Nursing case study: Management of right Common Iliac Artery (CIA) stenosis with Chronic Total Occlusion (CTO)

Unnamali1, Deula2

1Staff Nurse, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

2Nursing supervisor, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

Abstract

This case study highlights the nursing care provided to a 68-year-old female diagnosed with Right CIA Stenosis with CTO, systemic hypertension, dyslipidemia, and coronary artery disease (post-CABG 2023). The patient presented with progressive right lower limb claudication for 8 months. She underwent successful right CIA + EIA angioplasty and stenting.

Nursing management focused on pre and post-procedure care, monitoring complications, pain management, education, and promoting recovery.

Key words: Coronary artery disease; Peripheral arterial disease (PAD); Appendectomy; Tubal sterilization

Introduction

Peripheral arterial disease (PAD) involving the iliac arteries can lead to reduced blood supply to the lower limbs, causing claudication and impaired mobility. Timely intervention such as angioplasty and stenting can restore perfusion, relieve symptoms, and prevent complications. Nurses play a vital role in early detection, perioperative care, patient education, and long-term management.

Case Presentation

Patient: Mrs. X, 68 years old, female.

Chief Complaint: Gradually decreasing walking distance due to lower right limb pain (claudication) for the past 8 months.

History of Present Illness: No history of ulcers, sudden worsening, or tissue loss.

Past Medical History: Systemic hypertension, dyslipidemia, coronary artery disease (post-CABG in 2023).

Past Surgical History: Appendectomy, tubal sterilization.

Allergies: No known drug allergies.

Procedure Performed: Right CIA + EIA angioplasty + Right CIA stenting (Omni link 7×59).

Signs and Symptoms

  • Right lower limb claudication on walking short distances
  • Gradual reduction in walking tolerance
  • No ulcers or tissue loss
  • Vital signs stable: PR 70/min, BP 128/82 mmHg, SpO₂ 98% on room air
  • Bilateral legs warm on palpation

Diagnostic Evaluation

  1. Physical examination: Good perfusion, no gangrene, no ulcer
  2. Imaging: Angiography confirming Right CIA stenosis with CTO

Evidence (Enclosed CT scan Lower Limb report)

Lab Investigations

  • Lipid profile – Dyslipidemia present
  • Cardiac evaluation – post-CABG status stable
  • ECG/ECHO – No acute cardiac changes
  • Blood tests – Within normal range except lipid abnormalities

Nursing Assessment

Pre-procedure

  • Assessed limb color, temperature, pulses
  • Monitored vital signs and oxygen saturation
  • Evaluated pain level and mobility
  • Reviewed allergy status and medical history

Post-procedure

  • Monitored puncture site for bleeding/hematoma
  • Checked distal pulses and limb perfusion
  • Monitored for signs of infection
  • Maintained hemodynamic stability
  • Encouraged gradual mobilization

Nursing Diagnosis

  • Impaired physical mobility related to pain and reduced blood supply to the right lower limb
  • Risk for bleeding related to arterial puncture post-angioplasty.
  • Knowledge deficit regarding disease condition, procedure, and lifestyle modifications.
  • Risk for infection related to invasive vascular intervention.

Nursing Interventions

Pain Management: Administered prescribed analgesics; encouraged limb elevation when resting.

Circulatory Monitoring: Checked pulses, capillary refill, limb temperature every 2 hours post-procedure.

Bleeding Precautions: Applied pressure dressing at puncture site; avoided unnecessary limb movement.

Infection Control: Maintained aseptic technique during dressing changes; monitored site for redness/swelling.

Patient Education

  • Advised on diet low in saturated fats and cholesterol
  • Instructed on gradual walking exercise program
  • Education on medication adherence (antihypertensives, statins, antiplatelets)
  • Taught signs of reduced limb perfusion and when to seek medical attention
  • Psychological Support: Provided reassurance and addressed patient concerns about procedure outcomes.

Outcome

  • Patient tolerated angioplasty and stenting well.
  • No immediate post-procedure complications.
  • Improved walking distance without pain.
  • Patient demonstrated understanding of lifestyle modifications and medication compliance.

Patient Appreciation Feedback

“I am thankful to the doctors and nurses for taking good care of me. I was very worried before the procedure, but the nurses explained everything clearly and stayed with me. I am able to walk better now without pain.”

Conclusion

This case study emphasizes the critical role of nursing care in managing patients undergoing vascular interventions. Through timely assessment, close monitoring, education, and emotional support, the patient achieved a positive outcome with improved mobility and quality of life.

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