Symptoms
Depending on the extent of the circulatory disorder and where it is located, very different symptoms of circulatory disorders in the legs can be found. Circulatory disorders are often found in the extremities, especially in the legs. Acute circulatory disorders in arms or legs very quickly lead to the development of severe symptoms.
The 6 typical symptoms can be remembered with their English translations as the 6 “P “s. These include:
- Loss of pulse (pulselessness),
- Paleness and cold (paleness),
- Muscle weakness to the point of paralysis,
- Sensory disturbances, which become noticeable by a numbness feeling (paraesthesia), !
- Pain (pain) and
- Shock (prostration).
In addition, pain can also lead to sleep disorders. Chronic circulatory disturbances of the extremities are called peripheral arterial occlusive disease (PAD) in medicine, colloquially it is also often called “window dressing” disease when PAD affects the legs. If the musculature of the legs is not sufficiently supplied with blood, it is no longer supplied with sufficient oxygen under stress, which can cause pain.
As a result of this pain, a patient stops walking at regular intervals to allow his or her muscles a short break until the legs have been sufficiently supplied with blood again. The pAVK is divided into 4 different stages, each of which is associated with different symptoms. 1st stage: This stage is still without symptoms.
Stage 2: Here pain actually only occurs under stress. Stage 3: Pain also occurs at rest, especially when lying down. If a person concerned sits or stands up, the symptoms improve because the blood circulation in the legs increases due to gravity.
Stage 4: Here, the circulatory disorders are already so severe that they become visible through dead tissue; this is also known as “smoker’s leg” (skin discoloration with sometimes open wounds). A particular difficulty is the PAD in diabetes mellitus. This disease is very often accompanied by a reduced sensitivity to pain, which is why PAD is only diagnosed in the late fourth stage.
Circulatory disorders of the intestine lead to abdominal pain, which is particularly noticeable after eating, since the intestinal muscles have to work here. Since patients lose their appetite due to the pain, this type of circulatory disorder is often accompanied by weight loss. If the obstruction is acute, for example due to a blood clot that has been carried away, it can be life-threatening because intestinal tissue dies and the intestine becomes paralyzed (paralytic ileus).
If there is a circulatory disorder of the heart, this is called coronary heart disease (CHD). It manifests itself as severe pain in the chest area, which is perceived as constricting and frightening (angina pectoris). In some cases, this pain radiates into the arm or stomach and is associated with the feeling of not being able to breathe deeply.
Depending on the extent of the pain, it may occur only under stress or even at rest. In the worst case, the circulatory disorders of the heart lead to a heart attack. If the brain is affected by circulatory disorders and as a result is no longer supplied with sufficient oxygen, very different symptoms can occur depending on the location of the artery occlusion.
Among the most important are dizziness, temporary numbness in the extremities, difficulty speaking or seeing, ringing in the ears, mood swings, disorientation, confusion and memory disorders. In the worst case, the circulatory disturbance in the brain leads to a stroke. The type and timing of the onset of pain in a circulatory disorder of the legs depends on the extent to which the vessels are already blocked, i.e. how much blood still reaches the legs.
The less blood can flow due to the circulatory disorder, the faster the pain occurs. In stage I of peripheral arterial occlusive disease, no pain occurs yet, but the damage to the vessels is already objectively detectable. In stage II, the first pains occur under stress.
If the patient then stops for a while, the pain disappears again. This alternation between standing and walking has given pAVK the popular name of “window dressing”. Doctors also call this stage Claudicatio intermittens, which means intermittent limping.The reason for this is the pain that occurs as soon as the blood flow is no longer sufficient to supply the muscles needed for walking.
Depending on the progress of the disease, the pain-free walking distance is less or more than 200 meters, corresponding to stages IIa and IIb. In stage III, pain is then manifested that already exists at rest without any strain. Patients also report nocturnal pain that improves when the foot is hanging out of bed.
In addition to the pain at rest and under stress, in stage IV there are also skin symptoms, for example so-called gangrene, which are caused by a lack of blood circulation. The location of the pain depends on the level at which the circulatory disorder starts. There are three different types of PAD: the pelvic type, the thigh type and the lower leg type.
The pain occurs in the lower segment. This means that pain in the thigh indicates that the vasoconstriction is located in a pelvic artery. In the case of the thigh type, the pain occurs in the lower leg and in the case of the lower leg type, the pain occurs in the heel or foot.
With regard to pain, it should be noted that diabetics can remain asymptomatic for a long time due to the disease-related involvement of nerves and feel no pain despite a massive constriction of vessels. The presence of a circulatory disorder is only recognized in these patients when skin symptoms appear. In the case of circulatory disorders of the legs, which are caused by an acute occlusion of an artery, the pain occurs suddenly and without warning.
They are not motion-dependent and do not improve at rest. They are often accompanied by a numbness and a feeling of cold in the affected extremity. In such a case a doctor should be consulted as soon as possible.
Tingling can be a typical sensitive symptom of a circulatory disorder in the legs. This is a sensation caused by small sensitive nerve cells in the skin. If these nerve cells are supplied with too little oxygen, they can lead to faulty sensations and, in addition to tingling, cause unpleasant pain and numbness.
The tingling often starts at the point with the least natural blood circulation, the toes. With advanced circulatory disorders, the entire legs can be affected and nerve cells can even die off, leaving permanent sensory disturbances. An open leg is a wound on the leg that heals poorly and therefore often remains chronic.
Often this wound is located on the lower leg, since blood circulation is the first to decrease here. The open leg is caused by an extremely reduced wound healing caused by the circulatory disorder. Both the arterial and venous blood supply play an important role in the transport of messenger substances in wound healing, in the interaction of the immune system and in providing a healthy wound environment in which the wound can heal.
Open legs are typical secondary diseases of smokers, diabetics and overweight persons. It is important in treatment to improve the blood circulation around the wound and to avoid infections, as the immune system to defend against pathogens is also impaired by the lack of blood circulation. More information on this topic can be found here: Open leg – Causes & TherapyDifferent treatment methods are used depending on the cause of the circulatory problems in the legs.
The most common cause of chronic circulatory disorders in the legs is peripheral arterial occlusive disease (PAD). It is divided into four stages according to Fontaine. The treatment depends on the stage of the disease.
The basis of any therapy of pAOD in all four stages is the elimination of risk factors. These include stopping nicotine consumption, weight reduction, consistent treatment of pre-existing conditions such as diabetes mellitus and high blood pressure, and the reduction of elevated blood lipid levels. Furthermore, so-called platelet function inhibitors, including clopidogrel and ASA, are used in all four stages.
These counteract excessive and premature aggregation of thrombocytes and thus prevent the formation of thrombi, which can then constrict the vessels and lead to a circulatory disorder. Further treatment is then stage-specific. In stage II, in addition to the above-mentioned treatments, intensive walking training is used as a conservative therapeutic approach.The training program should be clearly structured and should be carried out at least three times a week for about 30-60 minutes over at least three months.
The walking distance can be significantly increased. However, not all patients are suitable for such a treatment. Another possibility is the so-called Naftidrofuryl, a drug that acts as a vasodilator and widens the vessels, thereby promoting blood circulation.
The drug is intended for the treatment of stage II pAVK. Like clopidogrel and ASA, cilostazol acts as an inhibitor of platelet function. If conservative and drug treatments fail to improve the symptoms or even lead to a progression of the disease, interventional procedures are used in stages two to four of peripheral arterial occlusive disease.
These include percutaneous transluminal angioplasty, or PTA for short, a minimally invasive dilatation of the affected vessels, and stent implantation. In this procedure, a fine, expandable tube made of metal or plastic mesh, known as a stent, is inserted after the vessel has been dilated to keep the vessel open. In stages three and four, pAOD is treated with Alprostadil, a prostaglandin, as a medication.
The drug improves pain at rest, ensures accelerated healing of ulcers, i.e. deep and often weeping wounds, and reduces the amputation rate. In addition, surgical treatment of pAOD in stages three and four involves the surgical treatment of bypasses and thrombectomy, i.e. the surgical recanalization of the blocked vessel. In case of acute circulatory disorders, immediate hospitalization is required.
There, the blocked vessel is reopened as quickly as possible. If muscle tension is responsible for the circulatory disorder, relaxing measures such as heat applications and massages can help. The suspected diagnosis of a circulatory disorder in the legs can already be made on the basis of the clear symptoms and complaints.
To confirm these, simple tests can confirm the suspicion and concrete measurements of the blood circulation can precisely define the extent of the disease. First of all, an attempt should be made to feel the pulse at various points on the leg. A blood pressure measurement using a cuff and a stethoscope can also indicate the height of the leg at which a restriction exists and the extent of the circulatory disorder.
Doppler sonography is another quick and inexpensive examination that can be carried out quickly and provides more precise information about the blood flow and the degree of vascular blockage. To complete the diagnosis, an angiography, a radiological imaging of the blood vessels of the leg, can be performed. This can give a particularly accurate picture of the blood flow and vascular constrictions.
The extent of the disease, however, depends on the symptoms and effects for the patient, regardless of the measured blockage, since the subjective complaints can vary greatly. Circulatory disorders in the legs can be attributed to numerous causes. Therapies can also vary greatly depending on the stage of the disease, which is why the monitoring of the disease must be carried out by doctors from different disciplines.
Often there are many risk factors behind the disease, which must be reduced, treated and medically adjusted by an internist. In addition to obesity, smoking and family predisposition, the disease of the blood vessels is often associated with fat metabolism disorders, high blood pressure and diabetes. These must be treated by the respective specialist and checked occasionally to prevent the disease from progressing.
In advanced stages, surgical therapies may become necessary, in which plastic surgeons take over the treatment. A stent is an interventional therapy that provides immediate relief of the symptoms of the circulatory disorder. Stent placement is a symptomatic therapy for circulatory disorders in the legs, which can be performed in cases of acute constrictions and rapid worsening of symptoms.
It represents an alternative to bypass surgery, but cannot be used for all types of circulatory disorder. During the procedure, doctors insert a catheter into the blocked vessel under X-ray control and inflate a balloon in the narrowed area, which expands the narrowed area. The vessel can then be held open by a wire tube, the stent.
An advanced surgical measure in the treatment of circulatory disorders in the legs is the application of a bypass.The vascular pathways are laid in such a way that the congested area in the arteries is bypassed and the legs can be fully supplied again via the remaining existing vascular system. In many cases, a more gentle stent therapy can replace a bypass, but in some cases a bypass operation is still necessary. Here, too, the symptoms improve immediately after the operation. Nevertheless, the risk factors and the underlying disease must still be treated, otherwise further blockages occur at the bypass or at new sites in the leg, causing new symptoms.
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