Arterial Insufficiency is a lack of enough blood flow through the arteries typically caused by atherosclerosis

Atherosclerosis

Atherosclerosis is a condition in which an artery wall thickens as a result of the accumulation of fatty materials such as cholesterol...

. Arterial insufficiency can affect many different parts of the body. The specific symptoms may indicate which artery is involved. If heart arteries are involved, it can cause symptoms of heart attack. If brain arteries are involved, it can cause symptoms of stroke

Stroke

A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

. If the arteries of the lower abdomen

Abdomen

In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...

 or legs are involved, you might have repeated episodes of leg cramping when you walk. Arterial insufficiency also can affect the arteries in the abdomen, causing pain after eating meals.

Epidemiology

• Symptomatic arterial insufficiency is present in 5% to 15% of the adult population over 55 years old
• Incidence and prevalence increases with age; rare in patients <40 years old.
• Males are affected more often than females in patients under 70 years old, whereas no gender differences observed in patients over 70 years old.

Pathophysiology

• Initial lesion is a fatty streak
  Fatty streak
  Fatty streak, though composed of macrophage white blood cells, not fat, is the term generally given to the earliest stages of atheroma, as viewed at autopsy, looking at the inner surface of arteries, without magnification....
  
   in intimal layer
  Tunica intima
  The tunica intima is the innermost layer of an artery or vein. It is made up of one layer of endothelial cells and is supported by an internal elastic lamina...
  
  .
• Intermediate phase of insufficiency formation is smooth muscle
  Smooth muscle
  Smooth muscle is an involuntary non-striated muscle. It is divided into two sub-groups; the single-unit and multiunit smooth muscle. Within single-unit smooth muscle tissues, the autonomic nervous system innervates a single cell within a sheet or bundle and the action potential is propagated by...
  
   proliferation
  Proliferation
  Proliferation may refer to:*Nuclear proliferation*Chemical weapon proliferation*Cell proliferation* The proliferative phase of wound healing...
  
  .
• Final phase of formation is a fibrous plaque overlying a soft tissue core of lipids and necrotic debris.

Diagnosis

• Inspection may reveal muscle atrophy
  Muscle atrophy
  Muscle atrophy, or disuse atrophy, is defined as a decrease in the mass of the muscle; it can be a partial or complete wasting away of muscle. When a muscle atrophies, this leads to muscle weakness, since the ability to exert force is related to mass...
  
   from disuse, trophic skin changes (loss of hair, dry skin), or thickened nails.
• Ulcers
  Arterial insufficiency ulcer
  Arterial insufficiency ulcers are mostly localed on the lateral surface of the ankle or the distal digits.-Etiology:...
  
   or gangrene
  Gangrene
  Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies . This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood...
  
   is present in critical limb ischemia.
• Pulses should be palpated in the femoral
  Femoral
  Femoral can refer to:* Femoral artery* Femoral vein* Femur* Femoral triangle* Femoral nerve...
  
  , popliteal
  Popliteal
  Popliteal refers to anatomical structures located in the back of the knee:*Popliteal artery*Popliteal vein*Popliteal fossa*Popliteal lymph nodes*Popliteal nerves*Popliteal pterygium...
  
  , dorsalis pedis, and posterior tibial
  Posterior tibial
  Posterior tibial can refer to:* Posterior tibial artery* Posterior tibial vein...
  
   positions.

Lab tests

• Routine laboratory tests
  Medical laboratory
  A medical laboratory or clinical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease.-Departments:...
  
   show no changes
• Serum chemistry (complete blood count
  Blood Count
  "Blood Count" is a 1967 jazz composition by Billy Strayhorn. It was originally meant for a three-piece work Strayhorn was writing for Duke Ellington and initially titled "Blue Cloud". However, Strayhorn was hospitalized in 1967 due to cancer and finished the composition while in the hospital. He...
  
  , including platelet count; lipid profile
  Lipid profile
  Lipid profile or lipid panel, is the collective term given to the estimation of, typically, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. An extended lipid profile may include very low-density lipoprotein...
  
  ; fasting blood glucose and hemoglobin
  Hemoglobin
  Hemoglobin is the iron-containing oxygen-transport metalloprotein in the red blood cells of all vertebrates, with the exception of the fish family Channichthyidae, as well as the tissues of some invertebrates...
  
   A1C; BUN/creatinine
  Creatinine
  Creatinine is a break-down product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body...
  
  ; homocysteine
  Homocysteine
  Homocysteine is a non-protein amino acid with the formula HSCH2CH2CHCO2H. It is a homologue of the amino acid cysteine, differing by an additional methylene group. It is biosynthesized from methionine by the removal of its terminal Cε methyl group...
  
  )
• Noninvasive vascular laboratory
  • Segmental limb pressures, Doppler waveform analysis
  • Treadmill
    Treadmill
    A treadmill is an exercise machine for running or walking while staying in one place. The word treadmill traditionally refers to a type of mill which was operated by a person or animal treading steps of a wheel to grind grain...
    
     testing
  • Toe plethysmography and pressures
  • Duplex
    Medical ultrasonography
    Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...
    
    

Differential diagnosis

• Compartment syndrome
  Compartment syndrome
  Compartment syndrome is a limb threatening and life threatening condition, defined as the compression of nerves, blood vessels, and muscle inside a closed space within the body . This leads to tissue death from lack of oxygenation due to the blood vessels being compressed by the raised pressure...
  
  
• Osteoarthritis
  Osteoarthritis
  Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
  
  
• Arterial embolus
• Vasculitis
  Vasculitis
  Vasculitis refers to a heterogeneous group of disorders that are characterized by inflammatory destruction of blood vessels. Both arteries and veins are affected. Lymphangitis is sometimes considered a type of vasculitis...
  
  
• Buerger disease

Treatment

Smoking cessation

Smoking cessation

Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance. This article focuses exclusively on cessation of tobacco smoking; however, the methods described may apply to cessation of smoking other substances that can be difficult to stop using due to the...

 and exercise therapy (regular walking) are useful both for treatment of arterial insufficiency and its prophylaxis. Two medications currently are approved by the U.S. Food and Drug Administration

Food and Drug Administration

The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

 (FDA) for treatment of intermittent claudication: pentoxifylline (hemorheologic agent) and cilostazol (phosphodiesterase inhibitor).

Surgery

The type of operation depends on the anatomic level and extent of arterial disease:

• Aortofemoral or extra-anatomic bypass for aortoiliac disease
• Infrainguinal bypass for femoral
  Femoral
  Femoral can refer to:* Femoral artery* Femoral vein* Femur* Femoral triangle* Femoral nerve...
  
  , popliteal
  Popliteal
  Popliteal refers to anatomical structures located in the back of the knee:*Popliteal artery*Popliteal vein*Popliteal fossa*Popliteal lymph nodes*Popliteal nerves*Popliteal pterygium...
  
  , tibial
  Tibial
  Tibial can refer to:* Tibia bone* Tibial nerve* Anterior tibial artery* Posterior tibial artery* Anterior tibial vein* Posterior tibial vein...
  
  disease

Diet

While there is no direct association between arterial insufficiency and diet

Diet

Diet, in relation to food, might mean:*Diet , the sum of the food consumed by an organism or group*Dieting, the deliberate selection of food to control body weight or nutrient intake*Diet food, foods that aid in dieting...

, a low fat, low cholesterol

Cholesterol

Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

 diet

Diet

Diet, in relation to food, might mean:*Diet , the sum of the food consumed by an organism or group*Dieting, the deliberate selection of food to control body weight or nutrient intake*Diet food, foods that aid in dieting...

 is generally recommended.

Activity

Regular walking exercise

Walking

Walking is one of the main gaits of locomotion among legged animals, and is typically slower than running and other gaits. Walking is defined by an 'inverted pendulum' gait in which the body vaults over the stiff limb or limbs with each step...

at least 30 minutes 3 times a week is recommended.