Individuals with diabetes are at increased risk for both peripheral vascular disease and coronary artery disease. In patients with severe coronary artery disease, a cardiac assist device called an intra-aortic balloon pump (IABP) often is used to aid the failing heart and prevent further cardiac ischemia. Because this device is inserted via the femoral artery, patients are at risk of limb ischemia distal to the insertion site. Patients with diabetes are particularly prone to this complication. Detecting the early signs and symptoms of ischemia is crucial to preventing serious sequelae. Standard vascular examination techniques, in addition to being subjective and not easily reproducible, may be misleading in patients with diabetes. This article provides a review of the signs and symptoms of lower limb ischemia and noninvasive vascular tests that clinicians can use to evaluate lower extremity circulation. Also included are protocols for patient care during and after hospitalization, and two case studies of cardiac patients with diabetes who were treated with an IABP.
Doyle JETreatment modalities in peripheral vascular disease. Nurs Clin North Am1986;21:241-53.
3.
Funk M.Gleason J.Focll D.Lower limb ischemia related to use of the intraaortic balloon pump. Heart Lung1989:18:542-52.
4.
Alderman JDGahliani GIMcCabe CH et al. Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters. J Am Coll Cardiol1987;9:524-30.
5.
Kantrowitz A.Wasfie T.Freed PSRubenfire M.Wajazczuk W.Schork MAIntraaortic balloon pumping 1967 through 1982: analysis of complications in 733 patients. Am J Cardiol1986;57:976-83.
6.
Wasfie T.Freed PSRubenfire M. et al. Risk associated with intraaortic balloon pumping in patients with and without diabetes mellitus. Am J Cardiol1988;61:558-62.
7.
Ronayne R.Acute lower limb ischemia: a case study. J Vascular Nurs1992;10(3):14-19.
8.
Bovington MMNeurologic complications in diabetes mellitus . Nurs Clin North Am1983;18:735-40.
Gordon T.Kannel WBPredisposition to atherosclerosis in the head. heart, and legs: the Framingham Study. JAMA1972;221:661-66.
11.
Kuhn JKMcGovern M.Peripheral vascular assessment of the elderly client. J Gerontol Nurs1992;18(12):35-38.
12.
Bright LDGeorgi S.Peripheral vascular disease. Is it arterial or venous? Am J Nurs1992;92(9):34-46.
13.
Levin ME, O'Neil LW. Peripheral vawular disease. In: Ellenberg M. Rifkin H. eds. Diabetes mellitus: theory and practice. 3rd ed. New York: Medical Examination Publishers. 1983.
14.
Orchard TJStrandness DEAssessment of peripheral vascular disease in diabetes. Report and recommendations of an international workshop. Circulation1993;8:819-28.
15.
Massey JADiagnostic testing of peripheral vascular disease. Nurs Clin North Am1986;12:207-17.
16.
Raines JKMechanics of air plethysmography in arterial disease: the pulse volume recorder . In: Bernstein EF, ed. Noninvasive diagnostic techniques in vascular disease. 3rd ed. St. Louis: CV Mosby. 1985.
17.
Hasson JEGould SAMoss GSBlood flow laboratory techniques of the arteries. In: Pinsky S.Moss G.Srikantaswamy S.Yunryo U.Gould S.Pond G. eds. Imaging of the peripheral vascular system. Orlando. Fla: Grune and Stratton. 1984.
18.
Yao Jst.Noninvasive techniques of measuring lower limb arterial pressure. In: Bernstein EF, ed. Noninvasive diagnostic techniques in vascular disease. 3rd ed. St. Louis: CV Mosby. 1985.
19.
Loherto FWCoffman JDCurrent concepts: vascular and microvascular disease of the foot in diabetes—imphcation of foot care. N Engl J Med1984: 311:1615-18.
20.
Dodd HJGaylarde PMSarkany I.Skin oxygen tension in venous insufficiency of the lower leg. J Soc Med1985;78:373-76.
21.
Fran/ek VKTalke P.Bernstein EF, et al. Transcutaneous PO2 measurements in health and peripheral arterial occlusive disease. Surgery1982;91: 156-63.
22.
Ballard JLEke CCBuntr TJ et al. A prospective evaluation oftranscutaneous oxygen measurements in the management of diabetic foot problems. J Vascular Surg1995;22:485-92.
23.
Modesti PABoddi M.Poggesi L. et al. Trancutancous oximeter in evaluation of the initial peripheral artery disease in diabetics. Angiology1987 ;38:457-62.
24.
Funk M.Ford C.Foell DW et al. Frequeney of long-term lower limb ischemia associated with intraaortic balloon pump use. Am J Cardiol1992; 70:1195-99.
25.
Chenevey B.Sexton-Stone K.Lower limb ischemia: an iatrogenic complication of IABP. Dimens Crit Care Nurs1985;4:246-73.
26.
Goldberger M.Tabak SWShah P.Clinical experience with intra-aortic balloon counterpulsation in 112 consecutive patients. Am Heart J1986;11: 497-502.
27.
Porler BAMcCabe CJAbbott WM et al. Vascular complications of intra-aortic balloon counterpubation . Arch Surg1983;118:957-62.
Emma LAChronic arterial occlusive disease. J Cardiovasc Nurs1992: 7(2):14-24.
30.
Gottlieb SOBrinkcr JABorkon AM et al. ldentifieation of patients at high risk for complications of intraaortic balloon counterpulsation: a multi-variate risk factor analysis. Am J Cardiol1984;53:1135-39.
31.
Eltchaninoff H., Dimas APWhitlow PLComplications associated with percutaneous placement and use of intraaortic balloon counterpulsation. Am J Cardiol1993;71:328-32.
32.
Miller JS, Dodson TF, Salam AA, et al. Vascular complications following intra-aortic balloon pump insertion . Am Surg1992;58:232-38.
