Definition
Peripheral arterial occlusive disease is a disease of the vessels. In pAVK, constriction (stenosis) or occlusion of the aorta or the arteries of the arm and leg, usually chronic, occurs. The arteries of the legs are most frequently affected (~90% of cases).
In more than 95% of cases, calcification of the arteries (arteriosclerosis) is responsible, more rarely inflammation of the vascular walls (vasculitis, e.g. M. Winiwarter-Buerger). While initially no symptoms are noticeable, those affected notice pain when walking, as well as pale and cold legs as they progress. This can increase to pain at rest or even tissue death (necrosis).
Synonyms in a broader sense
Special Forms English: Peripheral Arterial Occlusive Disease (PAOD)
- Arterial occlusive disease (AVK)
- Shop window disease
- Intermittent claudication
- Smoker’s leg
- Chronic arterial occlusive disease of the extremities
- Lériche Syndrome (special form of PAVK)
- Winiwarter-Buerger’s disease (rare cause of PAVK, also: Buerger’s syndrome, thrombangiitis obliterans (TAO)English: Buerger’s disease
- Takayasu syndrome (rare cause of PAVK)
Stages of peripheral arterial occlusive disease
The stages of peripheral arterial occlusive disease are classified according to the symptoms according to “Fontaine”. Stage I is usually an incidental finding during a medical examination, for example when the pulses on the extremities are difficult to palpate. In this stage the constrictions are very small and do not cause any discomfort for the person concerned.
Should leg pain occur, it must be taken seriously. In stage II, the peripheral arterial occlusive disease already causes the patient some discomfort. The constrictions are so far advanced that it comes to the picture which has given the peripheral arterial occlusive disease its nickname “shop window disease”: After a few metres of walking, leg pain (intermittent claudication) occurs due to an undersupply of oxygen from the blood to the muscles (calves, thighs, buttocks).
After a rest period, these symptoms improve. Stage II is subdivided into stage IIa, in which the walking distance without symptoms is greater than 200 metres. In stage IIb the described complaints occur below 200 meters.
The level of suffering is particularly high in stage III, as the pain also occurs at rest and is particularly pronounced when lying down. In the further course of the disease (stage IV) the tissue is damaged by the severe circulatory disturbance: chronic wounds, dead tissue and ulcers can occur. Here, amputation cannot be ruled out in order to prevent an inflammation from spreading from these sites in the body.
Frequency
About 3% of the population over 60 years of age suffer from symptomatic peripheral arterial occlusive disease (PAD), i.e. they have symptoms. It occurs particularly frequently among smokers, as smoking is the most important risk factor. With increasing age, the frequency of PAD increases and is found in over 5% of people over 70.
Men are affected 4 times as often as women. About half of those affected suffer from narrowing of the femoral arteries, the pelvic arteries are affected in one third and the arteries of the lower leg and foot in only about 15%. Since the narrowing can occur at different sites and be of varying severity, the symptoms also differ.
What they all have in common, however, is that only after 90% of the narrowing has occurred is the pulse (transmitted heartbeat) below (distal) the narrowing no longer palpable. Even at this stage, however, those affected can still be free of symptoms. This depends on the bypass circulation (collaterals) as well as the general physical resilience (e.g. due to other diseases such as cardiac insufficiency).
The first complaints that sufferers often notice are pain during exertion, usually when walking (uphill), climbing stairs or doing sports. These occur beyond (distally) the constriction and are therefore dependent on the location of the change. They usually manifest themselves in a cramp-like, later on stabbing and knocking feeling.
This pain forces the affected person to stop walking after a certain distance. The pain then disappears again after some time. The tissue has to do more work under stress and therefore consumes more oxygen for energy production.
As soon as one comes to rest, this oxygen requirement decreases again and the pain disappears. Many patients are therefore only able to walk short distances. In order not to attract attention, they stop after a certain distance and look at the shop windows again and again, just like when they go window shopping.
This has led to pAVK also becoming known as “shop window disease” (Claudicatio intermittens). Pain in the lower leg is very typical. Other causes of pain in the lower leg can be found under: Pain in/on the lower leg The pain is caused by a lack of oxygen in the tissue (ischemia) of the affected leg (arm). In addition, the affected limb often becomes especially the feet, pale and cool.
