Arterial insufficiency in the peripheral vessels is most often due to atherosclerosis, blood clots, trauma, spasms of smooth muscles in the arterial walls, and congenital structural defects in the arteries. A diminished or interrupted flow of blood through the peripheral arteries can eventually lead to ischemic necrosis and gangrene. A sluggish venous flow leads to increased pressure within the vessels, which in turn leads to varicose veins and, possibly, thrombophlebitis. When blood is not moved out of the veins of the lower extremities, it accumulates there and serves as an excellent medium for bacterial growth and contributes to the formation of leg ulcers. Treatment is aimed at improving blood flow by removing or mitigating the cause of impaired circulation.
Arterial insufficiency is characterized by two types of pain.
The pain is most often felt in the calves of the legs, but it may also affect the thighs and buttocks. A second type of pain is characteristic of advanced chronic occlusive arterial disease. It occurs when the patient is at rest, usually at night while lying down. The sensation is described as burning and tingling, with numbness of the toes. Assessment includes noting the color and temperature of the skin in the affected areas and any signs of trophic changes.