مرض الشرايين الطرفية

Definition

Peripheral arterial disease is narrowing of the limb arteries, usually the legs, from atherosclerosis.

Risk factors

Smoking (the most important), diabetes, hypertension, high lipids and age.

Symptoms

• Intermittent claudication: leg pain after a fixed walking distance that eases with rest
• Advanced disease: rest pain worse with leg elevation and eased by hanging the leg down

Signs

• Cool, shiny, hairless skin and thick nails
• Weak or absent pedal pulses
• Deep punched-out ulcers on toes and pressure points

Diagnosis

Ankle-brachial index (ABI): below 0.9 suggests disease; arterial Doppler.

Treatment

• Stop smoking and a regular walking programme
• Aspirin or clopidogrel, a statin, and glucose and BP control
• Angioplasty or bypass for severe disease

Nursing care

• Daily foot inspection and care, with comfortable footwear
• Keep the legs level or slightly dependent, not elevated
• Avoid cold and direct hot packs

Exam point

Sudden pain with pallor, coldness, absent pulses and paralysis is acute arterial occlusion, a limb-threatening emergency.