"Old cold legs" prefers these types of people. How to detect "old cold legs" early through self-examination?

Author: Shen Chenyang, Chief Physician, Beijing Tiantan Hospital, Capital Medical University

Reviewer: Liu Changwei, Chief Physician, Peking Union Medical College Hospital

When the weather gets cold, your legs start to hurt and walking becomes uncomfortable. This is what people often call “old cold legs”.

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Why do "old cold legs" occur when it's cold? The simplest reason is that heat expands and cold contracts. When it's cold, blood vessels contract. If the blood vessels themselves are already diseased, ischemia will become more obvious when they contract.

"Old cold legs" is medically known as lower limb arteriosclerosis obliterans.

Lower limb arteriosclerosis obliterans refers to the hardening of the lower limb arteries causing blood vessel blockage, resulting in ischemia of the tissue structure distal to the blood vessels. The most common symptom is soreness and pain in the legs when walking.

1. Who are the high-risk groups for lower limb arteriosclerosis obliterans?

The high-risk factors for lower limb arteriosclerosis obliterans and other arteriosclerotic diseases such as coronary heart disease and cerebral infarction are the same: first, age; second, smoking; third, obesity; fourth, the "three highs"; and fifth, suffering from special genetic constitutional diseases.

Most patients develop the disease after the age of 40 or 50, with the most common being between 60 and 75 years old. It is relatively rare for patients to develop lower limb arteriosclerosis obliterans before the age of 40.

Smoking is harmful to blood vessels. Studies have confirmed that nicotine and nicotine in cigarettes can cause blood vessel constriction. People who smoke for a long time will suffer certain damage to their blood vessels.

People who are obese and have three highs, high blood pressure, high blood sugar, and high blood lipids are prone to lipid components deposited in blood vessels, leading to hardening of blood vessels, plaque formation, and vascular stenosis.

2. How to self-check whether you have lower limb arteriosclerosis obliterans?

If the blood vessels in the lower limbs are not completely blocked and blood can still flow through them, you can still walk normally. If you walk fast for a long time and need a large amount of blood supply, blood cannot flow through and you will experience symptoms of ischemia.

In the early stages, walking too much will cause soreness, pain and discomfort, and your legs will always feel uncomfortable. At this time, you should be alert to whether you have lower limb arteriosclerosis obliterans. You should go to the hospital for examination in time. You can also do a self-examination before going to the hospital.

Self-examination is very simple. Take off your shoes and socks, and feel the dorsalis pedis artery on the instep of your foot. If it beats well and is symmetrical on both sides, it proves that the blood vessels are normal. If one side beats weakly or even cannot be felt, and there are symptoms, then there is a problem.

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3. What examinations are needed to diagnose lower limb arteriosclerosis obliterans?

The gold standard for diagnosing lower limb arteriosclerosis obliterans is angiography, also called DSA examination, which involves puncturing an artery to inject contrast agent to see where blood vessels are blocked and where blood circulation is blocked. It is an invasive examination.

There are many non-invasive tests now, such as ultrasound, CT, and magnetic resonance angiography, which can also show the blood supply of the lower limb arteries. Normal blood vessels flow very well from head to toe; diseased or narrowed blood vessels are seen on the film as intermittent, and some are even interrupted because the blood cannot flow down.

4. What are the consequences of lower limb arteriosclerosis obliterans?

The harm of lower limb arteriosclerosis obliterans is related to the stage, which is generally divided into stage IV.

Stage I: There are no symptoms, and any activity will not cause any symptoms; Stage II: After walking for a while, you will feel swollen and painful in your calves, and feel uncomfortable. You need to sit down and rest for a while, and then walk again after you have recovered. This is called intermittent claudication; Stage III: The resting pain stage, when you don’t walk, and when you are at rest, such as when you sleep at night, your feet will feel cold and painful, and you will have to hold your feet all night long and cannot fall asleep. This is very serious; Stage IV: Ischemia and necrosis of the distal limbs and gangrene of the limbs occur.

Arteriosclerosis obliterans of the lower limbs seriously affects walking, causing pain even when not walking, and the limbs feel very cold. Over time, gangrene will develop in the extremities, such as ulcers in the toes and heels, and even rot in severe cases. Many patients in the past would have undergone amputation if not treated in time. If infection is present, it is called wet gangrene, which can be life-threatening.

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Severe ischemia in lower limb arteriosclerosis obliterans must be treated. There are two main treatment methods: conservative treatment and surgical treatment.

Conservative treatment includes drug therapy and functional exercise. Drugs include antiplatelet drugs, antilipid drugs, vasodilators, and peripheral vascular drugs. Functional exercise means being more active, walking more, gradually establishing collateral circulation, and building up more small blood vessels. Mild ischemia can be maintained for a long time through functional exercise.

In the past, surgical treatment was done by surgery. If a section of the blood vessel was blocked, a bypass was made to connect an artificial blood vessel or the autologous great saphenous vein. This was quite traumatic. In the past decade or so, minimally invasive treatment has been the main approach, and good treatment results can be achieved through intravascular interventional treatment.