in a short period of time. Zhang Quan is only 40 years old, the future survival time is still decades, how to obtain a good long-term effect, to avoid the economic and physical burden of repeated surgery is a problem that doctors must consider.
If you choose amputation, first of all, you must start from the root of the toe, and later with the aggravation of the vascular occlusion of the lower limb, you may eventually need to amputate the thigh, which is undoubtedly too cruel for the young Zhang Quan and his family.
Finally, the vascular surgery team once again analyzed Zhang Quan's condition, and the doctor found that although Zhang Quan's toe had died, his left lower extremity large saphenous vein functioned well. Attending physician Yao Zuoyi has a bold idea - using "autologous large saphenous vein bypass grafting", using Zhang Quan's own large saphenous vein to connect the proximal and distant ends of the occluded artery, which is often called vascular bypass, "This is the technique I learned when I was studying in Germany." "Vascular bypass surgery, probably the most commonly heard is coronary artery bypass in coronary heart disease, in fact, peripheral blood vessels will also be used, because the trauma is greater than interventional surgery, generally not used as a routine, especially in the distal artery under the knee bridge, there are few vascular surgery in China."
For Zhang Quan, one of the long segments of the large saphenous vein of the left lower extremity is selected, the proximal anastomosis is in the unimpeded part of the upper knee of the popliteal artery, and the distal anastomosis is in the posterior tibial artery at the medial malleolus, and a vascular channel is reconstructed from the popliteal artery to the arch of the foot, thereby improving the blood supply to the foot and avoiding the further spread of toe necrosis to the soles and lower legs. Although the operation requires surgery and the wound is larger, the autologous vascular patency period after this transplantation will be longer, and if it is well maintained, it may even be unimpeded for life, because the vascular of the bridge comes from its own veins, there is no expensive consumables, so the cost is significantly lower than that of interventional surgery.
After careful consideration, the doctor in charge, Zhao Kan, fully communicated with the patient and his family to confirm the operation method. The vascular surgery team Yao Zuoyi, Zhao Kan, Zhang Qian, Liu Yunping jointly completed the operation, because the popliteal artery is thicker, the posterior tibial artery is thin to less than 2 mm in diameter, and the arterial canal wall has inflammatory changes, so the requirements for anastomosis are high, from the selection and repair of the great saphenous vein to the exposed popliteal artery and the posterior tibia artery to complete the anastomosis, the operation was carried out for about 4 hours, the preoperative cold left foot surgery finally had a warm temperature, the grafted blood vessel and the distal posterior tibial artery pulsated strongly, and the left foot pain was significantly alleviated after anesthesia resuscitation. Zhang Quan can finally lie down and sleep, and finally realize what a simple and ordinary wish it is for ordinary people.
On the 3rd day after the operation, Zhang Quan's left foot was no longer painful. Because he can sleep flat, his right foot is not swollen, his spirit is much better, doctors and nurses can often see him smiling around the ward, from time to time to monitor the pulse of the transplanted blood vessels.
Find the cause: Smokers should pay attention to the early diagnosis and treatment of limb pain
Zhang Quan's surgery is very successful, the blood supply of the left foot has improved, the toe has become black and necrotic has been controlled, it can be said that the foot is saved, and the later stage can try to transplant the blood vessels again, further improve the blood supply to the foot, and maximize the improvement and restoration of the left foot function.
So, what is "thromboangiitis obliterans"? In simple terms, it is a chronic, segmental, inflammatory, occlusive vascular disease that tends to occur in the small and medium arteries far from the popliteal artery of the lower extremities. This disease, which is more common in young and middle-aged smokers, has been found to be gradually increasing in female smokers. When the doctor asked about the medical history, Zhang Quan told the doctor that his smoking age was more than 20 years old, and he smoked more than one pack a day! However, now that Zhang Quan has quit smoking, "I don't dare to smoke." "Today, the patient was discharged.
Everyone knows that smoking can cause lung disease and cardiovascular disease, so why does smoking cause thromboangiitis obliterans? It turns out that some components in cigarettes can activate some cellular immunity and humoral immunity, causing damage to the inner membrane of blood vessels, causing vascular inflammation, and can also cause the reduction of a vasodilator leading to vasospasm, resulting in thrombosis and vascular occlusion.
The evolution of this disease is a chronic process, after the lack of blood supply to the arteries of the foot, just like there is no water in the field, it gradually begins to dry up from the farthest place from the water source, the nerve ischemia ischemia pain, muscle and other tissues begin to gradually necrosis, dry up, and eventually cause an irreversible situation.
For those with a long history of smoking, or long-term passive smoking, if there is a sudden foot pain or lameness of these symptoms, we must go to a regular medical institution in time, and if possible, go to a large comprehensive medical institution for treatment. Early detection, early diagnosis, and early treatment can save limbs as much as possible and improve the quality of life.
(Cloud late night express reporter: Liu Ranran Editor: Wang Jingtao)