Circulatory Disorders of the Legs – PAD
Arterial circulatory disorders in the legs caused by arteriosclerosis (peripheral arterial occlusive disease or PAOD) usually become noticeable during physical exertion. The cells suffer from an acute lack of oxygen and nutrients, leading to cramp-like pain in the legs, which sometimes forces the patient to stop walking. Patients can walk short distances before they have to stop – essentially "from shop window to shop window", which is why it is colloquially known as shop window disease. Severe circulatory disorders can also manifest themselves in pain without exertion and non-healing wounds on the legs. At this point at the latest, clarification and therapy are urgently needed.
In stage I (early stage), the narrowing (stenosis) in the vessel is so minor that it does not cause any symptoms. The disease is then usually discovered by chance (e.g. during a vascular examination).
In stage II, patients experience exertion-dependent pain after walking for a more or less long distance, often in the calf (less commonly in the thigh, hip/buttock area or foot).
In stage III, blood circulation continues to deteriorate. The pain occurs even at rest, especially when the legs are flat (nocturnal or constant pain at rest).
In stage IV, the circulatory disorder leads to dead tissue, usually on the toes, ankles or heels. Small wounds no longer heal, but become larger and larger.
From stage III onwards, there is an immediate risk of amputation!
Examination methods
Typical signs of circulatory disorders in the legs are absent or weak pulses over the leg arteries, pale, cold legs or non-healing wounds. Many narrowings or blockages can be detected or localised with an ultrasound examination.
Other diagnostic methods include X-ray examination (angiography), computed tomography and magnetic resonance angiography (MRI) – each using a contrast agent that is injected into the vessels to make them visible. In addition, there are a number of other examination methods (e.g. measuring the oxygen pressure in the tissue or examining small vessels in the nail bed under a microscope), each of which can be used for specific purposes.
Treatment methods
There are many options for treating narrowing and blockages of the arteries:
In many cases, the narrowing of the vessels can be treated using gentle, so-called endovascular procedures. Vascular dilation using a balloon (PTA) or stents is usually the first treatment option. With the aid of wires and catheters, most vessels can be reached after a puncture in the arms or legs. In most cases, these procedures can be performed under local anaesthetic.
Sometimes open surgery is necessary. In this case, the affected vessels are exposed, the calcium is removed or a so-called expansion plasty is performed. In the case of long-distance occlusions, bypass surgery may be necessary. This involves diverting the blood around the diseased area using a natural or artificial vessel replacement. The body's own veins are preferred for bypass surgery.
Medication can help with circulatory disorders. These are mostly preparations that inhibit blood clotting (so-called platelet function inhibitors such as ASS). Special preparations for lowering blood lipids have also proven to be an effective support for the treatment of circulatory disorders.
Be cautious with unconventional methods: resist methods whose scientific benefits have not been proven (e.g. oxygen, ozone, autologous blood, fresh cell or chelation therapy).
Complementary measures
If blood flow is only slightly restricted or if there are still sufficient bypass vessels in the body, controlled walking training can improve symptoms. We recommend daily walking training of at least 30 minutes.
In any case, discuss this with your doctor beforehand to ensure that walking training, toe stand exercises, knee exercises or cycling do not do you more harm than good. Sometimes, findings may indicate that certain forms of exercise are not advisable. In general, it is important to remain mobile.
Prevention
High blood pressure, smoking, diabetes mellitus, poor diet and lack of exercise are risk factors for the development and worsening of circulatory disorders. These can lead to "intermittent claudication" and/or "smoker's leg" with the threat of amputation. Heart attacks and strokes can also be the result. In any case, they reduce quality of life and can quickly have life-threatening consequences. It is therefore important to prevent vascular diseases, detect them as early as possible and have them treated in a targeted manner.
In episode 6 of our podcast "Focus on Blood Vessels", you can learn more about PAD.