Arterial insufficiency- Definition, Causes, Clinical presentation, Diagnosis, Treatment

Arterial insufficiency

Definition

• Arterial insufficiency refers to a lack of adequate blood flow to regions of the body.

• Peripheral vascular disease most commonly caused by arterial insufficiency and related to smoking, cardiac disease, diabetes, hypertension, renal disease, elevated cholesterol, triglycerides, obesity, sedentary lifestyle.

Disorders that occur with Abnormal Arterial Blood Flow

• Arteriosclerosis: 

• Arteriosclerosis is thickening, hardening, and loss of elasticity of arterial walls.

  
  
  

• Atherosclerosis: 

• A most common form of arteriosclerosis associated with damage to the endothelial lining of the vessels and the formation of lipid deposits, leading to plaque formation.

• Arteriosclerosis Obliterans (ASO): 

• Also called chronic occlusive arterial disease, peripheral arterial occlusive disease, or atherosclerotic occlusive disease. 

• ASO is a peripheral manifestation of atherosclerosis characterized by chronic, progressive occlusion of peripheral circulation.

• Thromboangiitis obliterans  (Buerger's disease):

• Inflammation leads to arterial occlusion and tissue ischemia in young male patients who smoke.

• Raynaud's disease: 

• A vasomotor disease of small arteries and arterioles that is most often characterized by pallor and cyanosis and pain, followed by numbness and cold sensation of the fingers.

• Occur more commonly in women than in males.

Clinical Presentation of Arterial Insufficiency

• Wound frequently located on lower extremities such as lateral malleoli, dorsum of feet, toes.

• When wounds are present on an ischemic limb, atherosclerotic occlusion of peripheral vasculature is always present.

• The majority of the patient with arterial insufficiency also have diabetes.

• Diminished or absent peripheral pulses.

• Skin is cool on palpation (skin temperature is decreased).

• Wounds are painful. 

  

  Fig. 1: Atrial insufficiency ulceration.
  

  
  

• The patients may also describe pain during exercise (intermittent claudication) or even at rest in the legs and feet (Table1).

• The wound base is usually necrotic and pale, lacking granulation tissues.

• The skin around the wound may be black, mummified.

• Trophic changes are present with abnormal nail growth, decreased leg and foot hair, and dry skin distal to the occlusion.

• Intolerance to heat or cold and paresthesia can develop.

• Other signs of arterial insufficiency will be decreased pulses, pallor on leg elevation, and rubor when dependent.

Table 1: Common Sites of Exercise Pain and Associated Arterial Occlusion in Chronic Artery Insufficiency
Site of Pain	Occluded Artery
Calf	Femoral artery
Foot	Popliteal artery
Thigh	Iliac artery
Buttocks or low back	Aorta

Investigation/Diagnosis

Management/Treatment