Local measures

Local measures should also be taken to prevent injuries and improve wound healing. This includes careful foot care (e.g. regular application of cream for chapped skin, pedicure and wearing comfortable shoes). Further measures can be taken, especially in stages III and IV.

For example, deep positioning of the legs helps to improve blood circulation and absorbent cotton bandages can be used to prevent pressure damage. If tissue damage of any kind has already occurred, treatment is of course also indicated. However, this will be carried out by the doctors/nursing staff and depends on the individual case of damage.

Drug therapy

A broad drug therapy is also possible: even if surgery is planned, the time until then can be bridged with prostanoids. Of course the circulatory disorder can also be treated with homeopathic medication.

For example, drugs that worsen the blood circulation should be omitted.
These include ?-blockers (beta blockers).
In every patient it is useful to inhibit platelet aggregation (“blood thinning”; in reality, however, it is not the blood that is thinned, but only the sticking of the blood platelets (thrombocytes) to each other that is made more difficult.) This is done with the help of ASASS 100S (Aspirin). Doses of 100mg/d – 300mg/d are prescribed.
Should side effects occur or an intolerance be known, it is possible to switch to Clopidogrel (75mg/d). More recent studies (CAPRIE study) even suggest that clopidogrel is more effective than ASA in peripheral arterial occlusive disease (PAD).
In contrast, anticoagulation (anticoagulation) by Marcumar should only be used if there are other reasons for doing so. This may be necessary if an arterial embolism (vessel occlusion) has already occurred or in the case of special types of arterial occlusion.
If restoration of vessel diameter by catheterization (see below) has not been successful, prostanoids can be administered in stage III and IV.
However, these are not administered in tablet form but intravenously, i.e. injected directly into the vein.
The improvement of blood flow by vascular dilatation is also one of the principles of action of another drug, cilostazol (Pental®, a so-called PDE-3 inhibitor (phosphodiesterase-3-inhibitor)). So far, however, no long-term data are available. The American professional societies recommend these drugs, the German guidelines are currently being revised.
Another procedure, the so-called isovolaemic hemudilutation, a blood dilution, is also supposed to improve the blood circulation.
However, this is only indicated in special cases when there is an excessive number of red blood platelets (erythrocytes) (polyglobulia). In this procedure, 500ml of blood is taken and at the same time 500ml of fluid is replenished by an infusion (usually table salt, NaCl). This reduces the viscosity of the blood.

It is indicated by the hematocrit value (Hkt), which indicates the number of solid blood components in %. By this dilution a Hkt of 35-40% should be achieved. Due to the rare conditions in which this therapy is used, there are no studies on its effectiveness yet.
In more advanced cases, treatment options from heart failure therapy may also be used (see Heart failure).