Occlusive Arterial Disease

WHAT YOU SHOULD KNOW

Causes

Occlusive arterial disease is almost always caused by atherosclerosis, the buildup of fatty deposits and scar tissue on the inside of the artery walls. Doctors still don't know exactly what triggers this buildup, but they do know that several factors make it more likely to occur. These include smoking, high blood pressure, diabetes, excess weight, lack of exercise, a high-fat diet, high blood cholesterol levels, and a family history of heart or vascular disease.

Signs/Symptoms

Coronary artery disease is usually signaled by burning, squeezing, heaviness, or tightness in the chest that may extend to the left arm, neck, jaw, or shoulder blade. (See the entry on Angina.)

Peripheral atherosclerotic disease typically starts with a symptom called intermittent claudication , or pain in an exercising muscle. Often this symptom first surfaces as a pain, ache, cramp, or tired feeling in a leg muscle after walking for a while. The calf is the most common location, but the foot, thigh, hip, or buttocks can also be affected. The symptoms disappear after 1 to 5 minutes of rest, but start again as soon as you've walked for a comparable amount of time. As this disease gets worse, the pain becomes constant. The foot becomes cold and numb. Hair and toenails grow slowly and the skin gets dry and scaly. Eventually sores develop and tissue begins to die, posing the danger of gangrene and possible amputation.

Care

If you have coronary artery disease, you'll need treatment for angina or possibly even heart attack. (See separate entries.)

For peripheral atherosclerotic disease, the first---and easiest---form of treatment is a regular exercise program that includes an hour of walking each day. You'll also need to adopt a low-fat diet and lose weight if necessary. If you smoke, it's essential to quit. You should take special care of your feet.

You may be prescribed medications to increase blood supply and prevent artery-blocking blood clots from forming. If you have diabetes, appropriate treatment may delay or inhibit the onset of occlusive arterial disease.

There are a number of treatment options to relieve a severe blockage. The most common include:

• Angioplasty: A very small, deflated balloon on the tip of a narrow tube called a catheter is inserted into a blood vessel and threaded to the site of the blockage. The balloon is then inflated to open the artery. Your doctor may insert a tiny, wire mesh cylinder (a stent) to keep the artery open.
• Atherectomy: An incision is made into the diseased artery and the fatty deposit is removed.
• Bypass grafts: A vein graft from another part of the body or a graft made from artificial material is used to create a detour around the blocked artery.
• Thrombectomy: If a clot (thrombus) has formed at the site of the blockage, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is then inflated and removed, taking the clot along with it.

Risks

All forms of occlusive arterial disease pose serious dangers. Coronary artery disease can quickly lead to a fatal heart attack. Peripheral atherosclerotic disease presents a less imminent risk, but can eventually lead to tissue death, gangrene, and amputation.

WHAT YOU SHOULD DO

• Always take your medicine as directed by your doctor. If you feel it is not helping, call your doctor, but do not quit taking it on your own.
• Maintain a healthy weight. Shedding excess pounds will reduce your chances of an arterial blockage.
• Follow a well-balanced diet low in fat, salt, and cholesterol. Lowering your intake of fat cuts your risk of arterial disease.
• Quit smoking. This is a key step in managing occlusive arterial disease. If you are having trouble quitting, ask your doctor for help or for additional resources that can assist you.
• If you have other illnesses, such as diabetes or high blood pressure, you need to control them. These disorders put you at a higher risk of suffering blockages in the arteries.
• If you have peripheral atherosclerotic disease, take special care of your feet:
• • Inspect them every day.
  • Wash them daily with warm water; dry gently and thoroughly.
  • Apply a lubricant such as lanolin to dry skin.
  • Use nonmedicated foot powder.
  • Cut toenails straight across.
  • Have calluses and corns treated by a professional.
  • Do not use adhesives on the skin.
  • Do not apply harsh chemicals or corn cures.
  • Change stockings daily.
  • Wear wool stockings for warmth; do not use hot water bottles or heating pads.
  • Choose comfortable, well-fitting shoes.
• Exercise daily. Regular exercise strengthens the heart, improves circulation, and lowers blood pressure.
• Learn to control stress by adopting new ways to relax such as deep breathing exercises, muscle relaxing techniques, meditation, or yoga.
• Limit alcohol consumption to no more than one drink per day.

Seek Care Immediately If...

• You experience severe abdominal pain.
• You experience pressure or squeezing pain in your chest that lasts for several minutes or goes away and comes back.
• You experience chest discomfort accompanied by light-headedness, sweating, nausea, or shortness of breath.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may experience the following procedures and equipment during your stay.

• Chest X-ray: This is a picture of the lungs and heart.
• Taking Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• IV: This is a tube placed in your vein for giving medications or liquids. It will either be capped or have tubing connected to it.
• Electrocardiogram: Also known as an ECG, EKG, or heart monitor, this device uses electrodes stuck to your chest to measure each heartbeat and check for abnormalities caused by damage to the heart. The electrodes are hooked up to a TV-type screen or small portable box that shows a tracing of each heartbeat.
• Echocardiogram: Also called an ECHO, this equipment uses sound waves to produce a picture of your heart. Conductive jelly is applied to your chest and a device called a transducer is placed on top of it to collect the sound waves.
• MRI: This machine takes images of your internal organs to help the doctors assess the extent of any damage your heart may have suffered. To get the images, you'll probably need to lie on a narrow bed that slides into the scanner.
• Cardiac Catheterization: This is a test used to study the arteries that send blood to your heart and measure pressure within the heart.
• Blood: Blood is taken from an artery in your wrist, elbow, or groin. Tests determine the amount of oxygen the blood contains and detect abnormal levels of certain enzymes in the bloodstream.
• Pulse Oximeter: This is a device that is placed on your ear, finger, or toe and connected to a machine that measures the oxygen in your blood.
• Medicine:
• • Blood Thinners: These include heparin, aspirin, and warfarin to keep the blood thin and prevent clots from forming.
  • Thrombolytic Therapy: Dissolves blood clots and improves blood flow. This type of medication is given in your IV, usually at the same time as blood thinners, and is often administered in conjunction with an angioplasty procedure. This medicine can make you bleed or bruise easily.
  • Analgesics: To relieve pain. These medications may be given in your IV, as a shot, or by mouth. If the pain does not go away or comes back, tell your nurse immediately.
  • Blood Pressure Medicine: Given to control high blood pressure.
• Treatment Procedures: May be needed to improve blood flow through your arteries. The type of operation depends upon a number of factors, including the severity of your condition, the size and nature of the blockage or narrowing in the artery, your overall health, and the location of the affected artery.

After You Leave...

• Continue to follow your doctor's advice regarding lifestyle changes including diet and exercise.
• Do not resume normal activities until you feel up to them.