Therapy of peripheral arterial occlusive disease (vascular surgery)

Key measures include:

• Cessation of smoking
• Eating a healthy diet
• Exercising regularly, a minimum of 30 minutes a day, all days of the week.

ccan help in prolongation of walking distance

and may thus be useful in patients with PAOD. This requires you to walk at a brisk pace until the pain starts. You may then take a break until the pain subsides and then continue walking. This may be done under the guidance of occupational therapists or as part of a walking sports group. Exercising for about an hour a day improves the blood circulation in the legs  since a network of smaller blood vessels (collateral circulation) develops over time which may compensate for occlusion of one of the main vessels. This helps restore the blood supply to the affected region. Exercise also helps reduce blood pressure and blood lipids.

Foot care is important for diabetic patients with PAOD.

Ensure you take good care of your feet if you suffer from diabetes mellitus as well as PAOD, since diabetes also affects nerves and you may not experience pain arising from wounds. Specially trained podiatrists can take care of your feet professionally. Even minor wounds may be problematic when wound healing is impaired. They may become infected following invasion by bacteria and other germs. Wounds may then become chronic and may no longer heal. Tissue death may occasionally occur due to reduced blood supply, and dead or necrotic tissue must then be carefully removed. Non-diabetic patients with PAOD can perceive pressure points and sores on their feet normally.

Medication in PAOD

We also treat pre-existent underlying diseases with medication. Thus, effective drugs are available against:

• High blood pressure: specific antihypertensive or diuretic medication
• High cholesterol levels: e.g., statins
• Diabetes: antidiabetics, insulin

It is important that you take these drugs regularly. A healthy diet and adequate exercise are likewise important.

Drugs which prevent blood clots (thrombi) in blood vessels,  e.g., antiplatelet drugs such as the active ingredients acetylsalicylic acid and clopidogrel, are also effective.

Balloon dilatation and surgery

Various options are available for restoring patency of narrowed or occluded vessels. The right choice depends on the exact site and nature of your disease, as well as your age and symptoms, and the optimal therapeutic strategy is therefore always individualized.

• However these interventions may not be feasible or useful in certain situations or do not promise long-term success based on experience, and therefore cannot be primarily recommended.
• Operation: A variety of strategies are available for the surgical treatment of PAOD, with bypass surgery and thrombendarterectomy (peeling) being the most common. Operations are usually performed under general anesthesia.

• Bypass: This operative procedure enables bypassing of the occluded vessel. In other words, occluded vessels are ‘bypassed’ which restores blood flow. Either a superficial vein from the same or another limb or a woven (Dacron) or a PTFE prosthesis is used to bypass the occluded segment. Bypass surgery may be performed in patients with long-standing vascular occlusion where balloon dilatation and stenting are unsuccessful.
• Thrombendarterectomy (peeling): Calcified plaques can be removed from vessel walls where accessible, usually the femoral arteries, and areas of severe narrowing. The remaining layers of the wall are strong enough to withstand blood pressure. The vessel is then sealed again using a patch made of vein or plastic in order to prevent subsequent narrowing due to remodeling of the scarred vessel wall.