Chp 3- Peripheral Vascular System Flashcards
What is stemmer’s sign, and what is it indicative of?
- dorsal skin folds of the toes or fingers are resistant to lifting
- indicative of fibrotic changes and lymphedema
What is bilateral edema associated with?
Congestive heart failure
What are some peripheral causes of edema?
- chronic venous insufficiency
- lymphedema
Do you examine venous or arterial insufficiency first?
Venous- b/c venous insufficiency can invalidate some arterial tests
What does the percussion test do, and what is a positive test?
1) determines competence of greater saphenous vein
2) if pulse wave is felt by lower hand, the intervening valves are incompetent
What does the trendelenburg test test?
Determines competence of communicating veins and saphenous vein
-also known as the retrograde filling test
Describe how to perform the trendelenburg test
1) patient is supine with legs elevated to 60 deg
2) tourniquet placed on proximal thigh
3) patient is asked to stand
4) examiner notes whether veins fill in normal pattern (should take about 30 sec)
Describe how venous filling time is measured
1) pt is supine
2) passively elevate LE to approx 45 deg for 1 min, then place in dependent position
3) note time for veins to refill
4) delayed filling (> 15 sec) is indicative of venous insufficiency
What does a doppler ultrasound do??
- determines blood flow within a vessel
- useful in locating nonpalpable pulses, and measuring systolic BP in extremities
What does air plethysmography (APG) do?
-pneumatic device calibrated to measure latency of venous system
What are the tests for Peripheral arterial circulation?
1) ABI
2) Rubor of dependency
3) Examine for intermittent claudication
What is Ankle Brachial Index?
The ratio of LE pressure divided by UE pressure
What is a ABI of < 0.9 indicative of?
2-4 fold increased risk for cardiovascular events and death
What is an ABI < .5 indicative of?
Increased risk of progression to severe or critical limb ischemia in 1 year
How is rubor of dependency measured?
Examine color changes in skin during elevation of foot followed by dependency (seated, hanging position)
