Diagnosis and treatment of vasculitis
Vascular inflammation name "thrombosis angiitis" is occurred in the vascular allergic inflammation, leading to small and medium-sized artery segmental stenosis or occlusion, acral lose nutrition, ulcers, necrosis is a more stubborn disease of the blood vessels, and not the vessel wall itself a inflammatory manifestations, and bacterial infection does not matter.
One, easy to suffer from the crowd
The high risk population of patients with vasculitis is a smoker (especially young men), mental stress, nutritional imbalance, cold and humid area residents, family genetic factors. The vast majority occurred in men aged 20-40 years, women are rare.
Two, clinical stage
The development of the disease is divided into three stages.
Initial (local ischemia)
Limb numbness, cold, afraid of the cold, heavy, toes needle like pain, leg muscles appear spasm pain, intermittent claudication, suffering from limb arterial pulse weak or disappear, can walk superficial phlebitis, systemic symptoms was not significant.
Metaphase (Nutrition)
Limb numbness, cold, cold, intermittent claudication and rest pain aggravated. Suffering from limb skin often red Chengchao, purple red or pale, foot, dry skin, peeling, toenail growth slow, thickening deformation, Ganmao exfoliated and calf muscles have atrophy, limb arterial pulse disappeared. Be agitated, dizziness, lumbago, soft bones.
Late stage (necrosis)
Limb due to the serious disturbance of blood circulation, ulcer or necrosis occurred, most of the limitations in the foot or toe, to spread to the ankle or calf is rare. Severe unbearable pain, patients often tuck sit, wringing, wailing cry, hardly wished to live. Gangrenous toe off, often left and ulcer healing. The body is often accompanied by fever, dry mouth, anorexia, insomnia, constipation, yellow urine Chideng symptoms.
Three, the cause of the vasculitis
The cause of the disease is more complex, and generally related to the following factors:
1, smoking can lead to vascular spasm, the disease has a smoking history of 80% - 95%;
2, cold, damp can cause vascular diastolic dysfunction;
3, sex hormones, lack of prostaglandin, resulting in high blood coagulation state and the formation of thrombosis;
4, their own immune function is low and pathogenic;
5, infection can cause vasculitis hyperplasia;
6, high blood fat, high blood viscosity;
7, chemical stimulation;
8, the disease factors such as the blood viscosity of patients with diabetes increased, the blood vessel is easy to form plaque, the formation of thrombus;
9, family heredity.
The cause of the disease is mainly due to the following reasons:
(1) smoking factor
(2) endocrine factors
(3) the effects of cold, damp, malnutrition, trauma, bacterial infection and toxin on the disease.
(4) genetic factors
This disease is the relationship between genetic factors, there have been reported abroad, domestic scholars have some kind of perspective, but the existing information can not be sure that the disease and genetic factors.
(5) immune factors
Study on the domestic and foreign scholars summed up in two views: one is that the disease and the type III hypersensitivity consistent; another view that the pathogenesis of the disease in addition to the type III hypersensitivity, still type IV delayed allergy in.
(6) blood coagulation tendency
(7) symptoms of various stages of the disease
Early: cold, cold extremities, numbness, mild pain, intermittent claudication. Toe (finger), pale skin, the skin temperature is low, the red test was positive. Peripheral arterial wave weakened or disappeared, some patients may appear repeatedly migratory superficial thrombophlebitis.
Mid: limb hair is cool, aggravate the cold, numbness, pain and intermittent claudication, rest pain, night pain is intense, hold enough to sit and could not sleep. Expression of foot skin dystrophy, flushing, purple or pale skin bruising, foot sweat reduced or no sweating.
Late: due to lesions of critical limb ischemia, acral occurred ulceration or gangrene, often from the toes start, gradually spread to gangrene is dry or wet, most of the limitations in the foot or toe, involving the ankle or calf. Seriously affect the quality of life of patients. treatment。
Four, diagnosis:
When patients with early symptoms should as soon as possible to the hospital. The conditions of the lower limb artery CTA examination is the best method for the diagnosis of vasculitis.
Five, treatment
1 non operative treatment
A general treatment: in addition to the ban on opium smoking and the opium trade, there should be to prevent the cold, damp and trauma, not overheating, in order to avoid tissue hypoxia increased. Limb exercise and be holding drooping movement. Movements such as the Buerper, namely with the patient supine, first lift the affected limb above 45 degrees, again in bed sagging for 2-3 minutes, and then placed Level 2 minutes, and for foot rotation, flexion and extension activities, repeated 20 minutes several times a day. Or simply walking, walking speed, distance, will not produce lame behavior standard.
The drug treatment
A, lower blood viscosity, platelet aggregation drug, hyperbaric oxygen therapy. B, vasodilator C, antibiotics and sedatives and other traditional Chinese medicine: D
2 surgical treatment
Aim to improve or eliminate the effect caused by ischemia, which is caused by ischemia, promote or rebuild the arterial blood supply. Surgery is not expected to be a direct or special treatment for this disease.
(1) artery bypass surgery: as the name suggests, is the use of artificial or autologous blood vessels to replace the already blocked arteries. This is the most classical method for the treatment of thrombosis. Used to bypass the material, there are two, one is artificial vascular, it is made of polytetrafluoroethylene (PTFE) material has the advantages of biocompatibility is better, larger diameter, length, can pick. The disadvantage is that the price is more expensive (usually in 1W~~1.5W), is not suitable for small blood vessel bypass, so generally used in the knee joint above the vascular bypass surgery. Second is the use of autologous saphenous vein and its advantages is drawn from their own, there is no rejection, small caliber, suitable for small vessel anastomosis. But the disadvantage is that surgical wound, and the patient's own condition limitations (some patients with great saphenous vein is meticulous and cannot be used for bypass).
(2) interventional therapy intervention is equivalent to an endovascular surgery, surgery is not needed to complete the operation effect. Generally above the knee vascular occlusion, preferred first balloon dilatation and stent implantation can in very small trauma to recanalization, and the use of local anesthesia can be completed without the risk of anesthesia and surgery. But the price is more expensive, generally a bracket price between 1.2~~1.5W.
(3) stem cell transplantation is one of the latest medical technology in the world at present, suitable for a variety of reasons leading to chronic lower limb ischemic diseases such as vasculitis, arteriosclerosis obliterans, diabetic foot, conservative treatment is invalid, imaging of vascular lesions without outflow, no method for coronary artery bypass grafting (CABG), or despite good outflow arterial and bypass may succeed, but frail, cannot tolerate surgery patients. But the long-term effect remains to be the test of time.
Six, prevention
1, quit alcohol limit
Smoking is an important factor in vasculitis. The nicotine in tobacco is a vasoconstrictor smoking can make skin vasoconstriction, blood flow is slow finger or toe skin temperature was significantly reduced. Therefore, the prevention of thromboangiitis obliterans should quit smoking.
2, the body warm
In addition to pay attention to the protection of the body, especially in winter and spring season should avoid chill, damp every day with hot water wash their hands, feet, promote local blood circulation.
3 good habits
Exercise is also very important to. Exercise can enhance physical fitness and resistance but also improve blood circulation; to prevent the infection to avoid the occurrence of lower limb necrosis beneficial.
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