Within the framework of diseases of the cardiovascular system, very different clinical pictures occur, which not only affect the heart, but also the blood vessels and the organs involved. This also includes peripheral arterial occlusive disease, or PAD for short .
What is Peripheral Arterial Disease?
The peripheral arterial occlusive disease is also abbreviated as PAD in medicine and is based on a predominantly mechanical impairment of the unhindered blood flow through the arteries. See electronicsencyclopedia for Slang HF.
Peripheral artery disease is so named because over time the arteries can become blocked, causing a disruption in blood flow. The PAD is therefore one of the life-threatening health impairments that are mainly limited to the lower extremities.
Peripheral arterial disease in the arms is rare. In colloquial use, peripheral arterial occlusive disease is often also referred to as claudication, which can be recognized by very typical symptoms and can severely limit the quality of life of those affected.
A typical reason why peripheral arterial occlusive disease can develop is an existing arteriosclerosis, within which the blood vessels become clogged with solid micro-deposits. In this context, arteriosclerosis not only occurs in the venous and capillary vessels, but is also regarded as a direct trigger for PAD.
The primary causes and risks that can trigger peripheral arterial disease include the same factors that are also relevant to arteriosclerosis.
In addition to the consumption of nicotine and alcohol, these also include various previous illnesses such as high blood pressure, diabetes mellitus and obesity, which is associated with excessive cholesterol and fat levels in the blood. A lack of exercise and individual hereditary factors also play a role in peripheral arterial occlusive disease.
Symptoms, Ailments & Signs
The disease is divided into four stages. At the beginning, in stage I, the symptoms are still absent. Although the vessels are gradually narrowing, the person affected cannot yet feel anything. Due to the absence of symptoms, the disease is usually not discovered at this point, even if it could already be diagnosed with an appropriate examination.
In stage II, the first pains in the legs can be felt whenever the patient has walked a distance of around 200 meters. He has to stop and wait again and again, because when he stands, his legs stop hurting. This is known as exercise-related pain. Once stage III has been reached, painful legs also occur at rest.
It doesn’t matter whether the person concerned lies down or sits, the muscles hurt. Walking is almost impossible or only possible with pain. In stage IV, the skin begins to change because the tissue is no longer supplied with enough oxygen due to reduced blood flow . Ulcers develop on the heels and toes and the tissue then dies off. It turns black and begins to rot. If this necrosis progresses, amputation of the leg may be necessary.
Diagnosis & History
The symptoms that are noticeably triggered by peripheral arterial occlusive disease for those affected consist of pain, general physical weakness and lack of strength.
In addition, people who suffer from PAD have pale skin and often suffer from cold feet. Pain is usually felt in the legs due to peripheral arterial occlusive disease and is primarily localized to the calf muscles. For this reason, patients with PAD have to stop constantly while walking and it seems as if they are looking at the shop windows.
This abnormality only occurs due to peripheral arterial occlusive disease when the advanced stage has already been reached. PAD can be precisely identified with a basic and subsequent differential diagnosis.
The emergence and course of peripheral arterial occlusive disease (PAOD) is favored by several factors. In principle, it is an arteriosclerosis that leads to circulatory disorders and causes consequential damage, especially in the legs – to a much lesser extent also in the arms. If the causative factors that led to the development of arteriosclerosis are not eliminated, other complications arise in addition to severe and sometimes cramping pain in the calves and the other leg and buttock muscles.
Complications that occur locally can be open, poorly healing wounds with partially necrotizing tissue and progressive stenoses in the corresponding arteries. If left untreated, PAD in the advanced stage can even necessitate amputation as the final treatment step. Further complications can also be independent of local effects on the affected arteries of the extremities, because the underlying disease, arteriosclerosis, can also extend to other arteries and the arterial coronary vessels.
As a result, this drastically increases the risk of suffering a heart attack or stroke. In order to be able to limit the risk of a stroke, it is therefore advisable to examine the carotid arteries (arteria carotis) for arteriosclerotic changes that occur as a result of plaques. If PAD is detected at an early stage and the causes of the atherosclerotic changes can be successfully eliminated, there is a chance that the symptoms will regress and a return to a symptom-free life is possible.
When should you go to the doctor?
A doctor should be consulted at the first sign of peripheral arterial occlusive disease. If circulatory problems, dizziness and other unusual symptoms are noticed, this indicates a condition that needs to be investigated. From the age of 35, blood pressure and blood lipid levels should be measured regularly. People with statutory and private health insurance can take advantage of the so-called “Check-up 35”. The check-up should then be carried out every two years, as this allows cardiovascular diseases, kidney diseases and diabetes to be detected at an early stage.
Peripheral arterial disease primarily affects people who lead an unhealthy lifestyle, are alcoholic or overweight, or have a genetic predisposition. If you have these risk factors, you should see your family doctor as soon as possible. Optimally, the triggers are resolved before peripheral arterial disease can develop. In addition to the family doctor, an internist or a cardiologist can be consulted. Depending on the cause, physiotherapists, nutritionists, alternative medicine practitioners and therapeutic specialists are involved in the therapy.
Treatment & Therapy
The therapy that can successfully cure peripheral arterial occlusive disease is extremely extensive, since PAD can be divided into several degrees of severity. In addition, various symptoms and risks are associated with every degree of severity of peripheral arterial occlusive disease, the reduction of which is largely important.
In order to be able to treat PAD in a targeted manner, several therapy methods are required in combination. These relate to quitting nicotine consumption and reducing physical obesity, as well as a healthy, balanced diet coupled with regular exercise. In the case of peripheral arterial occlusive disease, it is important to lower cholesterol and high blood pressure and to improve blood circulation in the arteries again.
In order to prevent a heart attack or stroke caused by PAD, medicinal procedures as well as so-called interventional and surgical techniques are carried out. During interventional procedures for the therapy of arterial occlusive disease, the affected sections of the arteries are widened with a surgical balloon or the nerve conduction is interrupted.
Outlook & Forecast
The prognosis of peripheral arterial occlusive disease depends on successful therapy of the triggering causes. If there is no treatment or if it is unsuccessful, the serious illness continues unhindered. However, it is quite possible to make the prognosis more positive if the patient strives for a healthier lifestyle. It includes a balanced diet, avoiding tobacco products, reducing obesity and regular exercise.
Reaching normal values for blood pressure, blood lipid levels and blood sugar also has positive effects on the course of PAD. If the patient also suffers from diseases such as diabetes mellitus (diabetes) or high blood pressure, it is important to treat them in a targeted and consistent manner.
Basically, the life expectancy of people suffering from peripheral arterial occlusive disease is classified as lower. The reason for this are the vascular diseases that also occur.
As a rule, the prospects of the disease also depend on the point in time between the first appearance of symptoms and successful reopening of the vessels. If the period of time in the event of an artery occlusion in the leg is less than six hours, the leg can be saved in 96 percent of all patients. However, if more than 12 hours pass, an amputation must be carried out in around 40 percent of all those affected. In the case of an acute arterial occlusion, the survival rate of patients after surgery is around 80 percent.
Eliminating all risk factors that promote high blood pressure, obesity and diabetes mellitus is advantageous for the prevention of peripheral arterial occlusive disease. If these diseases are already present, optimal treatment should be carried out.
Regular checks and adjustments to blood sugar levels are just as important. Nicotine consumption and too little physical exercise as well as a permanent excess of stress should be eliminated as far as possible when it comes to taking preventive action against PAD. This is the only way to achieve a long life expectancy with the best performance.
Follow-up care for peripheral arterial disease is extremely important. Its goal is to keep the arteries open. Re-constrictions or the formation of blood clots should be avoided at all costs. Another post-treatment goal is to improve or maintain quality of life. The aim is to reduce the risk of a stroke or heart attack.
One of the most useful PAOD aftercare measures is regular check-ups. This applies regardless of treatment by catheter, surgical intervention or medication. The follow-up examinations take place with the family doctor and a vascular doctor. Together with the family doctor, a healthier lifestyle is worked on, which primarily includes sufficient exercise, a healthy diet and abstinence from nicotine.
The doctor also checks blood pressure, weight and cholesterol levels at regular intervals. Ideally, the vascular surveillance program lasts at least two years. In principle, all PAOD patients must be medically monitored for the rest of their lives. In order to support the follow-up treatment, it is advisable to complete walking training. It is advisable to do it in a vascular sports group.
The ABI value is checked by the vascular doctor both after exertion and at rest. With the help of duplex sonography, the doctor also checks the condition of the vessels. Drugs given during PAD follow-up treatment are antiplatelet drugs such as clopidogrel or acetylsalicylic acid. They are usually used during the main treatment.
You can do that yourself
Coping with everyday life and self-help options depend on the severity of the peripheral arterial disease (PAD). In stages I and II, where there is only minor impairment or walking distances of up to 200 m can be managed relatively well, self-help measures are mainly aimed at combating the causes of PAD.
For example, quitting smoking in smokers, good glucose control in those with diabetes, and good blood pressure control in hypertensive patients can all lead to a significant improvement in symptoms. Significant obesity is also one of the risk factors that promote PAD. In addition, regular physical activity has a positive effect on PAOD as far as possible. A regular extra portion of omega-3 fatty acids has a positive effectout of. For example, a single tablespoon of cold-pressed flaxseed oil daily can help reduce arterial inflammatory processes, which are ultimately the cause of arterial constriction in the extremities. A low ratio of omega-6 to omega-3 fatty acids of around 2:1 to a maximum of 5:1 is important in order to combat arterial inflammatory processes with natural means.
The extent to which elevated cholesterol levels, especially elevated LDL concentrations with a simultaneously reduced HDL fraction, play a significant role as causal factors for PAD is a matter of controversial debate. An LDL to HDL ratio of less than 3.5 is considered beneficial for health with an anti-inflammatory effect on the arteries.