In intermittent claudication (claudicatio intermittens) there is an arteriosclerosis in the leg vessels. The technical term is Peripheral Arterial Disease (PAD). Typical symptoms of this narrowing of the arteries are severe leg pain. These express themselves primarily during physical exertion, as a result, those affected often have to take breaks while walking. Many try to make frequent appearances like window-shopping, always stopping in front of shops. With early diagnosis, the disease can be treated well. If it is detected late, often only one operation helps.
Narrowed arteries as a cause
The intermittent claudication is a form of peripheral arterial disease (PAD) in which the arteries are narrowed due to deposits in the walls of the vessel (arteriosclerosis). This restricts blood flow, which initially causes no discomfort at rest.
Only when physical stress, such as walking or running, increases the oxygen demand of the muscles, the circulation is no longer sufficient and the muscles get too little oxygen. This manifests itself in severe pain, which only disappears after an interruption of physical activity.
Arteriosclerosis occurs when fat is stored in the vessel walls. This is mainly due to high blood lipid levels, which may be due to poor nutrition and physical inactivity or genetic defects. Smoking, high blood pressure (hypertension), diabetes mellitus and obesity also increase the risk of vasoconstriction.
Symptoms of intermittent claudication
The constriction of the blood vessels is a creeping process that often goes unnoticed for a long time. The progression of PAD is divided into four stages according to the Fontaine classification:
- In stage 1 there are no complaints (asymptomatic PAD).
- Only when the vessel diameter is already significantly reduced, symptoms occur. At the beginning, the symptoms only appear under heavy load - for example when climbing stairs (stage 2).
- Later, the pain is already noticeable with ever-shorter walking distances. Other symptoms of intermittent claudication may be a pale complexion and cold skin on the lower legs.
- In the advanced stage (stage 3), the legs also hurt in peace.
- Due to the reduced blood flow, wounds on the feet heal worse, in the worst case tissue can die off (stage 4). If this is the case, the tissue must be removed, otherwise a life-threatening blood poisoning threatens.
Early detection and diagnosis of PAOD
Often an incipient occlusion of the arteries is determined randomly during a routine examination. If the doctor is unable to feel the pulse at the ankles and feet, this may be an indication of early-stage PAD in the case of appropriate risk factors.
If there is a suspicion of a PAD, the doctor raises the so-called ankle-arm index: If the blood pressure at the ankle is greatly reduced in relation to the blood pressure on the arm, this is a sign that the leg vessels are narrowed. This may also be the case if the intercock disorder has not yet manifested itself with its typical symptoms.
To ensure the diagnosis, the blood flow in the arteries can be displayed with a special ultrasound machine. In this way it can be determined where and how severe the constriction is.
Therapy of intermittent claudication
If the intermittent claudication is still at an early stage, reducing the risk factors is often enough to stop the disease: abstaining from nicotine and normalizing weight, blood pressure and blood lipid levels prevent atherosclerosis from progressing further.
A special training program supports the therapy: Through the targeted activation of certain muscle groups, the blood circulation is promoted, so that new vessels can form around a bottleneck. In addition, the doctor can prescribe drugs that interfere with the function of platelets. These platelet aggregation inhibitors prevent blood clots from forming on the bottlenecks.
Treatment of PAD in late stage
In the late stage of intermittent claudication, such treatment is usually no longer possible, so often an operation is necessary. A catheter is inserted into the leg artery and the vessel is dilated by a small balloon. Then a stent is used to restore blood flow. If the constriction is very long, it may be necessary to create a bypass: a bypass circuit is being built from another vessel in order to bridge the closed area.
If the PAD is not treated, threatened in the final stage by the lack of blood supply to the tissue in the worst case a leg amputation.
If a narrowing of the leg arteries is detected, other vessels in the body are also likely to be affected. The intermittent claudication thus indirectly indicates an increased risk of myocardial infarction and stroke. This is another reason why it is important to adjust lifestyle habits and minimize risk factors.
Prevent the intermittent claudication
In order to protect the vessels from calcification, abstaining from nicotine is a decisive step. In addition, a healthy diet with sufficient unsaturated fatty acids helps to normalize blood fat levels and reduce overweight.
If you have conditions such as diabetes or high blood pressure, it is important that they are treated accordingly. Because of a well-adjusted blood glucose level and the reduction of high blood pressure, the risk of arteriosclerosis also decreases.