In peripheral arterial occlusive disease (PAOD) (english peripheral artery occlusive disease, PCWP), it is a disorder of the arterial blood flow to the extremities. The disease is a chronic vascular disease of the arteries. It is caused by narrowing (stenosis) or closing (occlusion) of the arteries supplying the extremities, or more rarely the main artery (aorta).

The main cause is atherosclerosis with about 95%, the so-called “hardening of the arteries.” The complaints of those affected range from asymptomatic on stress-related pain with limitation of walking distance (intermittent claudication), gangrene requiring amputation up to. In Germany suffer, according to the German Society of Angiology – Society for Vascular Medicine around 4.5 million people in a PAD. [1]

Therapy

Objectives are:

• Prevention of heart attack, stroke and sudden cardiac death
• Stop the progression of PAOD
• Avoid amputation
• Improve quality of life
• Relieving symptoms
• Movement gain

 

A AVK (AVK can interchangeably use PAOD) and its risk factors need to be treated. If left untreated could result in death, heart attack, stroke or amputation. [10]

Therapy blocks:
Turning to the risk factors: absence of nicotine, setting of hypertension and diabetes, lowering cholesterol
Gait training: controlled walking up to the pain threshold in order to prolong the pain by improving collateral-free walking distance.

With a consistent walking training improves the blood circulation in the leg and the whole body. By muscle movement may be the bottleneck to form around small blood vessels expand or new. The blood is diverted and fed back the poorly perfused leg regions. The patient has only increased by the activity of less pain, and walking distance significantly. Way to improved quality of life through their own training. Any movement that lowers blood fat and blood pressure, diabetes changed positively, helps relieve stress and lose weight. With each movement also decreases the risk of suffering a vascular occlusion in the leg, a heart attack or stroke. The vascular physician determines the appropriate level of training – in every major city there are vascular sport groups where you can train with others [10].

For patients with PAOD (peripheral arterial occlusive disease is synonymous with PAOD) movement is the most important measure. Endurance sports are the best way to minimize risk factors to prevent coronary heart disease and to prevent an expansion of the disease. It economizes the cardiac output, heart rate and lowers blood pressure, reduces LDL cholesterol, forms collaterals, increasing the number of mitochondria, thus more oxygen is available and increases the general well-being. Conservative treatment is max. to Fontaine stage 2b possible.

Drug therapy:

• Inhibitors of platelet aggregation such as acetylsalicylic acid (ASA) or clopidogrel
• vasoactive substances (naftidrofuryl, prostaglandins)
• Anticoagulants for anticoagulation (after surgery)

Interventional procedures:

• vascular dilatation (percutaneous transluminal angioplasty [PTA]) with possibly with insertion of a stent,
• stent PTA Graphics
• Sympatholysis

Operational measures through the use of vascular prostheses (stents):

Bypass: aortobifemoraler / biiliakaler-Y gastric bypass at

 

Aortic closures

• Femoropopliteal bypass profundaplastiy or in closures in the current path of the femoral artery and outlet of the deep femoral artery,
• Thromboendarterectomy,
• Sympathectomy (L2-L4),
• Interposition

Local measures to improve wound healing in already dying tissue
Amputation fail, when all other measures, not applicable or not primarily are promising.