Uncle Wang likes sports very much. He loves mountain climbing and jogging, but he finds that he can’t run anymore. He used to be able to run a few kilometers, but gradually he only needs to run 500 meters, and his legs are getting weaker and weaker. In the end, he walked about 50 meters and the pain became unbearable. He had to stop and rest. Dr. Su Dawei, Physician of Vascular Surgery, Chang Gung Memorial Hospital, Linkou recalled that he was a very typical peripheral artery occlusion. Patients will develop “indirect claudication” because the blood vessels in the legs gradually narrow and block, so when exercise consumes a lot of oxygen, the feet cannot get enough blood supply, and they begin to feel pain.
If traditional surgery is used to treat blocked blood vessels, the wound will be larger and the risk of general anesthesia will be higher. Dr. Su Dawei said that at that time, we used minimally invasive catheter surgery to unclog the blocked blood vessels for the old man, first to remove the calcified blood vessel plaque, and then use the drug-applied balloon to reduce the chance of re-blocking in the next few years.
“After the operation, the old man was discharged from the hospital every two days, because the wound was very small, and the recovery was quite fast,” Dr. Su Dawei pointed out, “The patient can clearly feel the temperature of the whole foot before and after the operation. It was cold, but now the blood flow is smooth, it has become very warm, and the color is more ruddy. He also began to slowly increase the amount of exercise, no intermittent limping, and can return to the lifestyle he loves, climbing and exercising. I have tracked it for several years. It’s held up pretty well.”
The blood flow is blocked, and the limbs may be necrotic due to hypoxia
Our blood vessels are like rivers. As long as they are narrowed and blocked, they will cause many problems. Dr. Su Dawei explained that peripheral arterial blockages can be distinguished according to the time of occurrence, and can be divided into acute blockages and chronic blockages. When the peripheral artery is acutely blocked, the patient will immediately experience limb pain, hypoxia, and necrosis; chronic peripheral artery blockage is gradually narrowed and blocked. There are often no symptoms or only mild symptoms at the beginning, and it will be felt after it deteriorates to a certain extent. abnormal.
The causes of peripheral arterial occlusion are similar to those of cardiovascular disease. The three most common are high blood pressure, high blood sugar, and high blood fat. The other is smoking. Dr. Su Dawei said that about 90% of patients with peripheral vascular occlusion disease have it. Smoking, smoking can lead to vascular lesions, and eventually cause blockages over time.
When peripheral arterial occlusion causes limb ischemia, it will feel cold to the touch and pale in color. In more severe patients, the limbs will also turn black and purple. Dr. Su Dawei said that when patients walk and exercise, muscle oxygen consumption increases, which requires more attention. When there is too much blood supply, because the blood circulation is blocked, the patient will start to feel sore and uncomfortable, which is called “indirect claudication”. In some patients, the blood vessels are so clogged that the blood cannot reach the distal toe, and they become pale, very painful, and even have tissue necrosis and festering, requiring amputation.
Dr. Su Dawei explained that peripheral arterial occlusive disease can be graded according to the severity, and can be divided into four stages in simple terms.
- Grade 1: Clinically asymptomatic.
- Level 2: No symptoms at rest, but when he walks and moves, the pain starts and needs to stop and rest to relieve.
- Level 3: Severe pain even at rest.
- Grade 4: Blisters appear on the distal toes or soles of the feet, the skin is ulcerated, and even the entire body is purple and black.
“When peripheral arteries are blocked, you must seek medical attention as soon as possible and find a way to restore blood flow,” Dr. Su Dawei emphasized. “If you do not rescue in time, you will easily miss the golden opportunity for treatment, because any organ or tissue needs an adequate blood supply. Insufficient blood volume may cause different degrees of injury, including numbness, necrosis, and amputation may be required to avoid subsequent infection and sepsis.”
Timely rescue, smooth blood flow, avoid amputation
Drug treatment for peripheral arterial occlusion includes antiplatelet drugs, anticoagulants, and thrombolytics. Dr. Su Dawei explained that antiplatelet drugs and anticoagulants can avoid thrombosis, and thrombolytics can dissolve blood clots.
Non-drug treatment is to use traditional surgery or minimally invasive catheter surgery to open up the blocked blood vessels. Dr. Su Dawei said that if the blood clot is stuck, we must find a way to remove the blood clot. If the blood vessel is calcified and narrowed, we must use balloon dilation, transfer Remove sclerotic plaque and restore smooth blood flow.
Ductal plaque is composed of very hard calcification. If balloon dilation cannot be effectively resolved, a plaque atherectomy device can be used. For example, Dr. Su Dawei, sclerotic plaque is like a stone stuck in a blood vessel. The traditional operation is to open the blood vessel. The stone is removed and the blood vessels are sutured, but the wound is relatively large and invasive, and general anesthesia is required. Because the wound is large and takes a long time to heal, the chance of wound infection will be relatively high.
The atherectomy device is like a mini drill or scraper, which can enter the blood vessel through the catheter, pass through the calcified blood vessel plaque, remove the blood vessel plaque, and open up the blocked blood vessel.
Compared with traditional surgery, minimally invasive catheter surgery has smaller wounds, less pain, faster recovery, and lower chances of postoperative infection.
After opening the blood vessels, blood circulation can be restored, but the blood vessels will gradually narrow and block over time. Dr. Su Dawei said that in order to reduce the chance of re-stenosis of peripheral arteries, a drug-coated balloon can be used, and the surface of the balloon is coated with a layer of drugs. , When the balloon is opened, the drug will enter the inner wall of the blood vessel, and play the effect of preventing re-stenosis.
Dialysis tube to prevent blockage
Renal dialysis patients are also a group of people who are easily accompanied by peripheral vascular obstruction diseases. Their vascular walls often have varying degrees of calcification and stenosis. In addition to paying attention to peripheral arterial obstruction, they should also take good care of the dialysis ducts.
After kidney failure, kidney function can be replaced by dialysis, which usually requires a dialysis access in the arm. Dr. Su Dawei said that the dialysis access is to sew arteries and veins together through surgery. After the dialysis access is completed, it must be tracked and maintained regularly.
Regular follow-up visits allow doctors to assess the condition of the blood vessels and reduce the blockage of the blood vessels. Dr. Su Dawei said, because if the blood vessels of dialysis patients are narrow, they will be easily blocked if they are not treated early. The drug-coated balloon can also be used in the renal dialysis tube, and the drug-coated balloon is used to open the stenosis and release the drug, which helps to reduce the re-formation of the stenosis.
“There was a dialysis patient before. Every six months, the dialysis tube became stenotic and blocked. A catheter balloon was used to dilate the stenosis,” Dr. Su Dawei shared. The severity of the stenosis is getting worse, and a catheter balloon dilation is required in less than three months. To improve this situation, a drug-coated balloon can be used to open the tube and reduce the chance of restenosis. The patient There is no need for such intensive surgery.”
Intimate reminder
Arteriosclerosis, stenosis, and blockage have a great relationship with the three highs. In daily life, hypertension, hyperlipidemia, and diabetes should be controlled to the standard. Dr. Su Dawei warned that smoking is very harmful to blood vessels, so please be sure to quit smoking; eat less Oil, less salt, less sugar; regular exercise can promote blood circulation and help maintain the health of blood vessels!