Arteriosclerosis obliterans

1. Arteriosclerosis obliterans Maria Arteaga

2. 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.

4. 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 P’s pain, pulslessness, pallor, paresthesia and paralysis.

5. 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.

6. 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.

7. Doppler ultrasound

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

10. 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.

11. 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

12. Percutaneos transluminal angioplasty

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

14. 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

15. 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.