What are the early symptoms of thromboangiitis obliterans?

Most people do not know much about thromboangiitis obliterans because the cause of this disease is relatively hidden and the progression of the disease is very slow. It usually has periodic attacks, and the disease will worsen as the cycle of the disease changes continuously. Therefore, many people do not have any symptoms in the early stages of the disease. As the disease continues to worsen, symptoms will appear little by little.

(1) Coldness and paresthesia: Coldness and fear of cold are common early symptoms. The surface temperature of the affected area decreases, especially at the toes (fingertips). Due to ischemic effects on nerve endings, the affected limbs (toes, fingers) may experience abnormal sensations such as callous sensation, tingling, numbness or burning.

(2) Pain: This is also an early symptom. It originates from arterial spasm and is caused by stimulation of the nerve endings in the blood vessel walls and surrounding tissues. The pain is generally not severe.

(3) Intermittent claudication: It is a special manifestation of ischemic pain caused by occlusion due to endarteritis and thrombosis. That is, after the patient walks for a distance, the calf or foot muscles will swell or cramp. If he continues to walk, the pain will worsen and he will have to stop. After resting for a while, the pain will quickly ease, but it will reappear after he walks again. This symptom is called intermittent claudication. As the disease progresses, the walking distance gradually shortens and the time spent stopping to rest increases.

(4) Rest pain: As the disease progresses, arterial ischemia becomes more severe, and the pain becomes intense and continuous. Even when the limb is at rest, the pain continues. This is called rest pain. It is especially severe at night, aggravated when the limbs are raised, and the pain may be slightly relieved after lowering. The patient sat with his knees bent and his feet touched day and night, unable to sleep. Sometimes the affected limb is even hung down beside the bed to relieve pain. If infection occurs, the pain will be more severe.

(5) Changes in skin color: Pale skin due to arterial ischemia, accompanied by weakened superficial vascular tension and thinning of the skin. Flushing or cyanosis may also occur.

(6) Weakened or disappeared arterial pulsation: The pulsation of the dorsalis pedis or posterior tibial artery, ulnar or radial artery weakens or even disappears as the disease progresses.

(7) Nutritional disorders: Long-term chronic ischemia of the affected limb causes nutritional disorders in the tissues, which are manifested as dry skin, scaling, cracking, hair loss, thickening, deformation and slow growth of toenails (fingernails), relaxation, atrophy and thinning of the calf muscles. As the disease progresses, the extremities suffer from severe ischemia, eventually leading to ulcers or gangrene. Most of them are dry gangrene, which first appears at the end of one or two toes or beside the toenails, and then affects the entire toe. At the beginning, the toe tip becomes dry and black, and necrotic tissue falls off to form an ulcer that does not heal for a long time. At this time, the pain in the extremities becomes more severe, the patient cannot sleep day or night, has a decreased appetite, becomes thin and weak, has a pale complexion, and even becomes anemic. If infection occurs and wet gangrene occurs, symptoms of toxemia such as high fever, chills, irritability, etc. will appear.