Arterial occlusive disease (AVD) or peripheral arterial occlusive disease (pAVD), like smoker’s leg, is colloquially known as shop window disease. In this case, an arterial circulatory disorder of the extremities (feet, legs, arms, hands) occurs, which can be life-threatening. The main cause of this disease is arteriosclerosis due to an unhealthy lifestyle. Especially smoking, little exercise and a lot of fatty and cholesterol-rich food is responsible for arterial occlusive disease in this case.
What is arterial occlusive disease?
Hardening of the arteries can quickly lead to a heart attack or stroke. Arterial occlusive disease is also colloquially known as “shop window disease.” This is due to the fact that it forces the patient to stop and pause after only a short walk. The gait pattern thus resembles that of the flâneur, who strolls from shop window to shop window, stopping briefly each time to look at the goods on display. In addition, arterial occlusive disease is responsible for what is known as smoker’s leg. In principle, smoker’s leg is an arterial occlusive disease triggered or caused by the long-time smoking of the affected person. Especially older people from the age of 65 tend to get this disease. Especially men have here a higher risk of smoker’s leg or arterial occlusive disease.
Causes
Arterial occlusive disease is caused by a circulatory disorder of the extremities. This circulatory disorder is caused by narrowing or even occlusion of the aorta or those arteries that supply the extremities. In arterial occlusive disease, constriction or occlusion is caused by arteriosclerosis. This disease, also called arteriosclerosis, is the cause in about ninety-five percent of patients with arterial occlusive disease. Other causes of arterial occlusive disease, although significantly less common, are inflammatory vascular diseases. Because vascular calcification in this disease is a gradual and slow-progressing process, the effects worsen enormously, especially when risk factors interact.
Symptoms, complaints and signs
Arterial occlusive disease presents with different symptoms depending on the body parts affected and the stage of the disease. If the extremities are affected, the symptoms are the same as those of peripheral arterial occlusive disease. In the early stages, the condition does not cause any symptoms. As the arterial occlusion progresses, pain on exertion eventually develops. These occur where the arterial occlusion is pronounced. This can be in the legs, for example, or it can become visible in the form of angina pectoris. Initially, this pain occurs only after or during physical activity. Pain at rest occurs even later in the course of the disease. Finally, the last symptoms are inflammations, ulcers and necroses on the parts of the body with poor blood supply. The loss of tissue is accompanied by a loss of sensory abilities, especially in the extremities. Amputations may be necessary in severe cases. However, not only the extremities are affected by the narrowed vessels. Narrowed blood vessels can lead to a variety of symptoms in the body. For example, circulatory disorders can occur in the brain, and thromboses that develop carry an increased risk of strokes, heart attacks and embolisms. In addition, narrowed vessels contribute to general weakness, as nutrients and oxygen are not transported optimally.
Course
Arterial occlusive disease predominantly affects the lower extremities or their arteries. Depending on the stage of the disease, the symptoms of affected individuals range from a subjective lack of discomfort to pain on exertion while walking and a consequent limitation of walking distance to pain that is independent of exertion and ulcers called gangrene, which necessitate amputation. Arterial occlusive disease therefore initially starts unnoticed, since the occlusion of the artery occurs insidiously – just as, for example, high blood pressure does not hurt an arterial occlusion in the early stages.In women, it even takes an average of ten years longer for arterial occlusive disease to be diagnosed. This makes it all the more important to know the main risk factors for arterial occlusive disease. In addition to smoking and diabetes mellitus, these are high blood pressure and lipid metabolism disorders. The last three factors occur particularly in the case of overweight. In this respect, the first and best measure to prevent arterial occlusive disease is the reduction of excess weight and the immediate cessation of smoking. For example, in both men and women who smoke, the onset of the disease is on average fifty-five years. In non-smoking women, it is sixty-five years. And even though men have an overall three times higher risk of developing arterial occlusive disease, this advantage is negated by women who smoke. They are just as much a part of the main risk group. Unfortunately, the first signs of arterial occlusive disease are often neither noticed nor taken seriously. Most of those affected do not see a doctor until their calf hurts more often when they walk. However, even for those who do go to the doctor, the start of treatment for arterial occlusive disease can often be delayed due to misdiagnosis. Finally, pain in the calf can also be an indication of orthopedic problems, such as a torn muscle fiber. The dangerous thing is that arterial occlusive disease not only affects the legs, but also those arteries that supply the heart and brain are narrowed. This means a high risk of heart attack or stroke.
Complications
Complications that develop from arterial occlusive disease are always due to an inadequate supply of oxygen-rich arterial blood to certain areas of the body. Accordingly, the resulting complications can vary widely. They range from barely noticeable to immediately life-threatening. For example, coronary artery disease, which is also classified as arterial occlusive disease, can develop into angina pectoris associated with chest pain or, in the case of total occlusion of one of the main coronary arteries, even an immediately life-threatening heart attack. If one or both renal arteries are affected by the arterial occlusive disease and have higher-grade stenoses of more than 75 percent, so-called renal hypertension initially develops. The kidney secretes increased amounts of the vasoconstrictor hormone renin, which leads to increased blood pressure via the mechanism of vasoconstriction and can cause corresponding complications associated with high blood pressure. The reduced supply of arterial blood to the kidneys can severely hinder kidney function and, as an extreme complication, kidney infarction can occur analogous to myocardial infarction. The best-known arterial occlusive disease is probably peripheral arterial occlusive disease (PAVD), which affects the lower extremities. The disease, which disproportionately affects heavy smokers, is also known as shop window disease, because those affected like to stop in front of shop windows to conceal their disease due to severe pain in the legs after walking. Most of the complications addressed resolve after blood flow through the affected arteries is restored. This is provided that no irreversible limits have been exceeded.
When should you go to the doctor?
Occlusive arterial disease is a progressive condition that can lead to a variety of secondary conditions. These include peripheral arterial disease and coronary artery disease. The symptoms caused by these (and other) conditions are usually severe for the person affected. If the person notices that walking, lifting the arms or standing is more difficult, the limbs feel stiff after little exertion and there is a general feeling of weakness, arterial occlusive disease may be the cause. An onset of angina pectoris – chest pain on exertion – is also a clear sign. Both conditions should be urgently examined by a physician and treated if possible. If arterial occlusive disease is suspected, a physician should always be consulted, as this condition can be greatly delayed in its development. People who belong to a risk group should be examined as a precaution.This includes smokers, overweight people and people with other underlying diseases. In addition, a high-fat diet promotes the development of arterial stenosis. Patients already suffering from a diagnosed arterial occlusive disease should definitely consult the attending physician in case of acute deterioration of their condition. Depending on the equipment and specialization, a general practitioner may be consulted for the initial diagnosis. Further – possibly also invasive – measures require a visit to a vascular specialist.
Treatment and therapy
The therapy or treatment of arterial occlusive disease by a vascular physician aims to prevent just that. Treatment is based on the immediate elimination of risk factors. This includes abstaining from nicotine, lowering cholesterol levels, and adjusting high blood pressure and diabetes. Consistent walking training as part of so-called vascular sports leads to an improvement in blood flow in the legs, because the movement of the muscle forms new small blood vessels around the constriction or dilates the existing ones. Thus, increased activity can also relieve pain. Sparing would be the wrong approach here. In addition, any form of exercise helps lower blood lipid levels and blood pressure. Endurance exercise is the best medicine for treating arterial occlusive disease.
Outlook and prognosis
First and foremost, the prognosis for arterial occlusive disease depends on whether triggering factors can be eliminated. Progression of the disease can only be prevented in this way, because even surgical intervention is no guarantee of lasting freedom from symptoms. The constriction can sometimes close again. Life expectancy is shorter in patients with arterial occlusive disease, because they usually suffer from other vascular diseases and the risk of heart attacks and strokes is significantly increased. The prognosis is positively influenced by preventive measures in the form of a healthy lifestyle (e.g., achieving a normal body weight, abstaining from cigarettes, low-fat and low-cholesterol diet, physical activity). If the arterial occlusive disease is due to an embolism and its source cannot be eliminated, permanent medication to inhibit blood clotting is necessary for a better prognosis. If a thrombosis is the cause of the arterial occlusive disease, then a therapy with so-called platelet aggregation inhibitors is carried out, which can also positively influence the prognosis. For a favorable prognosis, however, the cooperation of the patient is always necessary. If the lifestyle is not adapted accordingly, then the prognosis is rather poor.
Aftercare
Immediately after surgery, the patient must initially remain in bed. Pulse, blood pressure, and dressing are checked regularly to detect complications as soon as possible and to take countermeasures. Even during the operation, the patient receives heparin, which inhibits blood clotting. This is to prevent blood clots from forming in the operated area or in other preloaded parts of the body. Heparin is also administered regularly after the operation. In the period after the operation, blood values are also checked regularly in order to be able to detect and treat inflammations or other discrepancies. Later, after the operation, the patient must visit the doctor for check-ups. At first, the check-up takes place after four to six weeks, later on every six months and finally only once a year. In these examinations, the doctor assesses whether the blood continues to flow well. If it does not, the question of a new operation may arise. In order to prevent future arterial occlusions, the patient can take preventive measures by adopting a healthy lifestyle with an appropriately balanced diet, sufficient exercise and refraining from smoking. Medications prescribed by the physician should also be taken as directed.
What you can do yourself
Arterial occlusive disease can still be delayed a little in its mild stages, or even greatly delayed in its development, if the affected person changes his lifestyle. Important risk factors should be banished from life as far as possible. These include smoking, eating large amounts of fat and lack of exercise.Instead, the focus should be on a light diet rich in vitamins and minerals. This is because the additional nutrients and improved metabolism help the body to form new blood vessels. This ensures an improvement in peripheral blood circulation and prevents further suffering. The undersupply of oxygen to the tissues must also be compensated for. Sporting activities improve blood circulation and increase lung volume in the long term, so that the blood becomes more acidic and the tissue can be better supplied despite arterial constriction. Endurance sports such as swimming, running or cycling are particularly suitable. Even regular walks can help. In addition, attention should be paid to breathing. Conscious and deep breathing leads to a better supply of oxygen. When strain pain occurs, it can help to stretch the legs (or arms), gently tap or rub them. However, these measures only relieve symptoms.