The blood vessels or veins are the life-bringing rivers of the body.

PAD is the most common arterial vascular disease, which is caused by arteriosclerosis (hardening of the arteries) of the vessels, mostly in the lower extremities. Risk factors such as smoking, high blood pressure, high cholesterol level, diabetes mellitus etc. favor the development of arteriosclerosis, which can lead to reduced blood flow, vascular occlusions and heart attacks.

PAD is initially symptom-free in over 3/4 of the patients and is often discovered as an incidental finding. Depending on the stage of the disease, the symptoms of reduced blood flow can range from a feeling of coldness in the affected extremity, to muscle pain during exercise, to painful ulcers on the lower extremity and, as a result, loss of legs. The name "intermittent claudication" describes the symptoms of PAD very clearly: The reduced blood flow to the affected extremity results in stress-dependent pain that prevents the patient from continuing, so that at certain intervals, e.g. B. must stop in front of a shop window. At rest, the muscles require less blood flow, which is why the pain caused by insufficient blood flow disappears after a while. Only now can the patient go on until the pain occurs again. This symptom is also known as intermittent claudication.

Based on the pain-free walking distance, the stages can be divided according to Fontaine:

Grade I corresponds to a symptom-free condition.

Grade II describes the pain-free walking distance of a over 200m and b under 200m.

With PAD Grade III , the pain persists even at rest.

Grade IV describes the most advanced stage of the disease with ulcers on the lower extremities.

If the typical symptoms of intermittent claudication occur, a doctor should be consulted, who can then diagnose PAOD with the help of some diagnostic aids. One of these examinations is duplex sonography, in which the vessels can be visualized and flow conditions recorded in them. Furthermore, the Doppler index is determined, which provides information about the severity of the constriction in the vessels. Here the systemic blood pressure is related to the occlusion pressure on the arteries of the foot. Angiography is performed to get a concrete impression of the situation and to visualize the arterial blood vessel system. The most modern and least stressful is magnetic resonance angiography.

If the diagnosis of PAOD has now been made, a suitable therapy is created depending on the findings. The basic therapy includes walking training and the administration of platelet aggregation inhibitors (e.g. ThromboAss), which reduce the risk of vascular occlusion. In principle, interventional radiological procedures are available in which constrictions are expanded or short closures are reopened and provided with a stent, and surgical rehabilitation. Here the vessels are opened and the calcified plaques are removed (thrombendarterectomy) or a bypass is created - a bypass. There are limits to both techniques and an individual decision is made as to which method is best used. If neither interventional nor surgical rehabilitation is possible, drug therapy with prostanoids (prostavasin) is available. This medication has a vasodilator effect with modest success, which is why it is only used as the second choice.

Leg exercises for arterial circulatory disorders

Varicose veins (varices) are pathologically dilated veins with non-functional venous valves. In addition to the aesthetic impairment, unspecific complaints such as heaviness, swelling, pain and nocturnal calf cramps in the legs can occur. Complications such as varicophlebitis, i.e. inflammation of the veins and chronic venous congestion syndrome with skin changes and ulcers, can occur.

The presence of varices can usually be seen after a physical examination, but should be confirmed with further diagnostic measures such as duplex sonography and venography in order to be able to plan the therapeutic strategies. A prerequisite for varicose vein therapy is an open deep leg vein system.

For the treatment of varicose veins, both conservative and surgical measures are available, which can be discussed and planned individually with the patient. As a conservative therapy, treatment with support stockings and medication are available, which are intended to improve the flow in the blood vessel. Surgical therapy includes interventions such as classic variceal surgery, minimally invasive surgery, laser surgery, foam sclerotherapy and endoscopic subfascial perforation ligature.

Chronic venous insufficiency (CVI) is caused by microcirculation disorders in the deep venous system. The typical symptoms are leg edema and skin changes such as pigment shifts, indurations and ulcers on the lower extremities. The therapy consists of consistent compression therapy with support stockings, gymnastics and the implementation of thrombosis prophylaxis with heparin or oral analogues such as Marcoumar, Eliquis, Xarelato, Pradaxa, etc. in risk situations.