Heart Center Brandenburg near Berlin – Cardiology, Cardiac Surgery and TelemedicinePeripheral Arterial Occlusive Disease is associated with impaired blood flow to the extremities. Pain during walking is typical. Due to its symptoms, this disease is also popularly known as "smoker's leg" or "shop window disease".
What is Peripheral Arterial Occlusive Disease??
Peripheral arterial disease (pAVK) is a lack of blood flow in the legs or – less frequently – the arms caused by vascular calcification. Because of the pain it often causes when walking and its frequent association with smoking, it is commonly referred to as "smoker's leg" or "shop window disease". Affected individuals must z. B. repeatedly standing in front of shop windows until the pain has subsided.
What are the main symptoms?
Depending on the severity, peripheral arterial disease is usually divided into four stages. The first stage of the disease does not yet cause any symptoms. As the disease progresses and the vessels become increasingly narrowed, the following symptoms appear:
– pain when walking, also known as intermittent claudication or "intermittent claudication. – Pain at rest in the extremities – dead tie areas, necroses, for example in the feet
What can be possible causes?
Like coronary heart disease or myocardial infarction, peripheral arterial disease is almost always caused by calcification of the vessel walls, known as arteriosclerosis. The arteries of the pelvis and legs are particularly affected. Important risk factors for the calcification process are:
– smoking – diabetes – hypertension – dyslipidemia
Diagnosis of peripheral arterial disease
The diagnosis of peripheral arterial occlusive disease is comparatively simple, especially when typical symptoms are present.
– Blood prere measurement: A measurement on the legs, by comparison with the measured values on the arm, the so-called ankle-arm index, can already quantify the degree of constriction quite accurately. – In addition, an ultrasound examination provides information about calcifications and the flow conditions in the blood vessels. – Computed tomography or magnetic resonance imaging using a vascular contrast agent allows precise visualization of the arteries. – Contrast imaging of the vessels by catheter technique is considered the gold standard of diagnosis. In this process, even very small vessels become visible, and stents, i.e. vascular supports, can be inserted into the constricted areas at the same time.
Therapeutic steps for peripheral arterial occlusive disease
Treatment of peripheral arterial disease aims to improve patients' quality of life and avoid the amputations that are sometimes necessary as the disease progresses. There are various strategies for doing so:
– Cause control – controlled gait training – medications – catheter interventions on the vessels – vascular surgery procedures
Combating the cause
Avoidance of nicotine, regular physical exercise, treatment of any high blood prere and diabetes that may be present, lowering cholesterol.
controlled walking training
This can improve leg perfusion by forming the body's own bypass circuits.
Medication Certain medications can also be helpful. Thus, agents such as acetylsalicylic acid, better known as "aspirin", improve the blood circulation in the arteries of the pelvis and legs, the flow properties of the blood.
Catheter interventions on the vessels By means of a vascular puncture at the groin, the doctor pushes an inflatable balloon catheter to the affected constriction. The stenosis is dilated by balloon prere and then treated with a stent, splinted from the inside. The method is particularly successful in the case of shorter vascular stenoses.
Vascular surgery procedures For example, vascular calcifications in the femoral arteries can sometimes be surgically excised. Vascular bridges, so-called bypasses, can also be created at various points. Both the body's own veins and plastic vascular prostheses made of Teflon are used to bridge the narrowed arteries.
Peripheral arterial disease (pAVK)
Calcification of the arterial vessel wall (arteriosclerosis) as a result of diabetes mellitus, high blood prere, smoking, obesity or heredity can lead to narrowing (stenosis) of the blood vessels. These can occur anywhere, but manifest in the body at preferred sites (predilection sites). Therefore, stenoses of the coronary arteries (coronary heart disease, CHD) as well as the carotid artery, the renal arteries, the arteries of the pelvis and the legs are frequent. More rarely, constrictions are found in the brachial artery. Here mostly directly at the outlet from the aorta. If the stenoses exceed 50% of the vessel diameter, symptoms of reduced blood flow develop. The special situation of the A. carotid artery is discussed in a separate chapter. In peripheral blood vessels, especially those of the pelvis and legs, the symptoms of reduced blood flow manifest themselves primarily during exertion, when the musculature of the musculoskeletal system requires more oxygen to function than at rest. Due to the lack of oxygen (ischemia), there is a release of lactic acid (lactate) and associated pain. Depending on the severity of the circulatory disorder, the clinical symptoms are divided into groups in order to estimate the respective diagnostic requirements and the need for treatment. This is done according to the classification of Fontaine (Fig. 1).
– Fontaine I: There is constriction, but the patient has no clinical symptoms. – Fontaine IIa: There is pain on exertion (typically in the legs; Claudicatio Intermittens: intermittent claudication). However, the patient can still walk more than 200 meters without feeling pain and having to stop. – Fontaine IIb: Per patient can walk less than 200 meters without pain. – Fontaine III: There is pain even with very short walking distances under 10 meters or at rest. – Fontaine IV: The circulatory disorder has already led to the death of tie, typically on the foot (especially the toes) (gangrene). In stages I. IIa can be waited for. In contrast to CHD, peripheral AVK does not necessarily pose an emergency situation such as a heart attack. The patient is recommended walking training. This leads in connection with blood flow facilitating medications, e.g. B. Platelet aggregation inhibitors (prevent platelets from clumping together and thus improve flow properties in small vessels) to form new small blood vessels (neoangiogenesis), but only to a limited extent. Further diagnostics are recommended for AVK IIb and above.