While Part 1 of the article by Professor Roswitha Wolfram deals with the contributing factors, Part 2 will be on the stages of the window-shopping disease.

Stage 1: Asymptomatic narrowing of the arteries

PAOD develops slowly, can remain undetected for a long time period and may only become symptomatic at older age. The rate of progression of this disease, however, varies between individuals. During the first stage, PAOD rarely causes any symptoms.

Window-Shopping Disease

Stage 2: When pain forces to stop

If the legs are involved, which happens in 90% of cases, the patient will experience pain after walking for a certain distance in either the lower leg or, to a lesser extent, the upper leg, buttock or the feet. Through this pain, the muscles signal that there is a severe lack of oxygen. While walking, the muscles are stressed and require more oxygen supply than during resting periods, thus the blood perfusion needs to be increased. In PAOD, this does not happen as the narrowed arteries do not allow adequate blood flow to reach the muscles. The pain results in frequent stops while walking to allow the muscles to rest, leading to intermittent limping. Its medical term is claudication.

Stage 3: Rest Pain

If it is not possible to prevent further progression of this disease, blood flow will become increasingly impaired. Patients will reach a stage where even at rest, the oxygen supplied is not sufficient for the demands of the muscles, finally resulting in rest pain. This pain will occur primarily at night when the legs are rested in bed.

Stage 4: Ulcerations and loss of tissue

A further consequence of impaired blood flow is that even the smallest injuries will not heal properly, leading to severe infections and lesions. Tissue may be lost and sometimes if an adequate blood flow cannot be reinstalled, an amputation may even be necessary. Unfortunately, this is not the end of the story: PAOD patients also have a highly increased risk of developing a heart attack and/or a stroke.

The final part will be on the treatment of PAOD.

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