Diagnosis
The physician may already suspect peripheral arterial occlusive disease during the conversation with the patient. This suspicion can be confirmed during the physical examination. The physical examination is divided into looking at the skin (skin colour, wounds), feeling the pulses (attenuated/no pulses for peripheral arterial occlusive disease) and checking the skin temperature and sensation in the leg.
Clinical functional tests, such as walking on a treadmill, can also be used to diagnose peripheral arterial disease. Imaging diagnostics are used to indicate the blood flow in the affected areas. Ultrasound, CT (with and without contrast medium) or MRT are used for this purpose.
Some blood values are also diagnostic parameters in peripheral arterial occlusive disease. As the disease progresses, the symptoms may worsen and pain may occur even at rest. This usually happens at night or after the leg has been lifted, as the blood pressure drops at night and the blood can therefore only pass the constriction with difficulty.
In the final stage of pAVK, tissue death (necrosis), black colouring (gangrene) of the legs and ulcers (ulcer) can even occur. In extreme cases, this can lead so far that amputation may be necessary. .
The nerves can also be damaged by the undersupply of blood (and thus oxygen) (ischemic neuropathy). This leads to misperceptions (paresthesia), which can manifest themselves in various ways. For example, feelings of numbness (hypaesthesia), but also painful and burning sensations (causalgia) are possible, which usually start at the feet.
Therapy
The therapy of peripheral arterial occlusive disease depends on the stages of the disease. At an early stage of the disease, it helps to change lifestyle habits and thus reduce cardiovascular risk factors. This includes, for example: Blood lipid levels and existing high blood pressure should be reduced in order to preserve the vessels.
Furthermore, a lot of exercise has a good side effect – the more you move, the higher the oxygen requirement of the muscles. If you move a lot every day, the body forms new blood vessels, so-called collaterals, in order to supply the muscles with sufficient oxygen. These collaterals reduce the extent of peripheral arterial occlusive disease, because the surrounding musculature gets more oxygen again.
In general, the legs should be positioned low so that enough blood can get into the legs and injuries should be avoided as wound healing is more difficult. In low stages of peripheral arterial occlusive disease, drug therapy is also helpful. On the one hand, blood-thinning drugs such as ASA or clopidogrel are used to prevent a clot (thrombus) from forming in the narrowed vessels.
If this is already the case, so-called thrombolytics are also used, which can dissolve the clot again. If the peripheral arterial occlusive disease is in a more advanced stage, surgical therapy can be considered in addition to conservative therapy. There are different possibilities in the field of surgical therapy.
One possibility is angioplasty, in which the narrowed blood vessel is dilated again by a catheter inserted via the vascular system. This procedure is minimally invasive, which means that only one blood vessel needs to be punctured to insert the catheter. In addition, a thrombendarterieectomy can be performed surgically, in which the blood vessels are surgically exposed and reopened.
Alternatively, one can also block the nerves (sympathectomy) that are responsible for narrowing the vessels in the affected area. Another possibility is the bypass operation. In this operation, a vessel made of either the body’s own or foreign material is inserted, which bypasses the constriction and thus still provides enough blood to the following tissue.
- A healthy diet
- Movement and the
- Stop smoking
If there is a peripheral arterial occlusive disease, patients have to be particularly careful with their legs and feet, because the circulatory disorders associated with the disease make wound healing difficult and thus even the smallest wounds can develop into chronic large wounds. It is therefore recommended to inspect the feet and legs daily for pressure points or wounds and to use a mirror for those areas that are difficult to see. Medical foot care helps to keep the feet in good condition and professionally removes cracked calluses.
Furthermore, injuries to the feet should be avoided and if they occur, consult a doctor in time to control the healing process. In addition, the skin should be creamed regularly, preferably before going to bed or after showering. Creams containing urea are recommended, as this active ingredient is particularly effective against dry skin.
