The basic pillar of therapy for peripheral arterial occlusive disease is the targeted treatment of the causes. For smokers, the most important measure is to stop smoking immediately. In general, the disease can be greatly improved by regular exercise, a balanced diet, normal blood pressure and blood lipid values in the normal range.
In the case of pAVK from stage 2, daily walking training is an important measure for improving the symptoms. First of all, the walking distance that can be covered until the onset of pain is determined - at least half of this distance should be covered several times a day from now on. In this way, the body is stimulated to form so-called collateral vessels. These are blood vessels that bypass the constriction in the artery and thus bridge it. However, daily walking training should not go so far as to cause pain.
In addition to gait training, so-called platelet aggregation inhibitors are administered in the case of pAVK. These are drugs that inhibit the clumping of blood platelets and thus prevent the formation of blood clots. Acetylsalicylic acid (ASS) is the drug of choice. If there are intolerances to this substance, clopidogrel can be prescribed as an alternative in individual cases.
From stage 2 onwards, the use of other drugs may be recommended. So-called phosphodiesterase inhibitors (PDE inhibitors) counteract clumping of the blood platelets, which makes the blood thinner.
If the blood supply to the vessel cannot be restored by means of surgery, the therapy may be extended to include intravenous administration of so-called prostanoids . These agents cause the blood vessels to dilate and improve the flow properties of the erythrocytes (red blood cells), allowing the blood to pass more easily through the constricted blood vessels.
Another option for treating pAVD is to surgically repair the narrowing of the blood vessels. Whether or not surgery is performed depends on the stage of the disease and the location of the narrowing. Despite surgery, there is a risk that a new constriction will form in the affected vessel over time.
The following surgical measures can be performed as part of pAVK treatment:
- Angioplasty (vascular dilatation): this procedure is mainly performed for vascular stenoses in the area of the pelvic or femoral arteries. A balloon catheter is inserted through the inguinal artery to the narrowed vessel and inflated at high pressure. In many cases, the constriction can be reopened or widened in this way. If balloon dilatation is not possible due to a rigid constriction, a so-called thrombendarterectomy (peeling out of the deposits) can be performed. If necessary, the implantation of a stent (vascular support) is necessary to reduce the risk of a renewed vasoconstriction.
- Bypass surgery: If the vasoconstrictions affect large parts of the leg vessels, a bypass surgery may be useful. In this case, blood is diverted around the narrowed vessel site by means of a newly inserted vein or a tube made of Teflon.
- Amputation: If the blood flow is so restricted due to the narrowing of the vessel that parts of the limb die off, the affected limb (e.g. toes) must be amputated.