In the context of diseases of the cardiovascular system, very different clinical pictures occur, which affect not only the heart, but likewise the blood-carrying vessels and the involved organs. This also includes peripheral arterial occlusive disease, or pAVK for short.
What is peripheral arterial disease?
Hardening of the arteries can quickly lead to a heart attack or stroke. Peripheral arterial occlusive disease is also abbreviated in the medical community as pAVD and is based on a predominantly mechanical impairment of unrestricted blood flow through the arteries. Peripheral arterial disease is so named because over time the arteries can become blocked, which is an interruption of blood flow. As a result, pAVD is one of the life-threatening health conditions that is predominantly confined to the lower extremities. Rather rarely, peripheral arterial disease occurs in the arms. In colloquial use, peripheral arterial occlusive disease is often referred to as shop window disease, which is recognizable by quite typical symptoms and can limit the quality of life of those affected quite enormously.
Causes
A typical reason why peripheral arterial occlusive disease can develop is existing arteriosclerosis, within which blood vessels become clogged with solid micro-deposits. In this context, arteriosclerosis not only occurs in the venous and capillary vessels, but is also considered a direct trigger for pAVD. The primary causes and risks that can trigger peripheral arterial disease include the same factors that are relevant to atherosclerosis. In addition to the consumption of nicotine and alcohol, these include various pre-existing conditions such as high blood pressure, diabetes mellitus, and obesity, which is associated with high cholesterol and fat levels in the blood. Lack of exercise and individual hereditary factors also play a role in peripheral arterial disease.
Symptoms, complaints, and signs
The disease is divided into four stages. At onset, in stage I, symptoms are still absent. Although the vessels are gradually narrowing already, nothing is felt by the affected person yet. Because of the absence of symptoms, the disease is usually not detected at this stage, even if it could already be diagnosed during an appropriate examination. In stage II, the first pain can be felt in the legs, and this always occurs when the patient has walked a distance of about 200 meters. He has to stop and wait again and again, because when standing, the legs stop hurting. This is called load-dependent pain. Once stage III is reached, painful legs occur even at rest. Whether the affected person is lying or sitting, the muscles hurt. Walking is almost no longer possible, or only with pain. In stage IV, the skin begins to change because the tissue is no longer supplied with enough oxygen due to the reduced blood flow. Ulcers develop on the heels and toes and, in the further course, the tissue dies. It turns black and begins to rot. If these necroses progress further, amputation of the leg may be necessary.
Diagnosis and progression
The symptoms, which are noticeably triggered by peripheral arterial disease for those affected themselves, consist of pain, general physical weakness, and lack of strength. In addition, people who suffer from pAVD have pale skin and often suffer from cold feet. Pain from peripheral arterial disease is mostly felt in the legs and is primarily localized to the calf muscles. For this reason, patients with pAVD have to stop constantly when walking and it seems as if they are looking at the shop windows. This conspicuousness is caused by peripheral arterial disease only when the advanced stage has already been reached. PAD can be accurately detected with basic and subsequent differential diagnostics.
Complications
The development and progression of peripheral arterial disease (pAVD) is favored by several factors.In principle, this is arteriosclerosis, which leads to circulatory disorders and causes secondary damage, especially in the legs – to a much lesser extent also in the arms. If the causative factors that have led to the development of arteriosclerosis are not eliminated, further complications arise in addition to severe and sometimes cramping pain in the calves and the remaining leg and buttock muscles. Locally occurring complications may include open, poorly healing wounds, with some necrotizing tissue as stenoses in the corresponding arteries progress. If left untreated, pAVD may even require amputation as a final treatment step in its advanced stages. The further complications can also be independent of local effects of the affected arteries of the extremities, because the basic disease, arteriosclerosis, can also extend to other arteries and to the arterial coronary vessels. As a result, the risk of suffering a heart attack or stroke increases dramatically. In order to be able to limit the risk of stroke, it is therefore recommended to examine the carotid arteries for arteriosclerotic changes due to plaques. If pAVD is detected at an early stage and the causes of the arteriosclerotic changes can be successfully eliminated, there is a chance that symptoms will resolve and a return to symptom-free life is possible.
When should you see a doctor?
A doctor should be consulted at the first signs of peripheral arterial disease. If circulatory problems, dizziness and other unusual symptoms are noticed, this indicates a condition that needs to be clarified. 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” for this purpose. Thereafter, the check-up should be carried out every two years, because in this way cardiovascular diseases, kidney diseases and diabetes can be detected at an early stage. Peripheral arterial occlusive disease mainly affects people who lead an unhealthy lifestyle, are alcoholics or overweight, or have a genetic predisposition. Anyone who is affected by these risk factors should see their primary care physician promptly. Optimally, the triggers are corrected before peripheral arterial disease can develop. In addition to the primary care physician, an internist or cardiologist may be consulted. Physical therapists, nutritionists, alternative physicians, and therapeutic specialists are involved in therapy, depending on the cause.
Treatment and therapy
The therapy that can successfully cure peripheral arterial disease is exceedingly comprehensive, as pAVD can be divided into several degrees of severity. In addition, each degree of severity of peripheral arterial disease is associated with various symptoms and risks, which it is largely important to reduce. In order to be able to treat pAVK in a targeted manner, several therapy methods are required in combination. These relate to stopping nicotine consumption and reducing physical overweight, as well as a healthy, balanced diet coupled with regular exercise. The goal in peripheral arterial disease is to lower cholesterol and high blood pressure and to restore blood flow to the arteries. In order to prevent a heart attack or stroke caused by pAVD, medicinal procedures as well as so-called interventional and surgical techniques are performed. Interventional procedures for the treatment of arterial occlusive disease involve dilating the affected sections of the arteries with a surgical balloon or interrupting the nervous conduction of impulses.
Outlook and prognosis
The prognosis for peripheral arterial disease depends on successful treatment of the precipitating causes. If treatment fails or is unsuccessful, the severe disease takes its course unimpeded. However, it is quite possible to make the prognosis more positive if the patient adopts a healthier lifestyle. This includes a balanced diet, avoiding tobacco products, reducing excess weight and regular exercise.Achieving normal blood pressure, blood lipid and blood sugar levels also has a positive effect on the progression of PAOD. If the patient also suffers from diseases such as diabetes mellitus (diabetes) or high blood pressure, it is important to treat these specifically and consistently. Basically, the life expectancy of people suffering from peripheral arterial occlusive disease is considered to be lower. The reason for this is the vascular diseases that occur in addition. As a rule, the prospects of the disease also depend on the time between the first appearance of symptoms as well as a successful vascular reopening. If, in the case of an arterial occlusion in the leg, the period is less than six hours, the leg can be preserved in 96 percent of all patients. However, if more than 12 hours elapse, amputation must be performed in about 40 percent of all affected patients. In acute arterial occlusion, the survival rate of sufferers after surgical intervention is about 80 percent.
Prevention
For prevention of peripheral arterial disease, it is beneficial to eliminate all risk factors that promote high blood pressure, obesity, and diabetes mellitus. If these conditions are already present, optimal treatment should be provided. Regular checks and adjustments of blood glucose levels are equally 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 PAOD. This is the only way to achieve a long life expectancy with the best performance.
Follow-up
Follow-up care for peripheral arterial disease is exceedingly important. Its goal is to keep the arteries open. Renewed narrowing or the formation of blood clots should be avoided at all costs. Another post-treatment goal is to improve or maintain the quality of life. The aim is to reduce the risk of stroke or heart attack. One of the most sensible measures in PAVK aftercare 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 physician. Together with the family doctor, the patient works on a healthier lifestyle, 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 monitoring program should last at least two years. In principle, all PAVK patients must have medical monitoring for the rest of their lives. In order to support the follow-up treatment, it is advisable to complete a walking training program. It is advisable to do it in a vascular sports group. The ABI value is checked by the vascular physician both after stress and at rest. With the help of duplex sonography, the physician also checks the vascular condition. Medications administered during PAVK follow-up are platelet function inhibitors such as clopidogrel or acetylsalicylic acid. They are mostly used during the main treatment.
Here’s what you can do yourself
Managing daily life and self-help options depend on the severity of peripheral arterial disease (pAVD). In stages I and II, where there is only minor impairment or walking distances up to 200 m can be managed relatively well, self-help measures are mainly aimed at controlling the causes of pAVD. For example, in smokers, a cessation of smoking, in existing diabetes, a good adjustment of sugar levels and in hypertensives, a good adjustment of blood pressure can lead to a significant improvement in symptoms. Significant overweight is also among the risk factors that favor pAVK. In addition, regular exercise, as far as possible, has a positive effect on pAVK. A regular extra portion of omega-3 fatty acids has a positive effect. For example, a single tablespoon of cold-pressed linseed oil daily can help reduce the arterial inflammatory processes that ultimately cause arterial constriction in the extremities.A low ratio of omega-6 to omega-3 fatty acids of about 2:1 to a maximum of 5:1 is important in order to combat arterial inflammatory processes by natural means. The extent to which elevated cholesterol levels, especially increased LDL concentrations with a simultaneously lowered HDL fraction, play a significant role as causative factors for pAVK is controversially discussed. An LDL to HDL ratio of less than 3.5 is considered beneficial for health with an anti-inflammatory effect on the arteries.
