Peripherhal Vascular Disease

Inspection:

  • Skin colour (pallor, dependent rubor)
  • Skin temperature
  • Loss of hair
  • Dystrophic nails
  • Muscle and skin atrophy (ulceration)

Measure BP

Palpation:

  • Peripheral pulses (absent or ↓): dorsalis pedis, posterior tibialis, popliteal, femoral
  • Delayed capillary refill
  • ABI (normal > 1.0)
  • Abdominal aortic area

Auscultation: bruits (abdominal, femoral, popliteal)



 

History: Claudication? Limb pain at rest? At night? Onset (gradual vs sudden)? Risk factors

Buerger’s test: Blanching of feet when raised 30-45O x 1 minute, THEN subsequent dependent rubor when legs dangled over bed

DeWeese’s test: Disappearance of previous PPP after walking

Acutely:

  • Pain
  • Pallor
  • Pulselessness
  • Poikilothermia
  • Paresthesias
  • Paralysis
  ARTERIAL insufficiency VENOUS insufficiency
Pain Claudication, Rest pain None or Aching
Pulses ↓/absent Present
Temperature Cold Normal/Warm
Colour Pale, Dusky red of dependency Normal, Cyanotic on dependency
Edema Absent Marked
Skin Trophic, Thin/Shiny/Dry, ↓ hair Brown pigmentation, Stasis dermatitis
Nails Thickened
Ulcers On points of trauma, Painful Sides of ankle (esp medially), Painless
Rate of drainage Blood drains quickly Blood drains slowly

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