(peripheralarterialocclusivedisease, pAVK)
in co-operation with interventional radiology/angiology
PAD is a narrowing of the arteries in the limbs that can lead to a circulatory disorder. The legs are typically affected. Due to circulatory disorders in the legs, muscle pain occurs in the legs after walking a certain distance, which often forces patients to take breaks when walking, which is why the disease is also commonly known as "intermittent claudication".
The causes are vascular calcification (arteriosclerosis), which is promoted by smoking, high blood pressure (hypertension) and diabetes mellitus.
Symptoms
Depending on the degree of vasoconstriction or vascular occlusion, the symptoms can vary.
The first typical symptoms are muscle pain in the calves, thighs or buttocks after walking a certain distance.
If the disease progresses and the blood flow continues to decrease, cramp-like pain occurs in the area of the affected extremity even at rest. The pain is often felt in the foot or toes at night.
If the circulatory disorder continues, tissue dies, usually first in the toes and foot. If no rapid and comprehensive treatment is given at this stage, infection can lead to blood poisoning.
Diagnostics
The first step is a physical examination of the patient, during which pulses are palpated and skin conditions are assessed.
Blood pressure is measured in the arms and legs to diagnose PAD. A treadmill analysis is carried out to determine the walking distance.
As an imaging diagnosis, an ultrasound examination is carried out first, which is often supplemented by magnetic resonance imaging or computer tomography with contrast medium (MR angiography, CT angiography).
Therapy
If the circulatory disorder is not yet very advanced, consistent and intensive walking training can achieve a significant improvement in symptoms.
In addition, risk factors such as smoking, high blood pressure, lipometabolic disorders or diabetes mellitus should be optimally treated or avoided.
If walking training is not sufficient or not suitable for the patient, the first step is to try to expand the narrowed vessel using a balloon under local anaesthetic in a minimally invasive procedure (endovascular) and possibly insert a stent to keep the vessel open.
In other cases, the improvement in blood flow can only be achieved through surgery. This involves removing the calcium from the vessel or bridging narrowed or blocked vessels with the body's own vessels or artificial tissue (bypass operation).
In addition, accompanying therapies such as infusions to improve blood flow (prostaglandin therapy) or CT-supported sympathicolysis can be carried out. In this procedure, the sympathetic nerves responsible for the constriction of the vessels are specifically switched off under computerised tomographic control.
