Arterial occlusive disease
With arterial occlusive disease, the obstruction or narrowing of the lumen of the aorta and its major branches causes an interruption of blood flow, usually to the legs and feet. Arterial occlusive disease may affect the carotid, vertebral, innominate, subclavian, mesenteric, or celiac artery. Occlusions, which may be acute or chronic, often cause severe ischemia, skin ulceration, and gangrene.
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, if the patient has acute disease, the time elapsed between occlusion and its removal.
Causes
Arterial occlusive disease is a common complication of atherosclerosis. The occlusive mechanism may be endogenous, due to embolus formation or thrombosis, or exogenous, due to trauma or fracture. Predisposing factors include smoking; aging; conditions such as hypertension, hyperlipidemia, and diabetes; and a family history of vascular disorders, myocardial infarction, or stroke.
Signs and symptoms
Evidence of this disease varies widely, according to the occlusion site. (See Clinical features of arterial occlusive disease.)
Clinical features of arterial occlusive disease
| Site Of Occlusion | Signs and symptoms |
|---|---|
| Aortic bifurcation (saddle block occlusion, an emergency associated with cardiac embolization) | Sensory and motor deficits (muscle weakness, numbness, paresthesia, paralysis) and signs of ischemia (sudden pain; cold, pale legs with decreased or absent peripheral pulses) in both legs |
Carotid arterial system
| Neurologic dysfunction (transient ischemic attacks [TIAs] due to reduced cerebral circulation produce unilateral sensory or motor dysfunction [transient monocular blindness, hemiparesis], possible aphasia or dysarthria, confusion, decreased mentation, and headache; these recurrent clinical features usually last 5 to 10 minutes but may persist up to 24 hours and may herald a stroke); absent or decreased pulsation with an auscultatory bruit over the affected vessels |
| Femoral and popliteal arteries (associated with aneurysm formation) | Intermittent claudication of the calves on exertion; ischemic pain in feet; pretrophic pain (heralds necrosis and ulceration); leg pallor and coolness; blanching of feet on elevation; gangrene; no palpable pulses in ankles and feet |
| Iliac artery (Leriche’s syndrome) | Intermittent claudication of lower back, buttocks, and thighs relieved by rest; absent or reduced femoral or distal pulses; possible bruit over femoral arteries; impotence |
| Innominate Brachiocephalic artery | Neurologic dysfunction (signs and symptoms of vertebrobasilar occlusion); indications of ischemia (claudication) of right arm; possible bruit over right side of neck |
Mesenteric artery
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