Smoker's leg (PAD) - causes, symptoms, therapy

Peripheral arterial disease (PAOD), intermittent claudication

The so-called "smoker's leg" is not an independent disease, but rather an advanced stage of peripheral arterial occlusive disease (in short: PAOD, also called "intermittent claudication"), a disorder of the arterial blood flow to the legs, in rare cases the poor. This is caused in most cases by arteriosclerosis, which leads to severe narrowing or even complete obstruction of the vessels and thus to strong circulatory disorders of the extremities. Here is a brief overview:

• definition: PAOD is a condition in which a body region (usually the legs) is not or insufficiently perfused due to an increasing arterial narrowing to occlusion.
• early warning Signs: Dry skin on legs and feet, severe calluses on the soles of the feet, noticeably slow-growing toenails, cool, pale and marbled skin, hair loss on the legs, chills, calf pain while walking.
• symptoms: Pain on leg strain, which disappears immediately after exercise. In the advanced stage also spasmodic or boring permanent pain in rest periods.
• causesIn most cases, PAOD is caused by arteriosclerosis, which is often the result of years of smoking or pre-existing conditions such as diabetes, hypertension and lipid metabolism disorders.
• treatment: Walking training, smoking cessation, medication to improve blood circulation, in worse cases, surgery to amputation of the affected body part.

contents

• Peripheral arterial disease (PAOD), intermittent claudication
• disease
• minimizing risk
• Peripheral arterial disease
• early warning Signs
• causes
• Smoker's leg symptoms
• Therapy with a smoker's leg
• drugs
• Stage three and four treatment
• Operations in PAD
• Prevent smoking leg

disease

PAD can cause massive health problems such as pain when walking, a so-called "open leg" or even the loss of limbs. In addition, there is an increased risk of stroke or myocardial infarction due to the vascular calcification. The commonly used term "smoker's leg" derives from tobacco smoking, which, in addition to diabetes, hypertension and lipid metabolism disorders, is the main risk factor for arteriosclerosis and therefore also for PAOD.

Smoking is the number one risk factor in developing a PAD. (Image: Sabphoto / fotolia.com)

minimizing risk

To keep the vessels healthy, nicotine should be better avoided, and a healthy, balanced diet and adequate exercise should be ensured. In addition, it is especially important with increasing age to regularly go to medical check-ups and preventive check-ups in order to recognize the first signs of PAD such as skin problems on legs and feet or a pale and marbled skin in good time and thereby avoid health risks.

Peripheral arterial disease

The term "smoker's leg" usually refers to an advanced stage of "peripheral arterial disease" (PAOD), also known as "intermittent claudication". These are constrictions or closures of the extremity-supplying blood vessels (arteries), through which the blood gets into the arms and legs.

Consequences of blood vessel constriction

If such a narrowing or a closure is present, accordingly, the legs can no longer be adequately supplied with oxygen and nutrients via the blood. In rare cases, the arms can be affected. As a result, severe health problems such as pain during walking, leg ulcers (leg ulcers, also called "open leg") or even loss of limbs occur during the course of the illness. Vascular constriction also increases the risk of heart attack and stroke.

early warning Signs

Possible signs of PAD should always be taken seriously and medically evaluated as early as possible. These include, for example:

• Dry skin on legs and feet,
• severe callus formation on the soles of the feet,
• remarkably slow-growing toenails,
• cool, pale and marbled skin,
• Hair loss on the legs,
• general feeling of cold or shivering,
• erectile Dysfunction,
• Stress pain such as calf pain, discomfort in the buttocks or pain in the thigh.

causes

The most common cause of PAD is arteriosclerosis, which is colloquially referred to as "arteriosclerosis". This gradually deposits fat, lime and protein components ("plaques") in the vessel and thereby restrict blood flow. If the plaques break, platelets attach themselves to the fracture site, resulting in the formation of a blood clot (thrombus) which can block blood flow directly at the site of formation or be entrained in the bloodstream and possibly block another vessel. In this case, there is a life-threatening situation when, for example, blood vessels in the heart, brain or lungs are affected by acute vascular occlusion (embolism).

risk factors

Arteriosclerosis is favored by several risk factors, with smoking clearly being number one in the hazard table. In addition, diabetes mellitus, hypertension, lipid metabolism disorders (increased blood lipids such as cholesterol), overweight (obesity), lack of exercise and a genetic disposition are among the main risk factors.

Arteriosclerosis is the most common cause of PAD. (Image: Bergringfoto / fotolia.com)

Other causes

In addition to the main cause arteriosclerosis in rare cases, injuries or inflammatory diseases such as Winiwarter-Buerger syndrome (medical: Endangiitis obliterans) or the so-called "Takayasu arteritis" (also Takayasu syndrome), the cause of circulatory disorders in legs or Be poor.

Smoker's leg symptoms

Peripheral arterial disease does not develop suddenly, but gradually evolves, so that the disease often goes unnoticed for a long time, leading to discomfort at an older age. Accordingly, four stages of PAOD have been distinguished throughout Europe to date, which were originally defined by the French surgeon René Fontaine (1899-1979).

The first stage - creeping spread

According to the classification, however, changes in the vessels and poor circulation of the legs can already be seen in the first stage. However, as the development of an arteriosclerotic stenosis progresses slowly, patients at this stage are usually free of complaints, even if the pelvic or femoral artery is already extensive is closed.

The first symptoms usually include stress in the legs, which usually disappear when the exercise is stopped. (Image: TANABOON / fotolia.com)

The second stage - movement pain

In Stage II, sufferers will then experience the first symptoms due to advanced vascular changes - usually in the form of leg-loading pain, which usually disappears immediately when movement is stopped. Accordingly, walking at this stage often causes such massive cramping symptoms after a certain period of time that they have to stop regularly ("Claudicatio intermittens")..

Intermittent claudication

In many cases, those affected are often uncomfortable with frequent stops, pretending to have discovered something interesting in the shop window. Hence the colloquial term "intermittent disease". However, the second stage is usually further subdivided into a distinction between a painless walkable distance of more than 200 meters (stage IIa) and less than 200 meters (stage IIb).

The third stage - rest pain

In the third stage, the blood flow in the legs is already significantly disturbed, which typically also comes to the so-called "rest pain". Accordingly, the spasmodic or boring persistent pain now occurs even without strain on the legs. The discomfort when lying or when storing the legs are particularly strong because the blood flows due to the horizontal position of the legs with less pressure through the already damaged vessel.

Serious lack of oxygen

In this stage, the muscles are poorly supplied with blood and the lack of oxygen is so strong that it comes to pain in the leg even at rest. When sitting, the pain usually decreases quickly, because the legs are better supplied with blood again by the force of gravity. At this stage, the disease has progressed so far that this measure usually only achieves a very short success.

The fourth stage of the disease can lead to severe tissue damage and poorly healing ulcers (open leg). (Image: coromayadil / fotolia.com)

The fourth stage - Strong tissue damage

In the fourth and most severe stage, the circulatory disorder is so advanced that it also comes to the complete occlusion of the smallest blood vessels. As a result, the affected region in the leg is no longer sufficiently supplied with oxygen. It comes to severe damage to the tissue and poorly healing ulcers ("open leg"). If the peripheral arterial disease is not treated appropriately at the latest at this stage, there is now a great danger that initially tissue regions as well as entire limbs (toes, foot or leg) die off and sometimes have to be amputated.

Early symptoms should be taken seriously

Since PAOD often goes unnoticed for a long time and usually not only the arteries in the legs, but in the whole body are narrowed, this can lead to serious sequelae such as coronary heart disease. In addition, the risk of a heart attack or stroke is immensely increased, causing over two-thirds of patients to die as the disease progresses. Accordingly, it is important to recognize the first signs of PAD in order to be able to start treatment soon enough.

Therapy with a smoker's leg

The treatment of PAOD depends primarily on the stage of the disease affected and where the vessels are narrowed. The main focus of therapy is to fight the causes and to minimize the risk factors in order to prevent a progression of the arterial narrowing. The goal of the treatment is also to minimize the risk of amputation or life-threatening complications such as heart attacks or strokes.

smoking cessation

Accordingly, first and foremost: Stop smoking! In this context, phrases like "This will not do anything anymore" should be banished from your own thinking. Instead, sufferers should be aware that only consistent and appropriate treatment of disease and risk factors can result in pain relief, freedom of movement, and quality of life.

Quit smoking is one of the main treatments and prevention of PAD. (Image: ra2 studio / fotolia.com)

Remove obesity

In addition, sufferers should break down next to an immediate stop smoking obesity and pay attention to a general healthy lifestyle with a low-fat and fiber-rich diet and regular exercise.

Treat pre-existing conditions

If the circulatory disorders are based on diseases such as diabetes or high blood pressure, they must of course be treated accordingly so that the symptoms can be alleviated.

walking exercise

In particular, in the second stage of PAD, the exercise training is an essential part of the therapy, by which the progression of the disease can be effectively stopped. In addition, consistent training offers the opportunity to increase pain-free and absolute walking distances. For this purpose, it is usually first determined how far affected can go with their "smoker's leg" without pain.

Promote bypasses

In the next step, the training now consists of running at least half of this distance several times a day to dilate the vessels around the constricted vessel and stimulate the body to form new vessels or so-called "bypasses" (collaterals). As a result, more oxygen-rich blood can enter the muscles and the pain can be alleviated.

drugs

In parallel with the exercise, at the beginning of PAD, medications to improve blood circulation are normally used, which inhibit platelet attachment and thus the formation of blood clots ("antiplatelet agents" such as acetylsalicylic acid (ASA) or clopidogrel). If surgery is out of the question, you may want to use additional medication to improve blood flow, such as cilostazol, which expands the blood vessels and reduces the platelet's ability to clot.

Anti-coagulant medications can prevent the formation of thrombi and improve blood circulation. (Image: ugreen / fotolia.com)

Stage three and four treatment

If the disease is more advanced, the pain is now also at rest (stage 3) or it can be seen on the legs of the affected wounds and ulcers (stage 4). In this case, the patient must be promptly hospitalized, because in this situation, there may already be danger to life and a massively increased risk of amputation. Accordingly, the PAOD must be treated as soon as possible.

A walking training may not be carried out at this time, because in this case the skin would be deprived of the required blood for wound healing by the increased blood circulation of the muscles. Instead, care must be taken here that the legs are properly stored to prevent pressure ulcers, at the same time the daily professional wound care is indispensable for the healing of the "open leg". In addition, the treatment of inflamed wounds usually needs to be supported by the use of antibiotics.

Thorough foot care

In addition, especially in stages 3 and 4, a thorough and professional foot care is important to avoid injuries and thus painful and difficult to heal ulcers. This risk is particularly high in diabetics, because not only do the wounds heal worse, but injuries to the foot are often not noticed, as there is often no pain (diabetic foot syndrome).

In this context, the nails should always be cut with the utmost care. It is better to have this done by a medical pedicure or a podiatrist. On the other hand, it is important to pay attention to suitable, breathable shoes in general. The feet should be creamed regularly as well as carefully dried after showering or bathing. For safety reasons, patients should walk barefoot as little as possible and have their feet examined more often by a doctor.

Operations in PAD

In many cases, even in advanced stages, there is still the possibility of promoting blood circulation and thereby preserving the leg. If no success has been achieved by drug therapy and walking training, there is the option of surgical intervention. There are different variants.

balloon

A standard method with a walking distance of less than 200 m and severe pain is the so-called "balloon dilatation" (percutaneous transluminal angioplasty, in short: PTA). In this, a constricted or occluded blood vessel is reopened by inserting a balloon catheter into the affected artery. If a complicated or prolonged vascular occlusion is present, a stent is usually implanted in the affected vessel to prevent repeated occlusion.

A constricted or occluded blood vessel can be reopened by inserting a balloon catheter. An additional stent (stent) counteracts a new closure. (Image: crevis / fotolia.com)

Nevertheless, catheter therapy offers no "guarantee" for a long-term improvement of the symptoms. The success of the treatment depends primarily on how consistently the patient subsequently eliminates the risk factors such as smoking and obesity.

Bypass surgery

If PAD is already in an advanced stage, which means, for example, that the walking distance is extremely short and the pain in the feet and legs occurs even at rest, vascular surgery is often necessary. In this case, the narrowed or occluded artery is either opened by surgery or a "bypass" (bypass) is placed around the constriction, for which an endogenous vein or alternatively a piece of plastic can be used.

amputation

If the late-stage vascular disorder is so severe that the tissue dies, depending on the extent, this can lead to amputation of the toes, foot, lower leg or leg - which affects up to 40,000 PAOD patients each year. Accordingly, at the first signs of peripheral arterial disease (see early warning sign), patients should seek medical attention immediately and seek medical attention.

Prevent smoking leg

The best way to prevent PAD is to consistently avoid the risk factors for arteriosclerosis, which in most cases is responsible for the slow development of the disease. Accordingly, smoking should generally be avoided, with various smoking cessation options, such as nicotine replacement therapy (such as nicotine patches), behavioral therapy, acupuncture, or hypnotherapy, which can help smokers overcome their addictions.

Healthy eating

In addition, obesity should be minimized as much as possible and attention should generally be paid to a healthy, low-fat and varied diet rich in vegetables, fruits and whole grains. Saturated fatty acids and so-called "trans fats", which are mainly present in fried foods such as French fries, but also in margarine, snacks, biscuits, cakes and chocolate, should be largely avoided, because they are particularly harmful to health and are co-causative agents of coronary heart disease.

A healthy diet supports PAOD therapy and is considered an effective preventive measure. (Image: happy_lark / fotolia.com)

Consistent treatment of other diseases

If there is a condition that can quickly lead to circulatory problems (for example, high blood pressure, diabetes mellitus), it is particularly important for the prevention of PAOD to have them treated continuously. In addition, sufferers should take no risks here and instead comply consistently with the medical requirements (medication, nutrition, etc.).

Sports and exercise

Likewise, attention should be paid to regular and adequate exercise. This can be done in the form of daily walks, but also suitable are sports such as running, walking, swimming or cycling.

Movement in PAD in the early stage

Even those who are already affected by a PAD and want to prevent a further deterioration of the blood circulation can improve their mobility and mobility through their own initiative. If there is only a slight restriction of the blood flow, consistent walking training is the only sensible measure, because the movement, the small blood vessels can expand around the bottleneck.

This again makes it possible for the blood to be redirected to the underserved leg regions, which can alleviate the discomfort and make it much easier to walk longer. In addition, the risk of a vascular occlusion in the leg, a heart attack or a stroke decreases with each movement - and should therefore be firmly anchored in everyday life for every PAD patient in the early stages.

Together against PAVK

In order to achieve the best possible success here, the training should not be done on your own. Instead, an individual exercise plan is created in collaboration with a vascular physician, and in addition, in most major cities there are vascular sports groups in which people can work together with other patients. In addition to the walking training, sports such as aqua jogging, Nordic walking or special gymnastics exercises are also suitable.

Training Log

In order to document the personal success, a training diary, in which day by day details of distances, times, occurrence of pain, etc. are recorded. Also a so-called "Pedometer" offers support, since with this the daily made steps and distances can be measured. In general, during the walking training, care should always be taken not to overwhelm the body and to stop it immediately if it comes to severe pain. Instead, you should train better at intervals. (nr, vb; updated April 23, 2018)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)