Wound Care

Arterial Insufficiency 147
• Buerger’s disease (thromboangiitis obliterans) is the second
most common cause of chronic arterial occlusion.
— It occurs in young adults who are heavy smokers—
exclusively limited to this population—especially males.
— It causes an intense inflammatory process—possibly
autoimmune—leading to occlusion of the arteries and
veins. The midsized arteries and veins are affected first
and the progression of the disease is proximal.
— Cold sensitivity, ulcers, and gangrene occur in the upper
and lower extremities.
— Marginal collateral circulation of toes and fingers causes
early tissue necrosis with occlusion.
— Ulceration may occur spontaneously but more commonly
follows minor trauma.
— Symptoms are always bilateral, frequently involving all
four limbs.
— Necrotizing vasculitides are the less common causes of
ischemic wounds. They are a broad group of disorders with:
Inflammatory reactions in the blood vessels causing
necrosis and destruction of the vessel wall such as
Takayasu’s arteritis, polyarteritis nodosa, rheumatoid
arthritis, and system lupus erythematosus.
• Sickle cell anemia is another cause of occlusion, affecting
both the arterial and venous systems at a microvascular
level.
— The majority of ulcerations are closely associated with
venous insufficiency but arterial ulcers may also occur.
Nursing Assessment
• If the patient has a lower extremity ulcer, it is necessary to
assess for arterial disease. 2
• Arterial ulcer clinical characteristics include: 5,3
— Skin color
— Elevational pallor: more advanced lesions require less elevation
to obtain the same results; elevation causes