Shop windows (peripheral arterial disease)

What are display legs?

Shop window legs is another name for an artery disease in the legs. It is also known as peripheral arterial disease (PAD) or intermittent claudication.

If you have display legs, the arteries in your legs don’t supply enough oxygen for the muscles you use when you walk. This is because these arteries are narrowed by arteriosclerosis. This constriction causes an acidification of the muscles. It causes a cramping pain and the legs feel stiff or painful when walking. After a short rest, the bloodstream replenishes oxygen and the pain disappears.

The longer you walk, the more you suffer from pain in your buttock, thigh, calf or foot. Once you stop, the pain often disappears within ten minutes. That’s why this artery disease is called shop window legs: if you stop for a moment in front of a shop window, the pain subsides. After a while the pain comes back.

old age disease

Men and women older than 85 years are more likely to suffer from display legs than younger men and women. Above the age of 85, the number of people with intermittent claudication is estimated at 56 percent. The percentage of 55-year-olds who suffer from display legs is about 8 percent.

Cause of display legs

Artery narrowing is a normal aging process. So your age plays an important role. You may also be predisposed to it: shop windows are hereditary. You are at greater risk of narrowing these blood vessels because of:

• to smoke
• too little exercise
• overweight
• diabetes
• high blood pressure
• high cholesterol

Symptoms: how do you recognize display legs?

With display legs you suffer from pain, cramping or a numb or tired feeling in your leg while walking. The complaints occur in the buttock, thigh, calf or foot after a fixed walking distance. If you stand still, the pain disappears within ten minutes. But as soon as you continue walking, the complaints start again after a while. Walking up a hill or accelerating is extra strenuous: you will suffer earlier. In winter, the complaints worsen because the blood vessels also narrow due to the cold.

The place where the pain arises says something about the location of the artery narrowing. The narrowing in the blood vessel is always above the level where you suffer from complaints. If you feel pain in your buttock and/or thigh while walking, there is a narrowing in your iliac artery. If your calf is bothering you, your artery in your thigh isn’t supplying enough oxygen. The pain is in your foot if one of the three lower leg arteries is narrowed.

Appearance Symptoms

As the condition worsens, the symptoms change. The pain can occur with less and less effort, until the complaints even arise when you are sitting or lying down. If the artery is not very narrow yet, your leg will look normal on the outside. In a more advanced stage, external symptoms may also appear:

• dry, flaky, cracked or shiny skin
• abnormal nail growth
• cold feet
• thinner leg muscles
• hair loss on your legs

Wounds on the shop window leg also heal poorly. Sometimes they don’t heal at all. Your leg will turn pale when you lift it and turn red when you let it hang. This is due to poor blood circulation.

Diagnosis

The GP makes a comparison between the sick and the healthy leg. He looks at differences in color, hair, nails and temperature. He checks the foot for pulses, which are palpable pulsations of the artery. If he doesn’t feel it, he confirms the diagnosis by measuring the ankle/arm index.

Measuring bloodpressure

The ankle/arm index is the ratio between the upper pressure in your arms and the upper pressure in your ankles. The doctor measures this ratio by measuring the blood pressure at both points. An ankle/arm index value less than 0.8 confirms an artery stenosis or shop window leg.

Measuring blood pressure in your ankles is similar to measuring blood pressure in your arms. Just like measuring the blood pressure in your arm, the doctor will put on a thick band. By inflating this band, the arteries are closed. When the blood vessel is completely occluded, the doctor stops pumping. The band slowly deflates and the blood flows through your veins again. At this moment the upper pressure is measured.

Treatment of display legs

There are several treatments for display legs. The choice of one or the other treatment depends on the severity of the complaints. If a leg artery is not narrowed so much yet, you can take the following measures to reduce the artery narrowing and prevent it from getting worse:

• quit smoking
• healthy food
• move more

With these three measures you ensure better blood circulation in the leg. If you have difficulty walking through your shop windows, a physiotherapist can help. Intensive running training ensures that you can eventually run longer distances again with less pain in your legs. The GP also prescribes anticoagulants (blood thinners). Aspirin is an example of this.

angioplasty

If the symptoms are more severe, angioplasty can help. A folded balloon is guided to the narrowing via a catheter. By gently inflating the balloon there, the narrowed artery is stretched. The blood vessel can narrow again after an indefinite period of time. That is why it is important to keep moving and to maintain a healthy lifestyle.

Sometimes angioplasty is not enough. Then the blood does not flow properly after the treatment. In that case, a stent is placed. A stent is a kind of ballpoint spring made of metal that gives the vessel wall extra support. It also prevents the blood vessel from springing back after angioplasty.

Operation

If the narrowing is in an artery that a catheter cannot reach, there are two types of surgery. Large strictures are also treated in this way.

The first option is bypass surgery. This surgery method is most commonly used. The vascular specialist creates a diversion in the blood circulation. He uses a vascular prosthesis or a vein of your own. Artery narrowing can also be treated with artery surgery. Then the doctor cuts open the artery to remove the calcified fat layer and the inner layer of the artery wall. Once the blood vessel is clean again, it is closed. The doctor sutures the blood vessel with a piece of plastic or a piece of vein.

Complications

An operation on the blood vessels carries more risks than an angioplasty. Think of thrombosis, a heart attack, pneumonia, bladder infection or wound infections. If there is any bleeding, surgery often needs to be performed again. After surgery, you should continue to take anti-clotting medications to keep your blood thinner. Both operations are heavy and have a long recovery period.

With angioplasty, bleeding can occur at the insertion site. People who suffer from display legs often suffer from this condition again. This can be prevented by developing a healthy lifestyle. Lots of exercise, a healthy weight, well-regulated blood pressure and normal cholesterol levels can prevent a relapse.