Arteriosclerosis obliterans

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Arteriosclerosis obliterans

• Maria Arteaga

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Etiology

• Disorder accompanied by a narrowing or an
  occlusion of the intima and media of the blood
  vessel wall.
• Plaque formation as a result of the
  arteriosclerotic process, form on the internal
  wall of the blood vessels, causing partial or
  complete occlusion of the blood vessel.
• Result is little or no blood flow to the
  affected extremity. The artery is unable to
  supply blood and oxygen to the tissue.

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Clinical Manifestations

• Pain is the first symptom that occurs in from
  tissue ischemia.
• Pain generally occurs in the affected extremity
  in conjunction w/sustained activity. This is due
  to the demand of the tissue exceeding the
  available blood supply.
• Claudication is the process of activity to
  ischemia to pain in an affected extremity.
• Symptoms are coldness, numbness, and tingling may
  be associated w/pain.
• Signs and symptoms to watch for are the 5 Ps
  pain, pulslessness, pallor, paresthesia and
  paralysis.

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Assessment

• Subjective data- focuses on pain associated with
  intermittent caudication.
• Does the pain occur w/activity ?
• Is it relived at rest ?
• Or is the pain occurring at rest ?
• Objective data- includes assessment of pulses in
  the affected extremity, which may be weak or
  absent, compare to unaffected extremity. Other
  assessment factors may include pallor and
  hairless, shiny skin that is dry and cool to
  touch, cyanosis, arterial ulcers, cellulitis, or
  gangrenous changes in the affected extremity.

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Diagnostic Tests

• Treadmill testing- form of monitoring hearts
  capability. The patient is put through a limit of
  exertion to evaluate ischemia.
• Digital subtraction angiography- is the procedure
  to visualize blood vessels with contrast medium
  in a bony environment by subtracting the
  pre-contrast image from the image with contrast
  medium.
• Doppler ultrasound- used to measure your blood
  pressure at various points along your arms or
  legs. These measurements can help your doctor
  gauge the degree of any blockage, as well as the
  speed of blood flow in your arteries.
• MRI are also obtained.

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Doppler ultrasound
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Magnetic Resonance Image showing a vertical
sagittal (divides the body into sinister and
dexter (left and right) portions. ) cross section
through a human head.
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Medical Management

• Is focused on preventing complete arterial
  occlusion.
• Frequently used medications are anticoagulants-
  used to prolong clotting time (heparin and
  warfarin).
• Fibrinolytics or thrombolitics are useful in
  dissolving existing thrombi (urokinase)
• Surgery is used for advanced disease. Includes
  embolectomy (the removal of embolism)
• endolectomy (the surgical removal of the lining
  of an artery).
• An arterial bypass operation is done to treat a
  blockage in a major artery that is causing
  symptoms due to lack of sufficient blood flow.

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Targeted, color-enhanced, 3D volume-rendering
reconstruction of the distal arterial bypass
graft confirms the normal appearance of the
distal anastomoses (thin white arrows). Note
postoperative clip material (white arrowheads)
and additional interposed short new graft segment
(thick white arrow).
Arterial bypass
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Percutaneos transluminal angioplasty

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Nursing Interventions

• Activity intolerance
• Related to ischemic pain or immobility.
• Prevent hazards of immobility by turning
• positioning
• deep breathing
• ROM
• promote exercise for circulation

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Nursing interventions continued

• Ineffective tissue perfusion
• Related to decreased arterial blood flow.
• Avoid raising feet above heart,
• keep extremities warm to promote vasodilatation.
• Administer medications

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Patient teaching

• teach patient importance in not smoking to
  prevent vasoconstriction
• also avoid caffeine or chilling.
• Not crossing their legs
• Not to wear constrictive cloths such as garters,
  tight stockings, or belts.