How thick is the femoral artery

Shop window sickness: recognize warning signs in good time

Status: 11/6/2020 1:45 p.m.

In Germany around eight million people suffer from calcification of the arteries. If the pelvic and leg arteries are affected, one speaks of peripheral arterial occlusive disease (PAD) or intermittent claudication.

When the arteries become calcified (also called arteriosclerosis), calcium and fat accumulate unnoticed on the vessel walls throughout the body. As a result, the elasticity of the veins gradually disappears and the vessels narrow until they are completely closed. Smoking, high blood lipid levels and high blood pressure in particular increase the risk. If the legs are affected, in extreme cases this can lead to death of the leg and amputation.

Symptoms of intermittent claudication (PAOD)

Typical for intermittent claudication are diffuse, cramp-like leg pain when exerted, for example when walking, which disappears when the person is at rest. Routes that used to be easy to manage are increasingly becoming a problem. The muscles ache because they lack oxygen due to the inadequate blood supply.

Over time, the pain also occurs in resting situations, especially at night when the legs are horizontal and the muscles are not adequately supplied with blood. When walking, those affected get so severe leg pain because of the lack of blood circulation that they have to take breaks again and again until the stabbing pain in the calves subsides.

Pain in the foot, wounds, dry skin and open spots on the legs can also be an indication of intermittent claudication. The problem: With older people, all of this is often dismissed as ailments of old age.

Early diagnosis can save lives

Peripheral arterial occlusive disease can be easily detected:

  • In the Blood pressure control is measured on the arm and ankles. If you then divide the value determined on the leg by the blood pressure measured on the arm, you get the ankle-arm index.
  • With a Blood pressure control on one toe
  • Pulse control on the feet, in the back of the knees and in the groin
  • Ultrasound examination and X-ray the leg arteries with contrast agent (angiography)

Treat atherosclerosis in the leg

The earlier the disease is treated, the easier it is to slow its progression. This is also extremely important because most people with PAD also affect the heart and brain vessels. This leads to an increased risk of a stroke or heart attack.

With targeted medication and a healthy lifestyle, the progression of arteriosclerosis can be counteracted. In any case, those affected must stop smoking. Consistent walking training is very helpful: walking five times for half an hour at a time, extending the walking distance - right up to the pain. This creates replacement blood vessels (collaterals) that take over the blood supply to the muscles.

Treatment according to guidelines

Experts complain that many general practitioners do not know the current guidelines for the care of PAD, so that those affected do not receive adequate treatment. According to a new study with 25,000 participants, three risk factors must be considered and treated in the treatment of PAD:

  • Thrombosis: The new generation of blood thinners are designed to protect against blood clots, so there is less risk of amputations.
  • Cholesterol: New lipid-lowering agents (PCSK9 inhibitors) are used against excessively high blood lipid levels.
  • Diabetes: Increased blood sugar levels can be brought under control with new anti-diabetes agents.

Operation with a balloon catheter

If the arteriosclerosis is already advanced, surgical interventions may be necessary.

Depending on the extent and location of the vascular narrowing, a catheter procedure, percutaneous transluminal angioplasty (PTA), can be used. The constriction is expanded with a balloon and, if necessary, additionally supported by a stent. The problem: The procedure can cause scarring and the vessel can close again.

The risk is lower with a new technology: It is used to widen the bottleneck Balloon catheter used, which is coated with drugs. Its purpose is to prevent vascular cells from reacting to the operation with increased growth. A stent is no longer necessary. Studies show that the new balloon therapy has lasting success and that hardly any follow-up treatments are necessary. It can be used not only in the large femoral arteries, but also in the lower leg.

In severe cases, the bottleneck can also be caused by a bypass be bridged.

After the procedure, the further course of the procedure depends on the lifestyle: Smoking, lack of exercise and being overweight damage the blood vessels and increase the risk of renewed blockage of the arteries. Sufferers should get plenty of exercise and try to get their weight under control.

Experts on the subject

Prof. Dr. Sigrid Nikol, chief physician
Clinical and Interventional Angiology
Center for Cardiovascular Medicine
Asklepios Clinic St. Georg
Lohmühlenstrasse 5
20099 Hamburg
(040) 18 18 85-24 01
www.asklepios.com

Prof. Dr. Oliver Müller, Head of Angiology
Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine
University Medical Center Schleswig-Holstein, Campus Kiel
Arnold-Heller-Strasse 3
24105 Kiel
(0431) 500-229 50
www.uksh.de

Dr. Sabine Bleuel
Orthopädie Elbchaussee practice
London 567
22587 Hamburg
(040) 86 23 21
www.orthopaedie-elbchaussee.de

additional Information
German Society for Angiology - Society for Vascular Medicine e. V.
www.dga-gefaessmedizin.de

German Society for Vascular Surgery and Vascular Medicine
www.gefaesschirurgie.de

German Vascular League e. V.
www.deutsche-gefaessliga.de

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