Therapy of peripheral arterial occlusive disease (vascular surgery)

The key measures are:

• Stop smoking.
• Eat healthy.
• Exercise regularly, at least 30 minutes a day, every day of the week.

Walking training can extend the walking distance for people with PAD

Walking training can help people with PAD. Walk at a brisk pace until the pain sets in. Take a break until the pain subsides and then continue training. You can complete gait training under the guidance of occupational therapy or as part of a walking group. If you exercise for about an hour a day, the blood circulation in your legs will improve because existing small blood vessels (bypass circulation) will strengthen over time and can compensate for a blockage or bottleneck in a main vessel. They restore the blood supply. Blood pressure and blood lipids also fall thanks to exercise.

Foot care is important for people with PAD and diabetes

If you are affected by diabetes mellitus as well as PAD, make sure you take good care of your feet. This is because diabetes also affects the nerves and you will no longer feel any wounds. There are specially trained chiropodists who dedicate themselves professionally to your feet. If wound healing no longer works properly, even minor wounds can become a problem. They can become infected if bacteria and other germs get in. There is then a risk that the wounds will become chronic and no longer heal. Sometimes the tissue dies due to the reduced blood supply. We have to treat these necroses by carefully removing the dead tissue. PAD patients and patients without diabetes can feel pressure points and wounds on their feet as normal.

Medication for PAVK

We also treat existing underlying diseases with medication. There are effective remedies for:

• High blood pressure: specific antihypertensive or diuretic medication
• Elevated cholesterol levels: e.g. statins
• Diabetes: antidiabetics, insulin

It is important that you take this medication regularly. A healthy diet and sufficient exercise also help with these diseases. Drugs that prevent blood clots (thrombi) in the blood vessels are also effective. Platelet aggregation inhibitors (platelet inhibitors), such as the active ingredients acetylsalicylic acid and clopidogrel, are used, for example.

Balloon dilatation and surgery

There are various ways in which we can reopen constricted or blocked vessels. The right choice depends on the exact location and nature of your vascular problem, as well as your age and symptoms, and the right treatment strategy is therefore always determined on an individual basis.

However, there are situations in which these interventions are not possible or sensible or, based on experience, do not promise long-term success and therefore cannot be primarily recommended.

Surgery

There are a number of different strategies for the surgical treatment of PAD. The most common are bypass (detour) and thrombendarterectomy (excision). Operations are usually performed under general anesthesia.

• Bypass: We bridge the blocked vessel. We are therefore creating a kind of “detour” to ensure blood flow in the future. To bridge the gap, we either take a superficial vein from the same or another limb or use a woven (Dacron) or molded (PTFE) plastic prosthesis. The bypass is an option for long-distance vascular occlusions where balloon dilatation and stenting do not lead to success.
• Thrombendarterectomy (peeling): At easily accessible sites, usually the inguinal arteries, and severe local constrictions, the calcific plaques can be peeled out of the wall. The remaining wall layers are strong enough to withstand the blood pressure. The vessel is then closed again using a patch made of vein or plastic to prevent subsequent narrowing due to scarring of the vessel wall.