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 |