The chronic vascular disease PAD is characterized by an oxygen deficiency in the legs. These circulatory disorders occur due to increasing calcification of the leg arteries. The result is pain when walking and a reduced ability to walk.
Those affected are forced to stop after walking a certain distance until the pain subsides. When strolling through town, those affected often stop in front of shop windows. This gave rise to the colloquial term"intermittent claudication".
Those affected have pain when walking and therefore have to stop more often © Viacheslav Iakobchuk | AdobeStock
Doctors also refer to PAD as intermittent claudication (Latin for "intermittent claudication"). Colloquially, the disease is also known as smoker's leg, as smoking is an important risk factor.
PAD is a widespread vascular disease. According to the German Society of Angiology (DGA), around 4.5 million people in Germany suffer from it. In the over-65 age group, around 20 percent of all people are said to be affected.
Smokers are particularly likely to suffer from PAD.
People over 65 and smokers in particular are often affected by PAD © Hunor Kristo | AdobeStock
Peripheral arterial occlusive disease is caused by
- a narrowing (stenosis) or
- a blockage (occlusion)
of the leg arteries. In around 90 percent of cases, vascular calcification, also known as arteriosclerosis, is responsible for this. The remaining 10 percent of arterial occlusive diseases are caused by inflammatory vascular diseases.
The following video shows how arteriosclerosis, and therefore also peripheral arterial occlusive disease, develops:
The most important risk factors for the development of arteriosclerosis and consequently also PAD include
The symptoms depend on the degree of vasoconstriction or vascular occlusion. In the early stages of the disease, the narrowing of the arteries in the legs is not yet so pronounced. Therefore, PAD does not initially cause any symptoms.
The vasoconstrictions increase over time. As soon as the tissue can no longer be adequately supplied with nutrients and oxygen, pain and discomfort occur.
The typical symptoms of PAD include
- Pain when walking, either in the calves, buttocks or thighs, depending on the location of the vasoconstriction
- Increasing restriction of walking distance
- later also pain in the feet and toes at rest
Pain in the calves is typical of peripheral arterial occlusive disease © Satjawat | AdobeStock
Other common symptoms of intermittent claudication are
- A feeling of coldness and weakness in the legs,
- pallor of the affected leg and
- muscle pain on exertion.
At an advanced stage, the lack of blood circulation can also lead to serious complications such as leg ulcers
- such as ulcers on the lower leg and
- tissue death on the toes, ankles and heel.
can occur.
In most cases, PAD is caused by arteriosclerosis. As a result, PAD patients also have an increased risk of suffering a heart attack or stroke. Heart attacks are the most common cause of death in PAD patients.
PAD patients have an increased risk of stroke © Alexandr Mitiuc | AdobeStock
Depending on the severity of the symptoms, doctors differentiate between four stages of PAD:
- Stage I: No symptoms yet (asymptomatic PAD)
- Stage II: Discomfort when walking and limited walking distance
- Stage III: Pain now also occurs at rest
- Stage IV: undersupplied tissue dies (necrosis, gangrene)
From stages III and IV, there is an immediate risk of amputation.
A serious complication in the last stage can be the death of tissue in the lower extremity © DOUGLAS | AdobeStock
If PAD is suspected, the doctor can carry out a series of examinations to confirm the diagnosis. These include, for example
- a physical examination, during which the doctor palpates the pulses of the affected leg, and
- a Doppler pressure measurement(duplex sonography) using a special ultrasound device to determine the so-called ankle-brachial index.
The ankle-brachial index measures the blood pressure at the ankle and arm. If the blood pressure at the ankle is significantly lower than that at the arm, this indicates a narrowing of the leg arteries. This makes PAD probable.
With duplex sonography, the examiner can examine the arteries from the pelvis to the foot. However, he assesses the condition of the vessel wall and the blood flow in the artery.
Duplex sonography of the leg arteries © New Africa | AdobeStock
First of all, the patient must eliminate all risk factors. This includes giving up nicotine as well as adjusting blood pressure.
Various therapy methods are available for the treatment of PAD, depending on the stage of the vascular disease. These include, among others
- Drug treatment with agents that promote blood circulation in the vessels,
- structured walking training, preferably in PAVK sports groups,
- interventional measures such as vasodilatation with stents and
- surgical measures such as bypass surgery.
For drug therapy, the doctor can prescribe anticoagulants or active substances such as acetylsalicylic acid.
However, the PAD specialist only performssurgical measures such as a vascular bypass at later stages of the disease.
The following video shows how a vasodilatation with stents is performed:
Advanced arteriosclerosis, and therefore also PAD, cannot be reversed. However, if treatment is started early, the progression of the disease can be slowed down considerably. In some cases, it can even be stopped completely.
A good prognosis depends above all on the patient's cooperation. In order to eliminate the risk factors, PAD patients should, among other things
- stop smoking,
- pay attention to their blood sugar, blood pressure and cholesterol levels,
- eat a healthy diet,
- get enough exercise
- and reduce their weight.
PAD is a disease of the blood vessels. Therefore, experts from the medical specialties of angiology and vascular surgery usually take over the treatment.
PAVK specialists can use the examination methods described above to assess
- whether the symptoms are caused by PAD,
- where the problems lie and
- how blood circulation can best be restored.
Vascular surgeons have the widest range of treatment methods. He masters
- conservative treatment methods,
- endovascular methods (balloon catheters, stents) and
- open vascular surgery methods.
