PAVK: When Every Step Becomes a Burden

Healthy arteries have elastic vessel walls and allow for a steady blood flow. In PAD, however, fat, calcium, and inflammatory components are deposited in the vessel walls. This process is known as atherosclerosis.

Over time, the blood vessels become increasingly narrowed. As a result, less oxygen-rich blood reaches the leg muscles. The muscles’ oxygen demand increases significantly, especially during physical activity. If blood flow is no longer sufficient, pain and muscle discomfort develop.

The most important risk factors include:

• Smoking
• Diabetes mellitus
• High blood pressure
• High cholesterol
• Obesity
• Lack of exercise

Smoking, in particular, is considered one of the strongest risk factors. Toxic substances from cigarettes damage the inner walls of blood vessels and promote chronic inflammatory processes. Diabetes mellitus also significantly affects vascular health. Chronically elevated blood sugar levels damage blood vessels and further impair the supply of oxygen to tissues.

Modern research also shows that chronic inflammatory processes play a greater role in vascular diseases than was long assumed. Adipose tissue, metabolism, and inflammatory responses are closely interrelated. 

Symptoms depend on the extent to which blood flow is restricted. Initially, the condition often goes unnoticed or causes only minor symptoms.

Typical symptoms include:

• Pain when walking
• Calf cramps
• Rapid fatigue in the legs
• Cold feet
• Numbness
• Wounds that heal poorly

A particularly characteristic symptom is pain while walking that subsides after a short rest. Many people with the condition therefore stop walking repeatedly, which is why the disease is colloquially referred to as “window-shop disease.” As the disease progresses, the distance that can be walked pain-free becomes increasingly shorter.

Later on, symptoms may occur even at rest, especially at night or while lying down. In addition, wound healing often deteriorates. Minor injuries to the feet or lower legs heal more slowly because the skin and tissue are not receiving an adequate supply of oxygen.

In severe cases, there is a risk of open wounds or tissue damage. Patients with diabetes mellitus are particularly at risk, as nerve damage and circulatory disorders often occur simultaneously. 

Modern vascular medicine now views PAD as an indicator of general vascular damage throughout the entire body. People with circulatory disorders in the legs often also have an increased risk of changes in the coronary or cerebral arteries.

This increases the risk of, among other things:

• Heart attack
• Stroke
• Heart failure
• further vascular occlusions

This is precisely why early diagnosis is so important. In addition, the condition often has a significant impact on daily life. Many patients reduce their physical activity out of fear of pain. As a result, muscle strength and stamina continue to decline, which can further exacerbate symptoms. Psychological stress also plays a role. Limited mobility and chronic pain significantly affect the quality of life and independence of many people with this condition. Especially in older patients, there is also a close link between immobility in old age and frailty syndrome. 

Diagnosis usually begins with a physical examination and an assessment of blood flow.

Important diagnostic methods include:

• Blood pressure measurements on the arms and legs
• Ultrasound examinations
• Doppler and duplex sonography
• Vascular imaging with contrast agents
• Stress tests

In particular, the so-called ankle-brachial index allows for a simple assessment of blood flow. Treatment pursues several goals simultaneously: to reduce symptoms, improve blood flow, and prevent complications.

Key treatment approaches include:

• Smoking cessation
• Walking therapy
• Blood pressure control
• Diabetes management
• cholesterol-lowering medications
• Vasodilatory procedures

Regular walking exercises play a key role. Exercise improves blood flow and promotes the formation of small collateral vessels. In advanced cases, catheter procedures or surgical interventions are used. These procedures widen narrowed vessels or create bypasses. 

Peripheral arterial disease (PAD) often develops slowly and therefore goes unnoticed for a long time. Modern research is increasingly showing how closely vascular health, metabolism, and chronic inflammatory processes are linked. This is precisely why early diagnosis, consistent management of risk factors, and long-term vascular prevention play a crucial role in maintaining mobility and quality of life for as long as possible. An early geriatric assessment can help identify risks in a timely manner and take targeted measures to counteract them.