Zhihong Wang, Department of Cardiovascular Surgery, Characteristic Medical Center (formerly 306 Hospital).
Edited by Liu Yan/Cui Yan, Medical Science Popularization Center
I believe most people have heard of "myocardial infarction" and "cerebral infarction", which are likely to be life-threatening if the diseases caused by these two "infarctions" are not treated in time.
In fact, arterial "infarction" in the human body does not only occur in the coronary arteries of the heart and cerebrovascular vessels.
The arteries of the human body are like a river that irrigates and nourishes the farmland, and the river flows down the river to transport water, so that the surrounding farmland can be nourished by the water and give people the hope of a good harvest. The blood flowing in the arteries is also constantly transporting oxygen and energy to the body's tissues to maintain the normal functioning of various organs in the body. However, with the increase of age, the blood vessels of the human body will age, and some "rivers" will have "sediment accumulation", which will affect the smooth flow of the "river", that is, the precipitation and accumulation of lipid plaques on the arterial wall, resulting in the arterial wall becoming stiff, the lumen narrowing, and even occlusion, and the corresponding limbs or organs will have ischemic symptoms.
Similar to myocardial infarction and cerebral infarction, "leg infarction" is also caused by narrowing and occlusion of blood vessels, which is medically known as "arteriosclerosis occlusive disease of the lower limbs", which is due to the narrowing and occlusion of the arterial lumen after the formation of atherosclerotic plaques in the lower limbs, resulting in a series of symptoms such as coldness, numbness and intermittent claudication of the lower limbs due to ischemia of the lower limbs.
The incidence and harm of leg infarction are no less than that of myocardial infarction and cerebral infarction, and if they are not detected and treated in time, severe cases may lead to amputation due to limb ischemia and necrosis, and even life-threatening. The occurrence of this disease often indicates that there are cardiovascular and cerebrovascular problems, and patients need to pay attention to some red flags and seek medical attention in time. It can be seen that timely detection of the early signs of "leg terrier" and active treatment are crucial to human health.
How does a leg terrier happen?
First of all, the occurrence of leg terriers is closely related to lifestyle. Unhealthy living and eating habits, such as overeating, excessive intake of high-fat and high-sugar foods, high-salt and high-oil diets, lack of physical exercise, excess weight, etc., can easily lead to diabetes, hypertension, hyperlipidemia and other diseases. Diabetes, high blood pressure, hyperlipidemia and smoking are the four major killers of arterial diseases of the lower limbs.
The direct cause of leg infarction is mainly atherosclerosis, but there are also other special causes, such as thromboangiitis obliterans, Takayasu's arteritis, trauma, arterial embolism, etc. Acute leg infarction has a dangerous onset, which we call acute lower extremity arterial embolism, and the emboli mostly originate from the heart. Atrial fibrillation and intraventricular thrombosis are high-risk factors for embolism. Once the embolus falls off, it will lead to blockage of blood vessels, and the tissues corresponding to the blood supply range will be ischemic and necrosis. Embolism may occur in places where there is arterial blood flow in the human body, and the size of the embolus is different, the embolization site is different, and the collateral compensation will have different clinical manifestations, and the arterial embolism of the lower limbs is particularly high, and its severity has an important impact on the efficacy and prognosis of surgical treatment, and is closely related to amputation and mortality.
Clinical manifestations of cerebral infarction
Leg peduncle is the infarction of the arteries of the lower limbs, resulting in ischemia and hypoxia of the distal lower limbs, and there may be no obvious symptoms in the early stage, or only slight discomfort in the lower limbs, such as chills, chills, numbness, etc. It then progressively worsens with intermittent claudication, which resolves with rest. Mild claudication symptoms may not be of sufficient concern to older people. As the lesion progresses further, pain at rest develops, i.e., acral pain symptoms occur at rest, which is evident at night rest. If no treatment is left untreated, you may eventually develop non-healing skin sores, gangrene infection, and even amputation. Leg infarction has become the leading cause of disability and mortality in patients.
If the ischemic manifestations of the lower limbs are not treated in time, a good person may lead to disability. Therefore, the "leg terrier" cannot be ignored! However, the symptoms of lower limb ischemia are also easy to disguise as two diseases: old cold legs: the often said "old cold legs" are called "knee osteoarthritis" in medicine, and the symptoms are mainly in the knees, mainly manifested as knee soreness, knee swelling, knee joint snapping and other symptoms. The arteriosclerosis occlusive disease of the lower limbs has similar symptoms to the old cold legs. Lumbar disc herniation and lumbar spinal stenosis: Lumbar disc herniation and lumbar spinal stenosis can also cause symptoms such as lower limb pain and intermittent claudication. However, in terms of symptoms, it is often accompanied by low back pain, and the pain in the lower limbs is radiating pain. Lumbar spondylosis may be painful at rest or when walking, segmental sensory deficits may occur in the lower extremities, and dorsalis pedis artery pulses are generally good. Claudication due to lower extremity arterial ischemia begins to be painful after walking for a while, and vascular intermittent claudication decreases or disappears dorsalis pedis pulse.
Treatment of cerebral infarction
(1) Conservative treatment: mainly including physiotherapy and appropriate functional exercises; Antiplatelet and vasodilator drugs are used to improve and increase blood supply to the lower extremities and prevent acute thrombosis; If necessary, anticoagulant drugs can be added to prevent and treat thrombosis of the lower limbs. Drug treatment is only suitable for patients with mild symptoms with a claudication distance of more than 500 meters, and is mainly antiplatelet, vasodilation, and improvement of collateral circulation. As long as there are no contraindications, symptomatic patients with arteriosclerosis occlusive disease of the lower extremities should be treated with antiplatelet aggregation therapy. Aspirin is the preferred antiplatelet aggregation drug, which can reduce the ischemia rate of lower limbs by 20%~30%. In addition, the US FDA recommends clopidogrel as the drug of choice for reducing ischemic disease in patients with peripheral arterial disease (PAD), and TASC recommends cilostazol as a drug for the treatment of arteriosclerotic occlusive disease of the lower extremities.
Schematic diagram of arterial bypass grafting
(2) Open surgical treatment: including lower extremity endarterectomy and arterial bypass grafting. The former is indicated for localized arterial stenosis or occlusive lesions. This procedure is often used as an adjunct to surgery. Arterial bypass grafting is strictly indicated, the surgical procedure is invasive, the operation is difficult, and the prognosis of patients is not very good, especially not suitable for patients with diabetic peripheral vascular disease. Endovenal intervention is currently the best treatment.
(3) Endovascular interventional therapy: Interventional therapy is a minimally invasive treatment carried out by high-tech means. It is different from the "medicine and injection" of internal medicine and the "open surgery" of surgery. Instead, under the guidance and positioning of medical imaging equipment such as DSA (digital subtraction angiography technology) and B-ultrasound, special puncture needles, catheters, guidewires, stents and other instruments are used instead of traditional scalpels to diagnose and treat arteriosclerosis diseases of the lower limbs.
At present, balloon angioplasty for arteriosclerosis obliterans of the lower extremities is a relatively mature technique. The main mechanism of percutaneous transluminal angioplasty is to dilate and separate the stenosis and hardened intima by the balloon, and at the same time destroy the strong layer of medial smooth muscle and collagen fibers. Breaking atherosclerotic plaques and stretching the midtima is a treatment for arteriosclerotic occlusive disease by vascular remodeling. Stent placement overcomes the two main defects of PTA by squeezing the plaque and compressing the tube wall, and is an effective complement to PTA in arteriosclerosis occlusive disease of the lower extremity.
The combined application of PTA and stenting can significantly improve the effect of endovascular surgery, and some studies have shown that the total effective rate of patients can reach 91.67% after the application of endovascular stent combined with PTA, indicating that the treatment effect is certain. Moreover, the ankle-brachial index was significantly improved compared with that before treatment, and the claudication distance was also significantly increased compared with that before treatment. At the same time, the overall incidence of postoperative complications was less than that of conventional conservative treatment.
Schematic diagram of endovascular arterial intervention of lower extremities
In recent years, with the advancement of endovascular technology and the updating of materials, the application of endovascular intervention in the treatment of arteriosclerosis occlusive disease of the lower extremities has achieved remarkable results and has become the preferred treatment method for this disease. Endovascular interventional treatment techniques include: balloon dilation (drug-coated balloon dilation), mechanical embolictomy, plaque atherectomy, stent implantation, etc., by opening the narrowed occlusion section of the blood vessel from the vascular cavity to the greatest extent, it can improve the blood supply of the affected limb to the greatest extent, save the limb, and the effect is immediate.
(The picture comes from the Internet)