Arterial occlusive disease – when the arteries clog
Everyone knows the nasty consequences of arteriosclerosis on the heart and brain. Heart attacks and strokes are life-threatening, common diseases that every person in advanced age is afraid of. However, the arteriosclerosis also leads to abdominal and leg arteries to serious diseases. This is referred to as arterial occlusive disease (AVC) or, more correctly, in connection with the extremities, peripheral arterial disease (PAOD).
Arteriosclerosis is a hardening and constriction of the arteries that take years or decades, that is, the blood vessels that carry the blood away from the heart. The narrowing of the arteries leads to a reduced blood flow and a lower supply of oxygen in the organs and body parts. Unfortunately, we still do not know exactly why arteriosclerosis develops, but there are certain risk factors that more quickly lead to atherosclerosis.
Arteriosclerosis does not occur overnight but creeping and unrecognized. 20 to 40 years may pass before the first symptoms appear, but they are already serious. The clogged blood vessels cause the affected organ under load is poorly supplied with oxygen – pain is the result. In the heart these symptoms are called angina pectoris, in the gastrointestinal tract, severe abdominal pain occurs after a meal, the so-called angina abdominals.
In extreme cases, it comes to an arterial occlusion and thus a heart attack, intestinal infarction or stroke. The arterial occlusive disease caused by arteriosclerosis affects not only the heart and brain, but all the arteries of the body and, more often, the arteries below the diaphragm: the abdominal, pelvic, and leg arteries.
How common is an AVC?
In Germany, about 4.5 million people are affected by an AVC. Meanwhile, one in ten people between 55 and 65 suffers from the arterial occlusive disease, and after the age of 65, one in five is affected. Approximately 80,000 people are constantly under medical treatment for an AVC and around 35,000 people annually have to undergo an amputation because the tissue that is no longer perfused would otherwise lead to life-threatening blood poisoning.
How is an AVK expressed?
Unfortunately, an AVC causes symptoms only at an advanced stage. Physicians divide the AVK into four stages:
- In the first stage can be detected with imaging techniques, a narrowing of the arteries while – but the patient does not notice it yet, because the blood flow is still sufficient even under the load of the affected arteries, for example, during prolonged walking.
- In the second stage, it comes with prolonged stress to pain, which forces the person in the case of narrowed leg arteries to stop. This stage is also called Shop Window Disease (Claudication Intermittent). At least now you should be active to stop the progression of AVK.
- In the third stage, the pain also occurs at rest, often at night, when the legs are raised and gravity cannot support blood flow in the arteries.
- In the fourth stage, the circulation is reduced so that the affected tissue dies. Of these, the furthest parts of the body, ie the toes, are usually affected.
The fact that circulatory disorders affect not only the muscles but all body tissues in the affected area can be seen, for example, in the changes in the skin such as healing disorders and a decrease in hairiness.
Narrowing of the arteries in the gastrointestinal tract
A massive narrowing of the arteries in the gastrointestinal tract, on the other hand, can balance the body long, because between the individual arteries, fortunately, there are connections, so that in a strong narrowing of an artery, the blood can pass through other to the hypoxia-sensitive intestine. But the consequences of a massive lack of oxygen can be life-threatening.
Since after the meal, the blood circulation of the intestine is particularly required because of the absorption of the food components, it comes in angina abdominals to painful colic, if the intestine cannot perform this task. It becomes life-threatening for the person concerned if a narrowed abdominal artery completely clogs, the other arteries cannot take over the oxygen transport and the intestine dies.
It must be removed as soon as possible because otherwise, the dead tissue causes peritonitis, which affects the entire abdomen. The necessary large abdominal surgery is then an emergency operation and carries a high risk for the person concerned.
treatment and prevention
What can you do to prevent an AVC from developing?
Among the risk factors for the development of arteriosclerosis and thus an AVC are mainly:
- lack of exercise
- a high-fat, unbalanced diet
These factors can be taken into account in your lifestyle and remedy the situation. Also, high blood pressure and high blood sugar levels in diabetes promote atherosclerotic deposits, so a good blood pressure and blood sugar control are so important.
Diagnosis of arterial occlusive disease
If you describe the symptoms, the doctor will first determine the extent of the AVC. To do this, it measures blood pressure on the foot arteries, determines your painless walking distance on a treadmill, and examines the arteries with ultrasound to detect deposits in the vessels.
To accurately diagnose the damage, a contrast agent angiography is then performed. A contrast agent is injected into the femoral artery and the X-ray image shows which arteries are affected in which section as much.
What can the doctor do against an AVC?
Short strictures ( stenosis ) may then be balloon-extended, with an inflatable tip catheter under X-ray control pushed to the narrowing and the balloon filled with saline until the debris is pushed to the edge.
For longer stenoses, on the one hand, there is the possibility of surgically removing the deposits, that is, the doctor performs a so-called thrombendarteriectomy and sews a piece of plastic skin, a patch, on the opened artery.
However, if the artery is massively damaged by the deposits, which have completely penetrated the wall of the artery and thereby cannot be exfoliated, or if the stenosis is very long, a bypass is used which serves as a new flow-through facility for the blood.
Drug treatment of AVK
Medically, the vessels can also be expanded with prostaglandin E1. This messenger substance, which is also produced by the body, in addition to the vasodilation leads to an improvement in the flow properties of the blood and lowers blood lipid content.
Antiplatelet agents, which are substances such as acetylsalicylic acid or clopidogrel, are so-called “blood thinners”, they are given to all patients with atherosclerosis to reduce the risk of a sudden occlusion of an artery.