– Acute or chronic occlusion of the blood supply to the extremities by atherosclerotic plaques.
Causes and Incidence
The most common cause is underlying atherosclerosis, and individuals with atherosclerosis are vulnerable.
The pathologic processes involved in atherosclerosis are detailed under coronary artery disease. In peripheral disease, an artery in an extremity is either suddenly occluded (acute), resulting in rapid tissue ischemia, or occluded after a long-term buildup of plaque in the vessel (chronic), leading to insidious development of tissueischemia.
Sudden onset of severe pain, coldness, numbness, and pallor of affected extremity; absent pulses distal to occlusion
Intermittent claudication progressing to pain at rest; decreased pulses; pallor after elevation; dry, scaly skin with sparse hair and nail growth on affected extremity; numbness and tingling; slow healing of wounds
Complications: Necrosis and gangrene, with resultant limb loss, is the most common complication.
Clinical evaluation and Doppler ultrasound to locate the obstruction are used for diagnosis.
Thromboendarterectomy or resection with or without graft to remove obstruction and make vessel patent; amputation for uncontrolled infection, necrosis, or gangrene.
Antiinfective drugs for infection; vasodilators, calcium antagonists, and thromboxane inhibitors for chronic disease.
Acute: percutaneous transluminal angioplasty instead of surgery to remove obstruction; lasers, mechanical cutters, stents, and rotational sanders are also being tried to clear the blockage Chronic: progressive exercise to develop collateral circulation; prophylactic nail and foot care to prevent secondary infection; careful monitoring of wounds, cuts, and ulcers; avoidance of all tobacco products and any other known vasoconstrictors.