Your ultrasound examination results have clearly shown that the right epigastric artery has formed collateral circulation, which is a compensatory manifestation of the body. At this time, the bypass capillary network plays the role of compensatory expansion to meet the body's blood supply needs, but after all, it is a compensatory function, and the blood flow is obviously reduced, resulting in insufficient muscle oxygen demand and painful feeling.

I suggest you have an operation. Only surgery is the fastest way.

Remove the blocked segment and do collateral anastomosis.

It also has a good effect of relaxing blood vessels.

Here is a pathology for you to learn from. Don't worry, little brother.

Clinical data of 1

1. 1 General information: male 14 cases, female 12 cases, aged 35-82 years, right lower limb 18 cases, left lower limb 16 cases. The main clinical symptoms are soreness, numbness, pain, chills, pale complexion and intermittent claudication. All 26 cases were arteriography, 5 cases showed the occlusion in the proximal iliac artery, 13 cases showed the occlusion in the middle and lower femoral artery, and 8 cases showed the occlusion in the middle and lower femoral artery. Arterial knee.

1.2 Methods Patients entered the interventional treatment room, were disinfected routinely and covered with towels. Seldinger method was used to puncture the femoral artery on one side (usually the healthy side), pig tail catheter was placed above the bifurcation of abdominal aorta for bilateral iliac femoral artery angiography or Cobra catheter with end hole was used for selective catheterization angiography of the contralateral iliac artery to determine the location and degree of vascular occlusion, and the catheter was fixed at the lesion site, and heparin was injected for 3000 ~ 5000 U. Nitroglycerin 200μg can prevent acute thrombosis and arterial spasm during balloon dilatation. For the lesions with high stenosis, a small balloon was used to dilate, and the diameter of the balloon was smaller than that of the normal artery adjacent to the stenosis 1 ~ 2mm. For completely occluded lesions, arterial thrombolysis, guidewire occlusion and vascular patency should be performed first, and then balloon dilatation should be performed. Generally, a 10ml syringe is used to push the dilating pressure to generate a pressure of 4-9 atmospheres, which lasts for 5-6 seconds (depending on the condition and the patient's reaction). After dilation for 2-3 times, angiography was performed again. All the 26 patients saw that the arterial occlusion was relieved and the blood flow was smooth, but there was still stenosis and the distal blood vessels were not well filled. At this time, the thrombolytic catheter or microcatheter (below the knee artery) is placed near the embolus or inserted into the embolus. Urokinase was given in a short time (30 ~ 60 min) for thrombolysis during operation, ranging from 250,000 u to 500,000 u (generally not more than 65,438+0,000,000 u). If it doesn't work, leave the catheter at the proximal end of the embolus and fix the outer end with the skin. Send the patient to the ward, pump urokinase at the rate of 800 U ~ 1000 U/min, with the maximum dose not exceeding 2000 U, and pull out the arterial catheter and sheath after 200s4h). At the same time, low molecular dextran 500 ~ 1000 ml/d, papaverine 60mg/d, low molecular heparin calcium 0.4ml subcutaneously injected into salvia miltiorrhiza twice a day, enteric-coated APC75mg/d for 7 ~ 10 day, and warfarin 3mg/d after stopping heparin for 3 ~ 6 months. During this period, the coagulation function should be closely tested to prevent bleeding. The first angiography time should be 3 hours after thrombolysis, and the interval between subsequent angiography should be 4 ~ 6 hours to judge the thrombolysis procedure and revascularization.

Results Three days after angioplasty combined with thrombolysis, routine angiography showed that the occluded vessels of 26 patients were unobstructed. The filling of distal blood vessels is close to normal, the clinical symptoms are obviously improved, the pain and numbness of limbs disappear, the skin temperature turns warmer, the color turns red, and the dorsal artery of foot beats well. Follow-up for 2 ~ 6 months showed no recurrence.

2 nursing

2. 1 Psychological nursing patients are prone to pessimism due to swelling and pain of limbs caused by embolism, and some of them form ulcers, which also affects their activities. Nurses should patiently comfort patients, create a quiet and comfortable environment for patients, and actively do a good job in the ideological work of their families to avoid showing negative feelings of boredom and eliminate patients' ideological concerns. Before operation, doctors and nurses discuss the best treatment plan together, so that patients can understand the process and importance of thrombolytic therapy and get the cooperation of patients. If there is any discomfort during the operation, ask the patient in time to eliminate the tension and fear of the patient.

2.2 Keeping the catheter unobstructed is the key to successful thrombolysis. The catheter must be prevented from being displaced, folded and blocked. The patient should take a lying position, straighten the limbs on the puncture side, and strictly disinfect the puncture point to avoid infection of the puncture wound. The proximal end was fixed with 6cm×7cm double-sided adhesive folded catheter, and the distal end was fixed with 10cm×30cm double-sided adhesive folded catheter, and the signs were recorded to ensure the patency of the catheter. In addition, due to the high arterial pressure, attention should be paid to the dropping speed of micropump and liquid to avoid blood coagulation and lumen blockage.

2.3 Observe the postoperative symptoms, pay attention to the skin color, temperature and pulse of the dorsal artery of the affected limb, ask the patient whether the pain is relieved in time, and evaluate the treatment effect. Observe whether the catheter is displaced and whether there is active bleeding at the puncture site. If there is bleeding, don't change the membrane in a hurry. Replace the film after the local pressure is enough to stop bleeding, so as to avoid unstable fixation and bleeding due to blood soaking the film.

2.4 No cold and hot compress can reduce the temperature of the affected limb after arterial occlusion. At this time, tell the patient that not applying cold and hot compress will promote tissue metabolism and increase oxygen consumption, which is not good for limbs with severe ischemia, and the sensory disturbance of the affected limb after embolization is easy to cause skin burns. Although cold compress can reduce tissue metabolism, it can also cause vasoconstriction, which is not conducive to spasmolysis and collateral circulation.

2.5 Prevention of Complications The main complication of this treatment method is bleeding, which is mostly caused by excessive dosage of urokinase, heparin and aspirin. Therefore, it is necessary to closely observe whether there is bleeding or hematoma in the puncture site, whether there is bleeding point in the skin and mucosa, and whether there is bleeding or hematuria in the gums. If there are signs of bleeding, stop using anticoagulants immediately and deal with the symptoms. When pulling out the catheter, local pressure should be applied for 20 ~ 30 min, and pressure should be applied to bandage it after stopping bleeding fully. The limb on the puncture side should be braked horizontally and compressed with 1kg sandbag for 6 hours to prevent bleeding.