Part 1

 Cause Thrombus (blood clot) Embolism Trauma Crush injuries

 Most Common location Femoral-Popliteal bifurcation

 Measures Complete bed rest Systemic anti-coagulation therapy, Thromboembolectomy Reconstructive arterial bypass surgery

 Contraindicated  Exercise  Use of support hose  Application of direct heat

 Also called Chronic occlusive arterial disease Peripheral arterial occlusive disease Atherosclerotic occlusive disease

 Accounts for 95% of all the arterial disorders  Affecting the lower extremities.  Elderly patients  men>women

 Risk factors Elevated serum cholesterol ( 200 mg/dL) Smoking High systolic blood pressure Obesity Diabetes

 Atherosclerotic plaque formation.

 Characterized by Chronic, progressive occlusion of the peripheral circulation Most often in the large and medium arteries of the lower extremities. Young male patients who smoke

 An inflammatory reaction of the arteries to nicotine.  Small arteries of the feet and hands and progresses proximally.  It results in vasoconstriction, decreased arterial circulation to the extremities, ischemia, and eventual ulceration and necrosis of soft tissues.

 The inflammatory reaction and resulting signs and symptoms can be controlled if the patient stops smoking

 Primary Raynaud’s syndrome  Chronic, functional arterial disorder  Women>men  Caused by an abnormality of the sympathetic nervous system

 Characterized by  Digital vasospasm  Affecting the small arteries and arterioles of the fingers and sometimes the toes.  Exposure to cold, vibration, or stress.  Temporary pallor (blanching), then cyanosis and pain, followed by numbness and a cold sensation of the digits.

 Symptoms are relieved slowly by warmth

 Raynaud’s disease Idiopathic (primary)  Raynaud’s Phenomenon Secondary Scleroderma, systemic lupus erythematosus, systemic sclerosis, or vasculitis

 Diminished or Absent Peripheral Pulses Collateral circulation

 Integumentary Changes  Skin discoloration Pallor (elevated), in rest or after exercise Reactive hyperemia (lowered after elevated)  Trophic changes (shiny, waxy, dryness, loss of hair  Skin temperature ?  Ulcerations (weight bearing, bony)

 Sensory Disturbances

 Exercise pain  Intermittent claudication Early: feeling of fatigue or weakness Later: cramping or aching in the muscles  Does not occur With extended periods of standing (as seen with spinal stenosis) With prolonged sitting (as seen with sciatica)  One limb or both??

 Burning, tingling sensation  At night??  Heart rate and volume of blood flow to the extremities decreases with rest  Relief of pain, if the leg is placed in a dependent

 Weakness  Atrophy  loss of motor function  Pain  Weakness