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Identify and Treat the Cause - Surgical and Medical Interventions

Interventions are aimed at reversing ischemia.

  1. Endovascular Perfusion Strategies (catheter-based revascularization)
    • Angioplasty
      • Least invasive
      • Cannula with guidewire inserted into artery guided by fluoroscopy
      • Diseases section of artery is dilated using an angioplasty balloon
      • Stent MAY be used to maintain the lumen
      • Potential complications include:
        • Hemorrhage
        • Thrombosis
        • Restenosis
        • Occlusion
    • Catheter-directed Thrombolytic Therapy
      • Thrombus dissolved using catheter
  2. Surgical Perfusion Strategies
    • Endarterectomy
      • Open surgical procedure
      • Lesions are removed from the artery
      • Can be performed under local anesthetic
      • Appropriate for higher risk surgical patients
    • Arterial Bypass
      • Used for extensive vascular pathology
      • Creates autogenous (natural) or prosthetic (artificial) vein that bypass obstruction
      • Restores circulation to ischemic tissue
      • Autogenous vein is usually preferred (saphenous vein)
      • Higher risk of infection if prosthetic graft used
      • Successful in 85-89% of patients with critical limb ischemia
  3. Oxygenation Strategies

    Used for patients with incomplete arterial obstruction to increase dissolved blood oxygen

    • Normobaric Oxygen (can increase plasma-dissolved oxygen by 40%)

      Venturi Mask Delivers 24% to 60% oxygen
      Nasal Cannulas Delivers 24 to 40% oxygen
      Requires nasal breathing
      Nonrebreather Mask Delivers 80 to 90% oxygen
      Use should be limited to 24-36 hours

    • Hyperbaric Oxygen Therapy

      RNAO Evidence Level:

      Level II(a or b?)
      • Can increase dissolved blood oxygen by up to 6 mL/dL
      • Can benefit angiogenesis, fibroblast growth and collagen production
      • Enhances removal of carbon monoxide from hemoglobin
      • Decreases neutrophil adherence to vessel walls
      • Reduces edema
      • Should be considered in patients with non-reconstructable anatomy or where ulcer is not healing despite revascularization

Provide Local Wound Care
  1. Weir G.R, Hiske S, Marle J.V, Cronje F.J, Sibbald R.G. Arterial Disease Ulcers, Part 2: Treatment. Advances in Skin and Wound Care: September 2014.

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