Except with advanced disease, chronic arterial insufficiency caused, for example, by ASO or Raynaud’s disease is managed conservatively by medical and physical means and does not constitute a medical or surgical emergency.

Medical/Surgical Management

Medical management of chronic arterial insufficiency must be ongoing. Related medical disorders must be identified and treated. Diabetes and hypertension are commonly associated with chronic arteriosclerotic vascular disease and must be controlled with medication, diet, and exercise.

Lifestyle changes are an important aspect of management. In all cases, patients are advised to stop smoking and alter their diet, such as limiting or avoiding salt, sucrose, and alcohol to lower blood pressure and triglyceride and cholesterol levels. These measures do not cure chronic arterial disorders but do minimize risk factors and promote wellness.

Management Guidelines-Chronic Arterial Insufficiency

Impairments

Decreased endurance and increased frequency of muscular fatigue with functional activities such as walking

Pain with exercise or at rest

Skin breakdown and ulcerations

Limitation of passive and active motion

Weakness and disuse atrophy

For patients with leg pain at rest due to advanced disease, reconstructive vascular surgery, such as a bypass graft, may be required. Patients with vasospastic disease may benefit from sympathetic blocks or sympathectomies to increase blood flow. If a patient develops ulcerations or gangrene that cannot be treated medically or with conservative surgical procedures, amputation of the limb is necessary.

Role of Exercise

For patients with mild to moderate arterial disease, a graded exercise program should be initiated to improve exercise tolerance and functional capacity in activities of daily living. A regular program of mild- to moderate-level aerobic exercise, such as walking or bicycling, is known to have benefits for patients with chronic arterial insufficiency.

Demonstrated benefits include an increase in the time before the onset of exercise pain during walking, improvement in the efficiency of oxygen utilization in exercising muscles (enabling patients to tolerate exercise over longer periods of time), and quantitative improvement of quality of life. However, the characteristics of an optimal exercise program or whether exercise programs improve collateral circulation in the extremities is less clear.

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