Management of Chronic Arterial Insufficiency

1. Educate the patient about how to minimize or prevent current impairments and correct impairment or Functional limitations.

Table 1: Impairments in Chronic Arterial Insufficiency

Decreased endurance Increased frequency of muscle fatigue with ADL Skin ulceration Limitation of passive and active motion Weakness and disuse atrophy

2. Medical or surgical management including;

1. Medications; 

2. Nutritional counseling for weight control, caffeine, salt, sucrose, cholesterol intake

3. Smoking cessation

3. The regular, graded aerobic problem of walking or bicycling to improve exercise tolerance for ADL and increase the claudication time.

4. To relieve pain at rest, sleep with the legs independent but the head of the bed is slightly elevated.

5. To prevent skin ulceration:

1. Give proper care and protection of the skin.

2. Give proper nail care.

3. Proper shoe selection and fit.

4. Avoid the use of restrictive clothing.

5. Avoid exposure to extreme temperature (Both hot or cold).

6. Improve vasodilation in affected arteries by iontophoresis and reflex heating.

7. Prevent or minimize joint contractures and muscle atrophy by:

1. Active ROM exercise

2. Stretching exercises

3. The positioning of the patient in bed to maintain joint and muscle extensibility.

8. Promote wound healing (skin ulceration).