Peripheral arterial disease examination

Peripheral arterial disease examinationCreated OnApril 16, 2020Last Updated OnApril 16, 2020byadmin You are here: Main Clinical Examination Peripheral arterial disease examination < All Topics Table of Contents LOCAL EXAMINATION Inspection Attitude of limb (hanging down over the bed to relieve pain) Muscle wasting Guttering of veins Skin : Colour changes (gangrene : blackish discoloration) Line of demarcation Dry or wet Skip lesion Extent of gangrene Sign of chronic ischemia Loss of hair Loss of subcutaneous fat Atrophic unhealthy skin Trophical changes like skin ulcer, brittle nail, dry gangrene Palpation Temperature (coldness compare to contralateral indicate severe ischemia) Gangrene area Sensation (sensory): Paraesthesia suggest severe ischemia Tenderness :Painless suggest severe ischemia Crepitation Movements of joints over the gangrenous area (paralysis : severe ischemia) Examine details of ulcer and note the characteristic if presence Examine vascular consistency Dorsalis Pedis (DP) : lateral to the extensor hallucis longus, proximal to the 1st metatarsal space Posterior Tibial : medial aspect of ankle, 1/3 of way between tip of medial malleolus to Achilles tendon Anterior Tibial : midway between 2 malleoli and lateral to extensor hallucis longus(ends as DP) Popliteal: flex the knee, roll your fingers over the tibial condlyes. Difficult to feel even in normal individual Femoral : below mid-inguinal point Radial : lateral border of lower end of radius Brachial : medial to biceps brachialis tendon in cubital fossa Subclavian : mid-clavicular point above the clavicle Common Carotid : medial border of sternocleidomastoid at the level of thyroid cartilage Superficial Temporal: in front of tragus Special test Buerger’s Test Raised the leg in supine position- the angle that, leg becomes   pale is known as the Buerger’s Angle (less than 30o indicate severe ischemia) Buerger’s Postural Capillary filling Pale limb on elevation turns pink in dependent position. If it is around 20 to 30 seconds, it indicates severe ischemia Venous filling Patient with PVD will have flat superficial vein even in flat position or slightest elevation will make the vein flat unlike normal person (around 90 degree only makes the vein flat). Normal venous feeling time upon making the leg horizontal is within 5 seconds, but in case of PVD it is few times more. Capillary refilling Press on the tip of nail and then release to see the color change): In normal individual it is <2 seconds but in case of PVD it is increased Venous refilling Block the distal end of a superficial vein and then milk the blood towards proximal end and closed the proximal end. Now release the distal end – in normal individual vein will fill up rapidly but in case of PVD it will feel very slowly Auscultation: hear for bruits SYSTEMIC EXAMINATION mainly Cardiovascular and Abdominal examination to assess the atherosclerosis and to rule out any aortic aneurysm Arterial system of lower limbs Taken from...

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