General measures
- Structured vascular training under supervision should be offered to all patients with PAOD as part of their basic treatment. This also applies during follow-up after drug, interventional, or surgical treatment measures. (Consensus recommendation)
- Optimal treatment of concomitant diseases (diabetes mellitus; hypercholesterolemia – increased cholesterol blood lipid levels; hyperfibrinogenemia – increased levels of fibrinogen in the blood; hyperhomocysteinemia – increased levels of homocysteine; hypertension (high blood pressure); renal insufficiency (kidney weakness)).
- Structured gait training – for peripheral arterial disease in clinical stage II according to Fontaine.
- Nicotine restriction (refraining from tobacco use).
- Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
- Limited caffeine consumption (max 240 mg of caffeine per day; equivalent to 2 to 3 cups of coffee or 4 to 6 cups of green/black tea).
- Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis.
- BMI ≥ 25 → participation in a medically supervised weight loss program.
- Review of permanent medication due topossible effect on the existing disease.
Conventional non-surgical therapy methods
Treatment of ulcerations (ulcerations):
- Improvement of perfusion/revascularization as far as necessary and possible.
- Local wound treatment – see under “chronic wound”: removal of necrosis (dead skin), moist wound environment, treatment of infection
- Pressure relief
Vaccinations
The following vaccinations are advised:
- Flu vaccination
- Pneumococcal vaccination
Regular checkups
- Regular medical check-ups, esp. peri- and postinterventional follow-up [S3 guideline]:
- All patients should receive acetylsalicylic acid (ASA) (100 mg) pre-, peri-, and postintervention. Treatment should be continued long-term if there are no contraindications. (Recommendation grade A, evidence class 1).
- After infrainguinal endovascular therapy with stent implantation, temporary combination of ASA with clopidogrel may be recommended to improve the openness rate (consensus recommendation)
- Oral anticoagulants should not be used after percutaneous transluminal angioplasty (PTA; method in which the affected vessel is dilated from the inside with a balloon catheter and, if necessary, stopped with a support (called a stent)) of the femoropopliteal or tibial stroma. (Recommendation grade A, evidence class 1).
- Oral anticoagulants (OACs, group of anticoagulant drugs) should not be routinely used in patients with infrainguinal, femoropopliteal, or distal venous bypass because of a significantly increased risk of bleeding. (Recommendation grade A, evidence grade 2).
- Patients with pAVD should have regular follow-up of cardiovascular risk factors (cardiovascular risks) and vascular comorbidity (concomitant vascular diseases). (Recommendation grade A, evidence class 1).
Nutritional medicine
- Nutritional counseling based on nutritional analysis
- Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grains, vegetables).
- Observance of the following special dietary recommendations:
- Diet rich in:
- Vitamins (folic acid, vitamin B6, vitamin C, D, E).
- Omega-3 fatty acids (marine fish)
- Other micronutrients (L-arginine, L-carnitine, cocoa polyphenols).
- Diet rich in:
- Selection of appropriate food based on the nutritional analysis
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
Sports Medicine
- Light endurance training (cardio training) and strength training (muscle training).
- Structured walking training under supervision and regular guidance: two to three times a week for 30 to 45 minutes leads to a threefold increase in walking performance.
- Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
- Detailed information on sports medicine you will receive from us.
Physical therapy (including physiotherapy)
- Supervised gait training in Fontaine Stages I +II (see below Sports Medicine/Structured Gait Training); gait training can be prescribed using Form K56.
Complementary treatment methods
In stage IV, complementary methods are often performed. These methods include:
- Acupuncture
- Hyperbaric oxygenation (HBO; synonyms: hyperbaric oxygen therapy, HBO therapy; English : hyperbaric oxygen therapy; HBO2, HBOT); therapy in which medically pure oxygen is applied under an elevated ambient pressure.
- Wound cleansing by maggots
- Ozone therapy
Rehabilitation
- An interdisciplinary treatment concept consisting of physiotherapy, occupational therapy, and educational measures for self-responsible management of individual cardiovascular risk factors is required for rehabilitation [S3 guideline].
- Rehab measure are indicated if [S3 guideline]:
- There is a manifest or threatened impairment of participation and there is a (participation) goal to be achieved by rehabilitation.
- The patient is capable of rehabilitation, ie he can actively participate in the treatment offers during rehabilitation.
- A realistic chance exists that the patient can achieve the desired rehabilitation goal.