Arterial Occlusive Disease
An obstruction or narrowing of the lumen of the aorta and its major branches, arterial occlusive disease interrupts blood flow, usually to the legs and feet. This disorder may affect the carotid, vertebral, innominate, subclavian, mesenteric, and celiac arteries.
Arterial occlusive disease is more common in males than in females. The prognosis depends on the location of the occlusion, the development of collateral circulation to counteract reduced blood flow and, in acute disease, the time elapsed between the development of the occlusion and its removal.
Causes
The most common cause of acute arterial occlusion is obstruction of a major artery by a clot. The occlusive mechanism may be endogenous, resulting from emboli formation, thrombosis, or plaques, or exogenous, resulting from trauma or fracture. Chronic arterial occlusive disease is a common complication of atherosclerosis.
Predisposing factors include smoking; sedentary lifestyle; obesity; stress; aging; conditions such as hypertension, hyperlipidemia, and diabetes mellitus; and family history of vascular disorders, myocardial infarction, or stroke.
Complications
Occlusions may be acute or chronic and commonly cause severe ischemia, skin ulceration, muscle atrophy, and gangrene.
Assessment
Assessment findings depend on the vessel involved. (See Detecting arterial occlusive disease.)
Acute arterial occlusion occurs suddenly, often without warning. However, peripheral occlusion can commonly be recognized by the five Ps:
Pain, the most common symptom, occurs suddenly and is localized to the affected arm or leg.
Pallor results from vasoconstriction distal to the occlusion.
Pulselessness occurs distal to the occlusion, and bruits may be auscultated.
Paralysis and paresthesia occur in the affected arm or leg from disturbed nerve endings or skeletal muscles.
A sixth P, known as poikilothermy, refers to temperature changes that occur distal to the occlusion, making the skin feel cool.
Intermittent claudication is manifested by aching, cramping, fatigue, or weakness in the affected extremity. The pain occurs during exercise or movement and is relieved by rest.
Diagnostic tests
Arteriography demonstrates the type, location, and degree of obstruction and the establishment of collateral circulation. It’s particularly useful in chronic disease or for evaluating candidates for reconstructive surgery.
Ultrasonography and plethysmography are noninvasive tests that, in acute disease, show decreased blood flow distal to the occlusion.
Doppler ultrasonography typically reveals a relatively low-pitched sound and a monophasic waveform. Duplex ultrasonography reveals blood flow velocity changes through the use of a pulsed Doppler.
Segmental limb pressures and pulse volume measurements help evaluate the location and extent of the occlusion.
Ophthalmodynamometry helps determine the degree of obstruction in the internal carotid artery by comparing ophthalmic artery pressure with brachial artery pressure on the affected side. More than a 20% difference between pressures suggests arterial insufficiency.
EEG and a computed tomography scan may be necessary to rule out brain lesions.
Detecting arterial occlusive disease
A patient with arterial occlusive disease may have a variety of signs and symptoms, depending on which portion of the vasculature is affected by the disorder.
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