Recognize and treat arterial circulatory disorders of the legs

A restriction in walking distance, usually due to pain in the calves that forces the patient to stop after a few hundred meters, are often the first symptoms of circulatory disorders of the arteries that bring fresh blood from the heart to the legs. Circulatory disorders of the feet or circulatory disorders of the toes are manifested by occasional pain at rest when lying down. Often, a circulatory disorder of the skin is then also apparent, and the toes are white or bluish. Such circulatory disorders must be treated immediately. In contrast, brown spots are not associated with circulatory disorders of the arteries, but are often an expression of venous weakness.

Arteriosclerosis treatment is the first step in the treatment of arterial circulatory disorders. In the case of circulatory disorders, blood values must first be determined (cholesterol and other blood lipids, blood sugar, kidney/thyroid values) and the other risk factors (high blood pressure, nicotine consumption, obesity) must be optimized as far as possible. In order to treat circulatory disorders, nicotine cessation is essential and the first step of a PAOD ( = peripheral arterial occlusive disease) therapy. To treat a circulatory disorder in a natural way by a healthy lifestyle with normal weight, renunciation of nicotine and regular walking training is possible. Especially circulatory disorders of the legs can already be treated well by structured walking training (at least 3 x week/ 30 min.), so that circulatory disorders become less symptomatic, i.e. the maximum walking distance can be improved.

However, if an acute arterial occlusion occurs (for example, due to an embolism), the symptoms of the circulatory disorder appear suddenly and cause severe discomfort. We treat such a circulatory disorder of the legs immediately, using catheter procedures (angiography with balloon dilatation, stent implantation if necessary, and thrombus aspiration if necessary).

Ultrasound examination for early detection of dilatation of the abdominal aorta (abdominal aortic aneurysm screening, recommended for all men > 65 years of age) is also useful, as it often results in circulatory disorders of the legs and the aneurysm must be treated in the sense of a circulatory disorder, as it is usually an expression of advanced arteriosclerosis (exception: congenital in young people).

Circulatory disorder of the brain – stroke prophylaxis

In order to be able to assess the blood flow situation to the brain, a duplex sonographic ultrasound examination of the carotid arteries is recommended. Here, the carotids can be well assessed, on the one hand when it comes to the start of arteriosclerosis treatment (usually decision-making before initiating therapy with a cholesterol-lowering drug), on the other hand, a circulatory disturbance to the brain can be directly detected here. If a carotid artery is critically narrowed or if the first symptoms appear, the circulatory disorder must be treated immediately and the affected vessel must be operated on or treated with a stent. In the context of stroke treatment, an examination of the carotid arteries is always indicated, since carotid stenosis is a frequent cause of apoplexy and the circulatory disturbance can be treated well.

Treat circulatory disorders in the area of the hands

A circulatory disorder of the hands is often functionally caused. This means that an external stimulus, usually cold or psychological stress, causes an excessive reaction of the smallest vessels, so that the circulatory disorder causes the fingers to turn blue or white. When warm, the supposed circulatory disorder of the fingers no longer causes symptoms. In most cases (typical for Raynaud’s syndrome), the circulatory disorders can be easily treated by appropriate cold prophylaxis or medication. In contrast, organically caused circulatory disorders of the hands and fingers are often characterized by pain, a feeling of cold, or restricted movement/lack of strength. If an arterial occlusion is the cause of the symptoms, the circulatory disorder must be treated immediately, usually with medication and/or catheter procedures.

How are circulatory disorders treated?

The most frequent cause of a circulatory disorder is arteriosclerosis. The first priority in therapy here is optimal adjustment of cardiovascular risk factors and consistent renunciation of nicotine. In addition to active nicotine consumption, manifest diabetes mellitus is one of the main risk factors. Therefore, optimal metabolic control is essential. In case of a relevant circulatory disorder, platelet aggregation inhibitors (e.g. ASA) or other blood thinners are often used. In addition to conservative, drug treatment options, circulatory disorders are primarily treated with catheter procedures. If this is not technically possible, a surgical presentation is made for surgical treatment (e.g. bypass).

What complaints or symptoms does a circulatory disorder in the brain cause?

Typical precursors of a stroke are passive circulatory disturbances in the brain, which typically manifest themselves in a focal neurological deficit: Visual disturbances in one eye (“as if blind, everything is black”) that are of short duration, after which vision returns to “normal.” Likewise, reversible speech disorders, a drooping corner of the mouth, or sensory disturbances in one arm may become apparent. Dizziness or blurred vision in one eye, on the other hand, are not typical symptoms of a circulatory disorder in the brain. If a stroke then occurs on the basis of a circulatory disorder in the brain, the symptoms are no longer reversible and neurological deficits or paralysis occur.

What can you do for the blood circulation?

In order to influence the vascular aging process, arteriosclerosis, as positively as possible, it is recommended to lead a sporty, active lifestyle with the aim of attaining a normal weight and abstaining from nicotine. Blood lipids, especially serum cholesterol, should be optimally adjusted, as should blood pressure and blood sugar. Furthermore, moderate physical activity is recommended (e.g. 3 x weekly 30 min. light endurance training). If there are already deposits on the vascular system (so-called plaque formation), it is advisable to start therapy with a cholesterol-lowering agent in order to positively remodel and stabilize the already existing plaques. This is because plaque rupture often leads to a carryover of thrombogenic material, which can then block a peripheral artery in the brain. To counteract these processes, there is also an indication for platelet inhibition, especially in the case of plaques or pre-existing constrictions in the area of the carotid arteries.

What can you do yourself against circulatory disorders of the legs?

If there is a manifest circulatory disorder of the legs and active nicotine consumption, this must be permanently discontinued. The circulatory disorder of the legs then corresponds to a so-called “smoker’s leg”. In addition to drug treatment and a healthy lifestyle, you can treat your circulatory disorder yourself by exercising your legs. This is a structured walking training, at least 3 times a week better a daily 30 minute- walk. If pain starts to occurs, which is typical for a circulatory disorder, training is continued until the pain increases, then standing still until the pain passes again and then walking is continued. In this way, bypass circuits can be formed that can compensate for vascular occlusion.

Walking is particularly important here; cycling does not achieve the desired effect. With walking training alone, the maximum walking distance can be extended and the quality of life significantly improved. To document the success of the treatment, keeping a diary in which the maximum walking distance per training unit is recorded has proven useful. If there is already a pronounced circulatory disorder of the legs, it is particularly important to ensure consistent protection of the extremities. The feet and toes must always be kept warm. Wool socks are much more suitable than pure cotton, which cannot retain heat. Suitable footwear is particularly important to prevent minor injuries. Likewise, professional, medical foot care, wearing shoes with soft soles, etc. is recommended.

How can you tell if you have circulatory problems?

In our practice, all possibilities for the diagnosis of a circulatory disorder are available. Starting with a detailed medical history, the clinical examination can usually already provide the first indications of a circulatory disorder: are the pulses all palpable? Is there a difference in temperature? Can flow sounds be auscultated?

Color-coded duplex sonography is then performed, in which the vessels can be precisely visualized and possible deposits, constrictions or vascular occlusions are detected. If anything is unclear or before a planned intervention, this method is supplemented by other imaging (e.g. computer tomography or magnetic resonance imaging). Often, we also perform a stress test on the treadmill in order to better differentiate movement-dependent pain caused by a circulatory disorder of the legs from, for example, orthopedic problems. Typical for a circulatory disorder of the legs is a pain that occurs while walking – not at rest – and disappears after a short break. Hence the name “shop window disease”: after a short distance of walking, the patient pauses in front of a shop window and stops until the pain goes away, after which it is possible to continue walking. However, usually only until the next shop window…

What are the arterial circulatory disorders?

The most common circulatory disorder of the arteries is caused by gradual arteriosclerosis (vascular calcification), which only becomes noticeable with symptoms at an advanced stage due to the obstruction of blood flow and the increasing lack of oxygen in the tissue. In addition, arterial circulatory disorders pose the risk of plaque rupture in the affected artery, which then leads to an acute worsening of the symptoms of failure and pain. Frequently, however, circulatory disturbances also originate from the heart. If atrial fibrillation is present, for example, blood clots are carried from the heart to the periphery by the blood flow and then become caught in an artery, leading to acute occlusion with interruption of the blood flow. Furthermore, there are also functional circulatory disorders, which are triggered, for example, by a cold stimulus with cramping of the vascular wall muscles, which often leads to paling of the fingers or toes and can easily be normalized again in the warmth. Other diseases of the arteries are e.g. vascular tumors, vascular malformations or immunological vascular diseases (e.g. giant cell arteritis).

What are the consequences of circulatory disorders?

The arteries in the body supply all organs and extremities with oxygen. If the blood supply and thus the oxygen supply to tissues is impeded by a circulatory disorder, an oxygen deficiency occurs. The result is damage or death of tissue cells. A distinction must always be made here as to whether an acute deficiency is involved or whether the circulation situation is compensated, i.e. still sufficient. If there is a compensated circulatory disorder, this can often be left as it is under regular medical control and optimal medication. If, on the other hand, an acute deficiency situation is present (e.g., sudden vessel occlusion), an interventional recanalization attempt must be made immediately.