As of: February 5, 2024 11:07 a.m
Peripheral arterial disease (PAD) – also known as intermittent claudication – is a dangerous circulatory disorder. Targeted walking training can often prevent surgery.
In Germany, around 10 to 20 percent of people over 60 years of age suffer from calcification of the pelvic and leg arteries, a so-called peripheral arterial disease (PAD) or intermittent claudication. In 2018 there were almost 2.3 million people affected, although experts assume that the number of unreported cases is high, as many of those affected do not show any symptoms for a long time or only show them now and then.
When the arteries become calcified – also known as arteriosclerosis – limescale and fat build up unnoticed on the vessel walls throughout the body. The elasticity of the veins gradually disappears and the vessels narrow until they are completely blocked. Smoking, high blood lipid levels and high blood pressure in particular increase the risk. If the legs are affected, in extreme cases this can lead to the leg dying and amputation.
Further information
5 Min
What are the symptoms of the dangerous circulatory disorder? How can surgery be avoided? Expert Dr. Ronja Westphal informs. 5 mins
Symptoms of PAD: Cramp-like pain
Typical of intermittent claudication is diffuse, cramp-like leg pain during exertion, for example when walking, which disappears when at rest. Routes that used to be easy to navigate are increasingly becoming a problem. The muscles hurt because they lack oxygen due to the inadequate blood supply.
Over time, the pain also occurs when resting, especially at night when the legs are horizontal and the muscles do not receive sufficient blood supply. When walking, those affected experience such severe leg pain due to the lack of blood circulation that they have to take breaks again and again until the stabbing pain in their calves subsides.
Pain in the foot, wounds, dry skin and open areas on the legs can also be an indication of intermittent claudication. The problem: In older people, all of this is often dismissed as ailments of old age.
Diagnosis with blood pressure and pulse control, ultrasound and angiography
Peripheral arterial disease is easy to diagnose:
At the Blood pressure control is measured on the arm and ankles. If you then divide the value determined on the leg by the blood pressure measured on the arm, you get the ankle-brachial index. With a Blood pressure control on one toePulse control on the feet, in the back of the knees and groinUltrasound examination and X-ray the leg arteries with contrast medium (angiography)
Early detection also reduces the risk of stroke and heart attack
The earlier intermittent claudication is treated, the easier it is to slow down its progression. This is also extremely important because the heart and cerebral vessels are also affected in most people suffering from PAD. This leads to an increased risk of a stroke or heart attack – more than 75 percent of all PAD patients die from it later on.
The progression of arteriosclerosis can be counteracted with targeted medication and a healthy lifestyle. In any case, those affected must stop smoking.
Walking training instead of surgery: running until the pain threshold
Consistent walking and vascular training is very helpful, as studies show: If those affected are able to walk more than 50 meters at a time, special, preferably guided training can even be more successful than the insertion of vascular supports (stents).
Good instructions are crucial for the success of the sporting activities. If you have been diagnosed with PAD, you are entitled to vascular rehabilitation, during which you will learn the appropriate training. Vascular rehabilitation is recommended with a pain-free walking distance of less than 200 meters. Depending on the location of the constriction, different muscle groups are specifically trained. If the artery in the groin area is narrowed, the nearest muscles in the thighs and buttocks must be specifically trained, for example with the leg press or on the bicycle ergometer. The “foot swing” is important: load the heel and the forefoot alternately. If the cause of the circulatory disorder is lower down, ergometer training is not useful. In this case, it is important to walk as briskly as possible. Those affected should not just walk straight ahead, but uphill and downhill, stepping intensively with their heel and rolling their foot – thereby extending their walking distance.
The key is to go to the pain threshold and beyond. Only when it hurts a little do tiny bypass routes (collaterals), which are important for blood circulation, form and vascular function improves. The muscle strain stimulates the cell power plants (mitochondria), blood flow and metabolism are increased.
Therapy according to guidelines: Pay attention to risk factors
Experts complain that many general practitioners are not aware of the current guidelines for the care of PAD, meaning that those affected do not receive adequate treatment. When treating PAD, three risk factors should always be taken into account and treated:
Thrombosis: New generation blood thinners are intended to protect against blood clots, meaning there is a lower risk of amputations.Cholesterol: New lipid-lowering drugs (PCSK9 inhibitors) are used to combat excessive blood lipid levels.Diabetes: Elevated blood sugar levels can be treated with new anti-diabetes drugs Get a grip.
According to a current study by the University of Münster, in which data from 200,000 patients who had to be treated in hospital because of critical lack of blood circulation in the legs were evaluated, only two thirds of the affected men had been treated with the therapies recommended in the guidelines. The proportion was even lower for women, although they were more likely to develop PAD.
This applied to catheter and vascular surgery procedures as well as medications. The impact on the life expectancy and quality of life of those affected was dramatic: 20 percent had to undergo an amputation during their hospital stay, and a further 18 percent in the following two years. Half of all patients died within four years.
Vasoconstriction surgery with balloon catheter
If arteriosclerosis is already advanced, operations may be necessary. Depending on the extent and location of the vascular narrowing, a catheter procedure, percutaneous transluminal angioplasty (PTA), can be used. The narrow area is expanded with a balloon and, if necessary, additionally supported by a stent. The problem: The procedure can lead to scarring and the vessel can close again.
The risk is lower with a new technology: the bottleneck is expanded Ballonkatheter used that is coated with medication. It is intended to prevent vascular cells from reacting to the operation with increased growth. A stent is no longer necessary. In severe cases, the constriction can also be removed by a Bypass be bridged.
After the procedure, what happens next depends on your lifestyle: smoking, lack of exercise and being overweight damage the vessels and increase the risk of another blockage of the arteries. Those affected should exercise plenty and try to get their weight under control.
Experts on the topic
Chief physician for cardiovascular rehabilitation
Specialist in internal medicine and cardiology
Klosterkamp 1a
23795 Bad Segeberg
Head Physician Department of Vascular Surgery
Alphonsstr. 14
22043 Hamburg
Specialist in internal medicine and angiology
Head physician at the Clinic for Vascular Medicine
Agnes-Karll-Allee 17
25337 Elmshorn
Graduate sports scientist for the field of rehabilitation & prevention
Koppeldamm 1
25335 Elmshorn
www.deutsche-gefaessliga.de/index.php/gefaesssportgruppen
www.dga-gefaessmedizin.de
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Visit | 02/06/2024 | 8:15 p.m