Occlusive Arterial Disease

 

Occlusive Arterial Disease

 

Definition

 

 It is a condition characterized by blocking of the arterial lumen due to any cause.

 

Aetiology

1.Burger’s disease.

2.Raunaud’s disease.

3.Tobacco chewing o smoking.

4.Diabetes mellitus.

5.Heredity.

6.Working with vibrating tools.

7.Trauma.

8.Ateriosclerosis.

9.Atherosclerosis.

 

Clinical features

 

Feature	Manifestations
Claudication	.Cramps in the calves during walking. .The person is forced to stop due to the pain. .The Cramps are relieved by rest.
Rest pain	.It is seen when the extent of the block is greater than that causing Claudication. .There is pain in the legs even when the person is  resting. .Sleeplessness due to pain. .The patient elevates his legs during sleep for obtaining relief from pain.
Nutritional changes	.Loss of sensation in the toes. .Toes are hard and flaky. .Moistness between toes. .Thinning of leg and loss of hair from the leg. .Features of gangrene.

 

 

Treatment

1.Any form of injury to the lower limb is avoided, by adopting the following measures:-

              . New footware isnot worn.

              .Tight shocs or socks are not worn.

             .Hot water bag or bottle is not   used for fomentation.

             . The leg is not tied tightly to  relieve pain.

             .Toe-nails are not pared. They ar allowed to grow because they protect the nail-bed.

             .The nails are well cared for, preventing development of paronychia.

2.General care

              .Tobacco is not used any form , such as smoking or chewing.

              .Deep breathing exercises are done to improve venous return through the deep veins.

              .Long walks are taken at a slow speed.

              . Hypertension is treated ,if any.

               . The head end of the cot is raised during sleep to improve  blood flow to the  lower limbs.

               .Diet rich in fats is avoided, to reduce the risk of  atherosclerosis.

               .Vasodilators are avoided because they may cause hypertension by dilating all the blood vessels in the body.

3. prevention of infection

              .Maintenance of hygiene.

             .Control of diabetes mellitus, if any.

4.Surgical treatment: It is done depending on the patient’s age, general condition, underlying cause and the prohnosis. Various forms of surgical treatment are shown in the following table.

 

 

                       Surgical Treatment of Arterial Occlusion

 

 

Surgery	Features
Thromboendarterectomy	The thrombus and arteriosclerotic patch are removed using a ring stripper passes through an incision in the arterial wall. Then the arterial incision is repaired.
Bypass graft	The diseased segment of the artery is left undisturbed and a segment of the patient’s saphenous vein removed surgically is sutured to the artery at two points,one above the  level of the block and the other below the level of the block.
Transluminal  angioplasty	If there is a stricture of the artery,a special type of ballon catheter is passed into it through the femoral artery using sedinger technique. Its passage is confirmed fluoroscopically. The balloon is inflated when it lies in the part with the stricture. This results in stretching of the stricture and its expansion.

 

 

Preoperative  Care

 

1.General care is taken as for any major surgery.

2. The patient is confirmed to be fit for anaesthesia and  surgery.

3.Diabetes mellitus is controlled ,if any.

4.Any infection in the body is treated.

5.Four to fix units of blood  are cross-matched with the patient’s blood and kept ready for the surgery.

6.Antibiotics may be started prophylactically.

7.Arterial radiography are  kept ready and sent to the operation theater with the patient.

8.If the patient is to undergo surgery on the abdominal arteries, a catheter is passed before sending him to the operation theatre.

 

Postoperative care

1.The pulse and blood pressure are watched carefully.

2.There may be drainage tube after leg surgery. If it is present, it is cared for as discussed before.

3.The surgical wound and the drainage tube are watched for haemorrhage and if it is present, the doctor is told about immediately.

4. The part of the limb  distal to the site of surgery is  observed carefully for skin colour, sensation,and arterial pulsations, and any abnormality is reported to the doctor immediately.

5.Complete rest in bed is given for the first 2 days. Then the patient is mobilized gradually.

6. Thrombosis of the graft is watched for, because that would require a repeat surgery.

7.If the graft  gets infected,  secondary haemorrhage may occur. That needs to be prevented, and if it does occur, to be treated energetically and  early.

8.paralytic ileus after aortic surgery is treated appropriately.