Peripheral arterial occlusive disease causes

As risk factors are considered: The main cause of peripheral arterial occlusive disease (PAD) is calcification of the arteries (arteriosclerosis). This leads to a narrowing (stenosis) or an occlusion of an artery, which can now only insufficiently supply its supply area with blood. Since the blood transports oxygen in the body and the tissue is dependent on a constant supply of oxygen, pain and even tissue death (necrosis) can result.

  • Smoking (main risk factor)
  • Diabetes mellitus (main risk factor)
  • High blood pressure (hypertension)
  • Lipometabolic disorders
  • Overweight
  • Genetic causes

Therefore, in peripheral arterial occlusive disease, the body tries to find a balance in order to remedy the insufficient oxygen supply. Existing small arteries are now supplied with more blood and begin to grow. They can then transport a larger volume of blood and thus bypass the affected, narrowed artery.

This is called bypass circulation (collaterals). The “residual supply” depends on the length and degree of constriction, as well as on the oxygen consumption of the tissue. In addition, bypass circuits can form to ensure blood supply.

This explains why peripheral arterial occlusive disease often causes no symptoms at first. In addition, an otherwise induced deterioration in physical performance can mask a peripheral arterial occlusive disease. In patients with heart failure (cardiac insufficiency), COPD (chronic constrictive pulmonary disease) or severe bronchial asthma, for example, shortness of breath can mean that they have to stop breathing even before the pain occurs due to exhaustion.

Pain only occurs when the oxygen supply to the tissue is no longer sufficient (ischemia). They then become noticeable in the area behind the constriction. Since our tissue depends on a constant supply of oxygen, tissue death (necrosis) can even occur in the case of severe constriction or total occlusion (see symptoms of pain).

In rare cases, sudden symptoms may also occur (pain, paleness, a feeling of cold, numbness in the legs/arms). In these cases, there may be an acute vascular occlusion caused by blood clots (embolisms or thrombi). In most cases, this cause is found in the area of the vascular bifurcations, as this is a natural vascular constriction.

This causes a sudden oxygen deficiency (ischemia). The symptoms, such as sudden leg or abdominal pain, are more noticeable here, since the bypass circulation (collaterals) could not slowly develop and intensify as in arteriosclerosis (calcification of the blood vessels). A further subdivision of peripheral arterial occlusive disease (pAVK) can be made with regard to vessel size: The disease of the large arteries (e.g. femoral artery) is called macroangiopathy, whereas the disease of the small and smallest arteries is called microangiopathy.

Microangiopathy occurs mainly in diabetics (diabetes mellitus). The subdivision is important for the choice of therapy for peripheral arterial occlusive disease. In the special case of Lériche’s syndrome, occlusion of the bifurcation of the aorta (aortic bifurcation) occurs.

Here, too, arteriosclerosis or a clot (thrombosis, embolism) and the resulting narrowing leads to a reduced supply of oxygen. Due to the special location, additional complaints may occur. In addition to leg pain, paleness and a feeling of cold, there may also be sciatic pain (from the sacrum on the back of the thigh to the hollow of the knee), impotence/erectile dysfunction and disorders of bladder and rectum function.

The causes in M. Winiwarter-Buerger are not exactly clear. This disease is very similar to peripheral arterial occlusive disease and is even considered a rare cause of peripheral arterial occlusive disease. The symptoms are almost the same, but the classic causes of PAD are not found.

However, smoking, genetic predisposition and circulating immune complexes play a major role. The mechanism of development of Takayasu syndrome is also unknown. Takayasu syndrome belongs to the group of vascular inflammations (vasculitis) and is an inflammation of the aorta.It is also one of the rare causes of peripheral arterial occlusive disease.

Symptoms are similar to peripheral arterial occlusive disease, but often affect the arms and may include impaired vision, difficulty chewing, strokes or fainting. Arteriosclerosis is not found here either. The therapy consists of a suppression of the immune system (immunosuppression) and is otherwise similar to that of peripheral arterial occlusive disease.