Intermittent Claudication PAD

Arte­ries are blood ves­sels that car­ry oxy­gen-rich blood from the heart to the body. Risk fac­tors, such as smo­king, lead to nar­ro­wing or occlu­si­on of the arte­ries in the long term. In the majo­ri­ty of cases, the­re is a lack of cir­cu­la­ti­on in the leg area so that cramp-like pain, usual­ly in the calf, occurs when wal­king. Depen­ding on the sta­ge of the ill­ness, the­se mus­cu­lar pains neces­si­ta­te regu­lar stops while wal­king, After a short peri­od of reco­very, wal­king can be brief­ly resu­med again (inter­mit­tent clau­di­ca­ti­on).

A mar­ked cir­cu­lato­ry dis­or­der cau­ses pain even when at rest and wit­hout phy­si­cal strain. The pati­ent can not sleep at night becau­se of the pain. In this case, the cir­cu­la­ti­on is alrea­dy so poor that the­re is a thre­at of the affec­ted tis­sue dying. The­re are open wounds on the lower legs or feet and, in the advan­ced sta­ge, black toes.

The aim of the tre­at­ment of inter­mit­tent clau­di­ca­ti­on is the pre­ser­va­ti­on of the abi­li­ty to walk, and thus the qua­li­ty of life, and, above all, the pre­ven­ti­on of ampu­ta­ti­on. The dia­gno­sis is made through a vascu­lar ultra­sound exami­na­ti­on and, addi­tio­nal­ly, through com­pu­te­ri­zed tomo­gra­phy or magne­tic reso­nan­ce angio­gra­phy.

  • Endo­vascu­lar The­ra­py through Bal­loon Dilatation/Angioplasty (PTA)

Through an ope­ra­ti­ve expo­sure of the affec­ted ves­sel or through the skin, the blo­cka­ge in the ves­sel is remo­ved with a bal­loon cathe­ter and, if necessa­ry, a stent (tubu­lar wire mesh) is used as vascu­lar sup­port.

  • Femo­ral TEA: Excisi­on of the Femo­ral Arte­ry

With a throm­bo­end­ar­terec­to­my in the area of the femo­ral arte­ry, the vascu­lar blo­cka­ge is sur­gi­cal­ly remo­ved via a small incisi­on. In addi­ti­on, the­re is a dila­ti­on plas­ty, which pre­vents a new blo­cka­ge in the future. In princip­le, no endo­vascu­lar pro­ce­du­re should be used in the area of ​​the gro­in, sin­ce the long-term results are wor­se here than with an ope­ra­ti­on.

  • Hybrid Ope­ra­ti­on of the Pel­vic Leg Ves­sels

In pro­noun­ced cal­ci­fi­ca­ti­ons, tre­at­ment of the gro­in arte­ries with a sin­gle femo­ral TEA is often insuf­fi­ci­ent. By com­bi­ning with an endo­vascu­lar pro­ce­du­re, the tre­at­ment can be opti­mi­zed. In par­ti­cu­lar, simul­ta­ne­ous stent implan­ta­ti­ons are used in the pel­vis and leg area.

  • Peri­pheral Bypass Sur­ge­ry

In peri­pheral bypass sur­ge­ry, long-seg­ment ves­sel con­s­tric­tion or occlu­si­ons of the ves­sels are bypas­sed (bypass = diver­si­on). The bypass mate­ri­al used is usual­ly the body’s own vein or syn­the­tic mate­ri­al. Bypass sur­ge­ry is used when an endo­vascu­lar pro­ce­du­re is not pos­si­ble due to the length or type of vascu­lar chan­ge. Depen­ding on the loca­ti­on, femo­ral-pop­li­te­al bypas­ses or femo­ral-crural recon­struc­tions are per­for­med.

  • Cen­tral Bypass Sur­ge­ry

Seve­re cal­ci­fi­ca­ti­ons in the abdo­mi­nal aor­ta and pel­vic arte­ries can be trea­ted with a bypass ope­ra­ti­on in the abdo­men. This is main­ly used when an endo­vascu­lar pro­ce­du­re is not pos­si­ble or has alrea­dy been car­ri­ed out wit­hout suc­cess. The ope­ra­ti­on is per­for­med via an incisi­on in the abdo­men and often addi­tio­nal­ly in the gro­in.