circulatory disorders
Window shopping disease and
circulatory disorders
One of the most common circulatory disorders of the legs is intermittent claudication. This condition causes narrowing (stenosis) of the arteries due to progressive calcification, which is responsible for the symptoms. The medical term for this condition is "peripheral arterial disease," or PAD for short. The term "intermittent claudication" has become established in common parlance because those affected have to stop walking after a certain distance due to increasing pain or cramps in their legs and end up looking at shop windows. Some patients also describe the discomfort as "a feeling of the calf being locked in a vice." The pain is caused by a lack of oxygen in the stressed leg muscles, as the blood can no longer supply the muscles with sufficient oxygen due to the existing narrowing of the blood vessels . The symptoms mainly occur in the calves and thigh muscles, and occasionally also in the gluteal muscles. As the condition progresses, pain can occur even at rest – in the worst case, there is even a risk of losing the leg.
Different stages according to the Fontaine classification
According to Fontaine, window shopper's disease is divided into four different stages:
The therapy
Combined treatment for window shopping syndrome
There are several options for treating peripheral arterial disease:
The basic approach for all forms of treatment is to take blood-thinning medication, which improves blood flow. The most important medication in this context is acetylsalicylic acid, taken once a day in combination with a lipid-lowering drug, statin.
In addition, there is movement and walking training to continuously improve the pain-free walking distance. This is usually offered by vascular sports and PAD self-help groups.
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If this does not sufficiently alleviate the symptoms, an invasive catheter examination (angiography) with dilation of the narrowed areas (balloon PTA) or reopening of the blocked vessel (known as arterectomy) may be considered. A stent ("vascular support") may be inserted to keep the vessel open for longer afterwards.
The third option is surgery, in which the vessel is cleaned using a procedure known as patch plasty, or a bypass is created using the patient's own vein or synthetic material to bypass the vessel occlusion, which is usually longer in length.
A change in lifestyle and diet and quitting smoking are essential additions to the treatment—sometimes the most difficult part of the entire therapy. Regardless of the stage of the circulatory disorder or the chosen therapy that is used for you, the following applies:
If it is successful, you will primarily regain mobility and thus a large part of your quality of life.
If this does not sufficiently alleviate the symptoms, an invasive catheter examination (angiography) with dilation of the narrowed areas (balloon PTA) or reopening of the blocked vessel (known as arterectomy) may be considered. A stent ("vascular support") may be inserted to keep the vessel open for longer afterwards.
The third option is surgery, in which the vessel is cleaned using a procedure known as patch plasty, or a bypass is created using the patient's own vein or synthetic material to bypass the vessel occlusion, which is usually longer in length.
A change in lifestyle and diet and quitting smoking are essential additions to the treatment—sometimes the most difficult part of the entire therapy. Regardless of the stage of the circulatory disorder or the chosen therapy that is used for you, the following applies:
If it is successful, you will primarily regain mobility and thus a large part of your quality of life.
Frequently asked questions about "peripheral arterial disease (PAD)"
The first signs of peripheral arterial disease (PAD) are pain in the calf, thigh, or buttock muscles when walking after a certain distance. Some patients also feel as if their calf is clamped in a vice. Due to the arterial circulatory disorder, the leg or buttock muscle does not receive enough oxygen under stress, and this lack of oxygen causes pain in the muscle – a kind of muscle soreness – which ultimately forces the patient to stop walking. Since affected people often pretend to be looking at a shop window (but are actually stopping because of muscle pain), this condition has been given the name "window shopping disease."
First, the patient's symptoms are recorded in an initial consultation, and then the pulses in both legs are palpated during a physical examination. This is followed by a Doppler occlusion pressure measurement, in which a blood pressure cuff is used to measure blood flow in both arms and legs and the measured values are compared with each other. In healthy individuals, the blood pressure measured in the legs is higher than in the arms or at least the same; in patients, it is lower than in the arms. Finally, a special vascular ultrasound (known as duplex) is used to visualize the vessel directly and examine it for possible calcification or narrowing.
Exercise and sport are essential pillars of therapy in the treatment of stage I or II PAD. Sufficient physical exercise, ideally intensive walking training as part of a self-help group, can lead to blocked arteries being bypassed naturally without surgery through the formation of new blood vessels (natural bypass). The first signs of success from walking training usually become apparent after 3 months. However, it is important to stop smoking completely, as nicotine quickly closes the newly formed small blood vessels again, thereby negating the effect of the walking training. In addition, it is advisable to take an antiplatelet agent once a day to minimize the risk of blood clots forming in the narrowed blood vessels.
PAOD (peripheral arterial occlusive disease) is divided into four stages:
Im Stadium I bestehen keine Beschwerden in den Beinen beim Gehen, obwohl bereits Durchblutungsstörungen vorliegen. Dies ist zunächst für den Patienten ungefährlich, kann aber ein Hinweis auf z.B. auch Durchblutungsstörungen auch am Herzen sein und sollte deswegen weiter abgeklärt werden. Im Stadium II liegt die sogenannte Schaufensterkrankheit vor, bei der nach einer gewissen Gehstrecke Schmerzen in der Muskulatur im Bein auftreten, meistens in der Wade, die zum Stehenbleiben zwingen. Das Stadium II wird noch unterteilt in ein Stadium IIa (schmerzfreie Gehstrecke > 200 Meter) und Stadium IIb (schmerzfreie Gehstrecke < 200 Meter). Im Stadium III liegen Ruheschmerzen vor, d.h. der Patient hat insbesondere nachts im Liegen Schmerzen im Bein und muss das Bein heraushängen lassen, damit die Beschwerden besser werden. Und im Stadium IV bestehen offene Stellen der Haut, die nicht mehr verheilen. Im Stadium III und IV besteht eine unbedingte Therapienotwendigkeit, um dem Verlust des Beines durch eine drohende Amputation vorzubeugen. Im Stadium I und II besteht eine sogenannte Life-Style-Behandlungsindikation, d.h. der Leidensdruck des Patienten entscheidet darüber, ob eine Behandlung durchgeführt werden sollte oder nicht.
The range of treatments for peripheral arterial disease extends from intensive walking training and smoking cessation to taking blood-thinning medication, catheter examination of the vessels with balloon angioplasty (PTA) and stent placement (known as intervention), or even surgical treatment. The decision on the treatment method to be used depends on the type and extent of the vascular changes and the patient's wishes. In an intervention, the calcifications are pushed away or removed using a catheter and a balloon or a vascular burr and then, if necessary, kept open with a stent. During surgery, the calcifications are removed from the vessel or bypasses are created to bypass a long-distance blocked blood vessel.
Impressions from practice
