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INTRODUCTION
Atherosclerotic occlusive disease (ASOD) is the most common form of peripheral vascular disease. Thisform of vascular disease is a metabolic process that evolves into an eccentric narrowing of the arterial lumen. Unchecked, it may progress to complete occlusion of the artery by thrombus, or ulceration of the artery's intimai layer and emboli formation. The results are diminished blood flow, pain, tissue damage and debilitation. Atherosclerotic occlusive disease is chronic in nature, with periods of acute exacerbations. The incidence is most prevalent in the male population over the age of 45 years.
The focus of this article is the maintenance and promotion of optimal health in individuals with atherosclerotic occlusive disease. Content will include: anatomy of the vascular system, pathogenesis, vascular assessment, restorative, and preventive care pertinent to the role of the occupational health nurse.
ANATOMY OF THE VASCULAR SYSTEM
The arterial system is constructed much like a tree in the forest. The main trunk is the aorta rising from its root, the heart. The first branches off the aorta are the coronary arteries, delivering nutrients and oxygen to the various structures of the heart, including the myocardium. At the aortic arch, one inch below the sternal notch, the aorta sends off the innominate, left common carotid, and left subclavian arteries. These arteries provide circulation to the upper extremities, head, and neck. The aorta descends anterior and slightly to the left of the spinal column. The abdominal aorta ends at the level of the umbilicus and divides into the common iliac arteries. Branches off the abdominal aorta supply blood flow to all the visceral organs, including the kidneys, stomach, liver.spleen, pancreas and intestines (Figure 1). The iliac arteries feed the buttock and hip areas, and are continuous with the femoral arteries. The femoral arteries, popliteal arteries and distal branches off the popliteal arteries nourish the lower extremities and feet (Figure 1).
The arterial wall consists of three layers: the adventitia, the media and intima (Figure 2). The adventitia, the outer layer, is composed chiefly of white fibrous connective tissue, which strengthens and limits the distensibility of the arterial wall. The media, the middle layer, consists of smooth muscle fibers predominantly structured in a circular fashion. The media is interspersed with elastic fibers, which enhance the...