OVERVIEW

What is arteriosclerosis obliterans?

Arteriosclerosis obliterans refers to a group of diseases caused by the thickening and loss of normal elasticity in human arteries. The most commonly affected areas are the cardiovascular, cerebrovascular, and peripheral vascular systems.

What is lower extremity arteriosclerosis obliterans?

Lower extremity arteriosclerosis obliterans (abbreviated as PAD) involves the narrowing or occlusion of blood vessel lumens due to atherosclerotic lesions in the arteries of the lower limbs. Factors such as smoking and high blood sugar can increase the risk of developing this condition.

This disease can lead to insufficient blood supply to the legs, resulting in symptoms such as pain, coldness, numbness, and ulcers in the limbs.

Only some patients with severe symptoms require surgical treatment, while most with mild symptoms can effectively improve their condition through medication and exercise.

Is lower extremity arteriosclerosis obliterans common?

With the aging of society, the incidence of lower extremity arteriosclerosis obliterans is gradually increasing.

Is arteriosclerosis obliterans the same as vasculitis?

They are different diseases.

Vasculitis is an ischemic disease of the lower limbs that primarily affects young men, with smoking being the main risk factor. It is most common in males aged 20–40.

In contrast, arteriosclerosis obliterans is a disease typically seen in elderly men and is often associated with cardiovascular and cerebrovascular diseases, hypertension, and hyperlipidemia.

Is arteriosclerosis obliterans the same as arterial thrombosis?

They are different diseases.

Arterial thrombosis usually presents with acute onset, sudden limb pain, pallor, numbness, movement disorders, and weakened or absent arterial pulses. This condition is often associated with a history of atrial fibrillation, valvular disease, or other conditions that predispose to arterial embolism. Delayed treatment can lead to amputation or even life-threatening consequences.

Arteriosclerosis obliterans is a chronic disease but can also be complicated by acute thrombosis.

SYMPTOMS

What harm does arteriosclerosis occlusion cause to the human body?

Arteriosclerosis occlusion in different parts of the body often produces different symptoms:

• When it occurs in the cardiovascular system, it often leads to chest pain, chest tightness, shortness of breath after activity, and even a sense of impending death, usually indicating severe cardiovascular occlusion.
• When it occurs in the cerebrovascular system, symptoms such as dizziness, weakness in the legs, lack of coordination, difficulty walking, slurred speech, and blurred vision may appear. Acute cerebrovascular occlusion often leads to hemiplegia, aphasia, coma, or even life-threatening conditions.
• When it occurs in the lower limb arteries, arteriosclerosis occlusion can cause discomfort and pain in the calves after activity, and in severe cases, leg ulcers, necrosis, or even amputation.

Does lower extremity arteriosclerosis occlusion always cause leg pain?

Not necessarily.

Many conditions can cause lower limb pain, including lower extremity arteriosclerosis occlusion, bone and joint diseases, venous diseases, muscle-related diseases, and lumbar or neurological disorders.

If you experience lower limb pain, it is essential to seek medical attention at a reputable hospital to determine the cause.

What are the typical characteristics of lower extremity arteriosclerosis occlusion?

Lower extremity arteriosclerosis mainly causes leg pain:

• Pain in the lower limbs after activity, forcing the person to stop and rest.
• Significant relief or disappearance of pain after rest.
• Recurrence of pain upon walking again.

This regular pattern of pain is called intermittent claudication, typically measured by pain onset after walking 200 meters, which is a hallmark of lower extremity arteriosclerosis occlusion.

How does the pain of lower extremity arteriosclerosis occlusion differ from other causes of leg pain?

PAD-related pain often follows a regular pattern of intermittent claudication, while bone and joint pain is localized to the joints. Pain from venous diseases is often accompanied by leg swelling after activity, and neuropathic pain may be associated with cerebrovascular or neurological disorders.

How is the severity of lower extremity arteriosclerosis occlusion classified?

• Early stages may show no obvious symptoms, only mild discomfort such as cold sensitivity.
• Gradual development of intermittent claudication, a characteristic symptom, with the location of pain correlating with the vascular lesion.
• Further progression leads to rest pain, occurring even during inactivity, especially when lying down or at night.
• Ultimately, ulcers or gangrene may develop, often triggered by minor injuries.

How can lower extremity arteriosclerosis occlusion be detected early?

Lower extremity PAD is more common in the elderly and often coexists with cardiovascular and cerebrovascular diseases. Comprehensive examinations, including blood pressure, blood sugar, lipid tests, and cardiovascular/cerebrovascular assessments, are necessary. Individuals with these risk factors should undergo regular check-ups at specialized hospitals.

CAUSES

What are the main risk factors for the onset of lower extremity arteriosclerosis obliterans?

There are many risk factors contributing to lower extremity arteriosclerosis, among which smoking, diabetes, hyperlipidemia, hypertension, and advanced age are the most common. Smoking and diabetes are particularly harmful, as both can increase the incidence of peripheral arterial disease by 3–4 times.

DIAGNOSIS

What is the most commonly used examination for lower extremity arteriosclerosis obliterans?

The most commonly used examination method for vascular diseases is color ultrasound, which can detect atherosclerotic plaques, the degree of vascular stenosis, and whether the blood vessels are occluded. This method is non-invasive, convenient, and relatively low-cost. However, due to the limitations of ultrasound, if severe vascular stenosis is detected, further examination at a formal hospital is required.

When diagnosing lower extremity arteriosclerosis obliterans, doctors may check ABI (ankle-brachial index). What is ABI?

ABI is the abbreviation for ankle-brachial index, which measures the ratio of systolic blood pressure in the ankle arteries to that in the brachial arteries of the upper limbs. Under normal conditions, ABI typically ranges between 0.91 and 1.30. A value above 1.30 suggests stiff arterial walls that are difficult to compress, while a value below 0.90 indicates lower limb ischemia.

What examinations are performed after the onset of lower extremity arteriosclerosis obliterans?

Once symptoms of ischemia, such as lower limb pain, appear, doctors may recommend color ultrasound or CTA (CT angiography) to further clarify the extent of vascular lesions. Based on the results, they will advise whether further hospitalization for digital subtraction angiography (DSA) or surgical treatment is necessary.

What is the purpose of CTA examination for lower extremity arteriosclerosis obliterans?

CTA provides a comprehensive view of the normal range of arterial pathways in the lower limbs and clarifies the extent of lesions. This helps physicians assess the severity of the condition and decide on the appropriate surgical approach. It also serves as a guide for evaluating surgical outcomes and difficulty.

What is the role of DSA in lower extremity arteriosclerosis obliterans?

DSA, short for digital subtraction angiography, is the gold standard for diagnosing vascular diseases. It accurately displays the location, extent, and severity of lesions. DSA is crucial for evaluating lesions and selecting surgical methods. In well-equipped hospitals, endovascular treatment can be performed simultaneously during angiography, addressing arterial lesions in the same session.

What are the advantages and disadvantages of CTA and DSA examinations for lower extremity arteriosclerosis obliterans?

Patients with lower extremity arteriosclerosis obliterans often face the choice between CTA and DSA:

• CTA plays a significant role in preoperative assessment and postoperative follow-up. It is relatively non-invasive and less expensive. However, as a computer-reconstructed image, CTA may have some margin of error.
• DSA, as the gold standard for vascular disease diagnosis, allows for simultaneous diagnosis and treatment. However, it is an invasive procedure with potential surgical complications and higher costs.

TREATMENT

Which department should I visit for lower extremity arteriosclerosis obliterans?

If you suspect lower extremity arteriosclerosis obliterans, you should first visit the vascular surgery department of a regular hospital. If the hospital does not have a vascular specialty, you can go to the general surgery or cardiovascular medicine department and seek a referral to a higher-level hospital's vascular surgery specialty as soon as possible.

What are the general treatments for lower extremity arteriosclerosis obliterans?

Arteriosclerosis obliterans is a systemic disease and should be treated holistically.

This includes:

• Controlling blood pressure, blood sugar, and blood lipids, and strictly quitting smoking;
• Actively diagnosing and treating potential comorbid cardiovascular and cerebrovascular diseases;
• Engaging in exercise under medical guidance to promote collateral circulation formation;
• And paying attention to foot care to avoid skin damage, burns, etc.

For drug treatment of lower extremity PAD, patients should follow a physician's guidance at a regular hospital outpatient clinic. Symptomatic patients should undergo further examinations as recommended by a specialist and decide whether hospitalization is necessary based on the results.

What are the drug treatments for lower extremity arteriosclerosis obliterans?

The foundational drug treatment for lower extremity PAD is antiplatelet therapy, with main medications including aspirin, clopidogrel, and cilostazol. These are primarily used for early- and mid-stage PAD patients or as adjuncts to surgical and interventional treatments. Vasodilators such as papaverine and Anplag may also be used. Additionally, medications like alprostadil are available.

Do patients with lower extremity arteriosclerosis obliterans need pain management for limb pain?

The primary treatment for lower extremity PAD is antiplatelet and circulation-improving drug therapy. However, due to pain from leg ischemia that may disrupt sleep or appetite, pain management is also important. Drugs with strong, long-lasting analgesic effects and minimal side effects should be chosen, but must be taken under the guidance of a specialist.

Do all patients with lower extremity arteriosclerosis obliterans require surgery?

Only some patients with severe symptoms require surgical treatment. Most patients with mild symptoms can effectively improve their condition through medication and exercise.

What are the surgical treatments for lower extremity arteriosclerosis obliterans?

The treatment for lower extremity PAD is mainly based on the degree of vascular blockage, with two primary approaches: surgical and interventional procedures.

• Surgical treatment involves using artificial or autologous blood vessels to connect the blocked segments, improving blood circulation.
• Interventional treatment uses balloons or stents to reopen the blocked vessels and restore blood flow. However, stents can currently only be used for thigh vessels, not calf vessels.

Additionally, localized arterial blockages may be treated with endarterectomy, but due to the typically extensive nature of lower extremity arterial blockages, standalone endarterectomy is rarely used and is often a supplement to surgery. Venous arterialization, as a palliative treatment, is suitable for patients with widespread arterial blockages and has shown some efficacy.

Can surgery cure lower extremity arteriosclerosis obliterans?

Lower extremity PAD currently has no cure. Surgical and interventional treatments are the main methods to alleviate limb ischemia symptoms, but restenosis of the treated segments remains a major challenge for long-term efficacy. Drug-eluting balloons, drug-eluting stents, and bioresorbable stents are the primary research focuses for treating lower extremity PAD, with the potential to improve long-term outcomes in the future.

What is drug-eluting balloon therapy for lower extremity arteriosclerosis obliterans?

Drug-eluting balloon therapy for lower extremity arteriosclerosis obliterans involves coating balloons with drugs that inhibit intimal hyperplasia. During treatment, the drug contacts the vessel lining to reduce restenosis after balloon dilation. Currently, drug-eluting balloons are still in clinical trials.

What is drug-eluting stent therapy for lower extremity arteriosclerosis obliterans?

Drug-eluting stent therapy for lower extremity arteriosclerosis obliterans involves coating stents with drugs that inhibit intimal hyperplasia. The drug continuously interacts with the vessel lining to improve symptoms. This method offers longer-lasting effects and theoretically the best restenosis prevention, but drug-eluting stents are also still in clinical trials.

What is bioresorbable stent therapy for lower extremity arteriosclerosis obliterans?

Bioresorbable stent therapy for lower extremity arteriosclerosis obliterans uses biodegradable materials to create stents that initially reopen blocked vessels and gradually degrade in the body. This avoids long-term medication and adverse reactions from metal implants. Currently, bioresorbable stents for lower extremity arteries remain in the research phase.

Which is more effective for lower extremity arteriosclerosis obliterans: surgery or interventional therapy?

For treating lower extremity PAD, surgical and interventional therapies each have advantages and disadvantages depending on the lesion location. Minimally invasive interventional therapy is currently the trend, but both methods can effectively alleviate leg ischemia symptoms caused by vascular blockages.

How often should follow-ups be conducted after treatment for lower extremity arteriosclerosis obliterans?

Patients with lower extremity arteriosclerosis obliterans generally require regular follow-ups post-surgery, typically at 1, 3, and 6 months, and then biannually at a vascular surgery specialty clinic to monitor treatment efficacy and adjust medication plans and dosages.

Can lower extremity arteriosclerosis obliterans recur?

After treatment, especially surgical or interventional therapy, lower extremity arteriosclerosis obliterans has a certain likelihood of recurrence, primarily due to restenosis in bypass grafts or stents.

DIET & LIFESTYLE

Can patients with lower extremity arteriosclerosis obliterans still exercise after getting sick?

Patients with lower extremity arteriosclerosis obliterans need to exercise if their physical condition permits, and appropriate exercise can promote blood circulation in the lower limbs and improve symptoms. Especially for patients who already experience intermittent claudication, proper exercise helps alleviate and control symptoms.

However, before exercising, it is essential to consult a specialist for specific exercise methods and avoid blind or excessive workouts.

How should patients with lower extremity arteriosclerosis obliterans exercise?

For patients with lower extremity PAD, the specific exercise methods are:

• Elevate the affected limb for 1–2 minutes, lower it for 2–3 minutes, and lie flat for 2–3 minutes.
• Rotate, flex, and extend the foot repeatedly for 20–30 minutes, or walk for 20–30 minutes, several times a day. This can promote collateral circulation in the affected limb.

How should patients with lower extremity arteriosclerosis obliterans care for their affected limbs in daily life?

Since blood circulation in the affected limb is poor, it is important to keep the legs warm. However, avoid applying heat to the limb, as this can worsen ischemia and lead to necrosis of the foot or leg.

What dietary precautions should patients with lower extremity arteriosclerosis obliterans take?

Maintain a balance between calorie intake and expenditure:

• Control fat intake: Reduce animal fats and use vegetable oils for cooking; eat less organ meat; limit egg yolks to no more than two per day; minimize fried or greasy foods.
• Avoid or limit sweets, cream, candy, and sugary drinks.
• Limit daily salt intake to less than 5 grams.
• Avoid smoking and secondhand smoke.
• Limit alcohol consumption—ideally, no more than 1,000 mL of wine, 3,000 mL of beer, or 500 mL of liquor per week.
• Caffeinated beverages stimulate the cardiovascular and cerebrovascular systems and may disrupt sleep, so consume them sparingly.
• Tea has refreshing, diuretic, cardiotonic, and lipid-lowering effects, and drinking it regularly may help prevent arteriosclerosis. However, avoid strong tea—opt for mild tea instead.

Reminder: If lower extremity arteriosclerosis obliterans is detected, seek treatment at a reputable hospital's vascular surgery department. With proper medical guidance, arteriosclerosis obliterans is manageable, preventable, and treatable.

PREVENTION

How to prevent arteriosclerosis obliterans?

To prevent the recurrence of lower extremity arteriosclerosis obliterans, the main focus is on controlling related risk factors such as blood pressure, blood sugar, and blood lipids. Under the guidance of a specialist, regular medication and exercise should be carried out, along with periodic follow-up visits at a specialized clinic, which can help control and reduce the likelihood of recurrence.