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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.