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What is Arterial Insufficiency?


Arterial insufficiency is one of the more common lower leg wounds you’ll encounter when you work in a nursing home. It’s essential to understand how this condition comes about so appropriate treatment can be identified based on the patient’s condition.


What is Arterial Insufficiency?

Also known as Ischemia, arterial insufficiency pertains to reduced blood flow in the arteries due to plaque buildup and blood clots brought about by several factors that include diabetes, hyperlipidemia, hypertension, peripheral vascular disease, and advanced aging, among others.


It is usually found between the toes or tips of the toes, around lateral malleolus, over phalangeal heads, or any site that was subjected to trauma or rubbing of footwear.


Arterial insufficiency comes in two forms.


Acute arterial insufficiency is the type of ischemia characterized by a sudden slowing or stoppage of blood flow and is considered a medical emergency that requires immediate attention and care.


Chronic arterial insufficiency on the other hand, is due to an underlying condition that gradually slows blood flow. Symptoms can get worse over time, putting the patient at a higher risk of developing complications.



Symptoms

Some of the common symptoms of arterial insufficiency are as follows:


  • Ankle/brachial index < 0.8

  • Decreased skin temperature

  • Delayed capillary refill (> 3 seconds)

  • Diminished or absence of peripheral pulses

  • Hair loss to lower extremity

  • Pain - intermittent claudication (exercise), nocturnal, positional, or even resting

  • Pallor on elevation

  • Shiny, taut, and dry skin

  • Thickened toe nails


Arterial insufficiency wounds are typically characterized by the following:


  • Even and punched out wound margins

  • Deep (full thickness)

  • Frequent infection

  • Minimal exudate

  • Pale color or necrotic ulcer bed (gangrene may be present)


Patients may also feel dizziness, stomach pain that consistently starts 15 to 20 minutes after a meal and may last a couple of hours, and weight loss.


Immediate medical care is required if the patient experiences the following symptoms:


  • Chest pain

  • Double vision (or vision loss)

  • Fainting

  • Gangrene

  • Pale or blue skin

  • Rapid pulse

  • Slurred speech

  • Sudden and sharp pain in the arm, chest, jaw, neck, or shoulder

  • Sudden and unexplained shortness of breath

  • Sudden and unexplained pain in the belly, neck, shoulders or back

Treatment

Treatment options for arterial insufficiency may vary depending on the cause and level of severity. Below are some of them:


  • Adequate nutrition

  • Consistent medication

  • Diabetes control

  • Neutral or dependent position of legs

  • Avoiding constrictive clothing

  • Routine foot care

  • Revascularization (if necessary)

  • Quit smoking

  • Increased physical activity

  • Medication to control blood pressure, blood glucose, and cholesterol levels

  • Medication to reduce the risk of blood clots

  • Stents


Who is at Risk of Developing Arterial Insufficiency?

While arterial insufficiency can happen to anyone, there are people who are at a higher risk and are more likely to develop the said condition especially those who are suffering from the following medical conditions:


  • Diabetes

  • Hypertension

  • Hyperlipidemia

  • Protein C deficiency

  • Protein S deficiency


People who are above the age of 60 are also at risk of developing this medical condition along with people who are pregnant, smokers, as well as those who use estrogen-based birth control medication.


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