A short introduction to Peripheral Arterial Disease (PAD)

It typically causes pain when walking and due to its frequent connection with smoking, it is also commonly referred to as „smoker‘s leg“ or „shop window disease“. Sufferers have to repeatedly stop, e. g. in front of shop windows, until the pain has subsided .

What are the most important symptoms? Depending on the severity of the PAD, it is usually divided into four stages.

Severity classification according to Fontaine

Stage I No Symptoms

Stage II Claudicatio intermittens IIa Walking distance > 150 m IIb Walking distance < 150 m

Stage III Resting pain

Stage IV Manifest tissue damage

In stage I, patients do not (yet) show symptoms, but if the disease progress es and the vessels become more narrowed, the following symptoms may appear:

Pain, when walking (also called “ intermittent claudication ”)

Pain, at rest (in the extremities)

Dead tissue areas (necrosis, for example on the feet)

Coldness in the lower leg or foot

Leg numbness or weakness

No pulse or a weak pulse in the legs or feet

Painful cramping in one or both of the hips, thighs or calf muscles after certain activities, such as walking or climbing stairs

Shiny skin on the legs

Skin color changes on the legs

Slower growth of the toenails

Sores on the toes, feet or legs that won‘t heal

Pain, when using the arms (such as aching and cramping when knitting , writing or doing other manual tasks)

Erectile dysfunction

Hair loss or slower hair growth on the legs

What causes are possible? PAD is almost always caused by arteriosclerosis. The arteries of the pelvis and legs are particularly affected . Important risk factors for the calcification process are:

Smoking

Diabetes

High blood pressure

Obesity

Heredity

Lipometabolic disorder s

How is PAD diagnosed? The diagnosis of PAD is relatively simple, especially in the presence of typical symptoms. Comparing blood pressures on the legs with the arms can already quantify the degree of constriction quite accurately. The gold standard of diagnostics is the contrast imaging of the vessels by catheter technique. Moreover, it can also be used for direct treatment in a single session by inserting a stent into an easily accessible constriction. It allows even very small vessels and stents to be visualized. In addition, ultrasound shows the constrictions and the flow conditions in the blood vessels. Computer tomography or magnetic resonance tomography provide excellent imaging of all major vessels in the body.

What is the therapy for PAD? The treatment of PAD is intended to improve the patient‘s quality of life and to avoid amputations (that may become necessary as the disease progresses).

There are several strategies to achieve this:

controlled walking training

medication

catheter interventions on the vessels

vascular surgery procedures

avoiding nicotine

treatment of high blood pressure

treatment of diabetes

lowering of cholesterol levels

These treatments include:

tailored pain therapy

protection of the affected limbs from pressure (no compression stockings!) and cold (which has a vasoconstrictive effect)

preventive foot care to prevent wounds or to detect lesions at an early stage

consistent cleaning and disinfection of existing wounds plus possibly taking antibiotics in the case of wound infection

positioning affected limbs below heart level when lying or sleeping

avoidance of medications that have a vasoconstrictive effect (inc. Nicotine)

therapy of accompanying heart and lung diseases

When is surgery indicated? In some cases, a revascularization (surgery) is indicated. For example, if your leg pain is strong enough to prevent you from doing everyday activities, or if your symptoms have not responded to the above treatments.

There are two main types of revascularisation treatment for PAD:

Angioplasty : a blocked or narrowed section of artery is widened by inflating a tiny balloon inside the vessel.

Artery bypass graft: blood vessels from another part of the body are used to bypass the blockage in an artery.

Which procedure is best? An angioplasty is less invasive than a bypass. It does not involve making major cuts ( incision s) in your body and is usually performed under local anesthesia. You‘ll be able to go home on the day of the operation, and you may recover more quickly. For this reason, angioplasty is generally preferred to bypass surgery.

By contrast, the results of a bypass are generally considered to be longer-lasting than those of an angioplasty.

Both angioplasty and bypass surgery carry a low risk of serious complications, such as a heart attack , stroke or death.

EXERCISE:

1. There are absolutely no risks associated with either angioplasty or bypass surgery. A) True B) False

2. In stage I, the patient has already resting pain. A) True B) False

3. What causes PAD?

A) Smoking B) Lipometabolic disorders C) High blood pressure D) Obesity E) Allergies

You’ll find the answer below.

BIBLIOGRAPHY 1. www.dict.cc 2. www.heart.org 3. www.hopkinsmedicine.org 4. www.merriam-webster.com 5. www.nhs.uk 6. www.unimedizin-mainz.d

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTL. Sie gründete 1998 in Berlin lobitz seminare, die unter anderem Englischseminare für Health Professionals anbieten.

Kontakt: mail@lobitz-seminare.de

www.lobitz-seminare.de

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Lösung für Exercise:

1. B)

2. B)

3. A)–D)

A short introduction to Peripheral Arterial Disease (PAD)

What are the most important symptoms?

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A short introduction to Peripheral Arterial Disease (PAD)

What are the most important symptoms?

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