Thromboangiitis obliterans in three stages
1. The ischemic period. At the beginning, the affected limbs feel fatigue and cold, and the skin appears transient or persistent paleness, cyanosis, numbness, tingling, and burning sensation. The patient limped intermittently and walked shorter and shorter distances as the condition worsened.
2. Nutritional disorder period. Pain that persists in the affected limb at rest is called rest pain. Patients tend to bend over and bend their knees to sit with their limbs hanging from the bedside to relieve pain. The muscles of the affected feet were significantly atrophied, the skin was dry, the hairs were lost, and the toenails were thickened and grew slowly.
3. Tissue necrosis stage. If the arterial lumen is completely occluded and the blood supply to the tissue stops, dry gangrene occurs in the extremities, with black and shriveled finger/toe tips or around the nail, followed by ulceration or gangrene. The necrotic finger/toe ends fall off on their own, forming a long-lasting ulcer.
Treatment of thromboangiitis obliterans
(1) General treatment
1. Quit smoking. 50% to 95% of patients with this disease have a history of smoking, mostly heavy smokers. After smoking, nicotine and carbon monoxide hemoglobin in the blood increase, which can cause inflammation of the vascular intima and lead to thrombosis. Therefore, smoking cessation is considered the cornerstone of all therapies for thromboangiitis obliterans.
2. Buerger movement. Contribute to the establishment of collateral circulation in the affected limb and improve blood circulation. The patient lies supine, and the affected limb is raised 450 degrees for 1 to 2 minutes; then the feet are dropped on the side of the bed for 4 to 5 minutes, and the feet and toes are moved up, down, inside and outside for 10 times; Rest your legs flat for 2 minutes. Repeat this 5 times.
(2) Drug
therapy , including antiplatelet drugs, anticoagulant drugs, thrombolytic drugs, dextran, pentoxifylline, calcium antagonists, prostaglandins, etc., can be used as long-term treatment measures for patients without surgical indications, or Adjuvant therapy after surgery. Among them, iloprost and bosentan are research hotspots in recent years.
Iloprost is a prostaglandin analog that dilates blood vessels by stimulating adenylyl cyclase, increasing the concentration of cAMP in smooth muscle cells. Results of a randomized controlled trial showed that iloprost was more effective in promoting ulcer healing than aspirin. However, further large-scale clinical trials are needed to confirm the safety and efficacy of iloprost. Bosentan is a specific endothelin receptor antagonist, which acts by competitively antagonizing endothelin receptors to achieve the purpose of vasodilation. Some foreign scholars have used bosentan to treat 12 patients with thromboangiitis obliterans accompanied by limb ulcers or rest pain. After 20 months of follow-up, it was found that bosentan can increase the peripheral extremities of patients with thromboangiitis obliterans. blood flow, improve symptoms.
(C) surgical treatment
1. Interventional treatment. It has the advantages of strong targeting, direct effect, less trauma, integration of diagnosis and treatment, and repeatability. Percutaneous arterial balloon dilatation can be performed on the patient. Patients with early clinical stage have better surgical effect, and patients with advanced stage can also try to use it. In the case of failure of interventional treatment, other treatment methods can be considered.
2. Bypass bypass. Use autologous blood vessels or artificial blood vessels to bridge both ends of the occluded blood vessels to improve distal tissue ischemia and reduce clinical symptoms, limb injury and amputation. However, because the lesions of thromboangiitis obliterans are mainly small and medium-sized arteries in the extremities, and the lesions are prone to involve superficial veins and cause inflammatory reactions, few patients are suitable for bypass bypass.
3. Lumbar sympathectomy. It can reduce arterial spasm, improve blood supply to limbs, relieve pain, and promote ulcer healing. It has become an important surgical treatment method for thromboangiitis obliterans, and can obtain relatively satisfactory results.
4. Bone marrow stem cell transplantation. Bone marrow stem cells contain CD34+ stem cells, which can differentiate into vascular endothelial cells in ischemic tissues to promote new blood vessels. However, its long-term efficacy and complications remain to be studied.
There is currently no cure for thromboangiitis obliterans. Treatment mainly focuses on isolation of relevant risk factors and prevention. The most important means of prevention is smoking cessation, protecting feet, preventing cold and dampness, avoiding trauma, and preventing limb vasospasm. Properly change the body position during labor to prevent the blood vessels of the limbs from being compressed for a long time and affecting the blood circulation.
