Peripheral Vascular Flashcards
What is a good way to remember what to do in each section of the peripheral vascular exam
TCPS (Remember ‘Tightly Constricting Pipes Squeeze’)
What should you inspect for in the peripheral vascular exam
Trophic changes
Colour (cyanosis, pallor, redness)
Pressure points (between toes, under heels - ULCERS)
Scars (check groin and inside of legs)
TCPS
Missing limbs!
What do trophic changes include in the inspection of the lower limb when assessing peripheral vasculature
- Muscle atrophy
- Hair loss
- Shiny skin
- Thickened toenails
What do you feel for in the peripheral vascular exam
Temperature
Capillary Refill Time
Pulses
Sensation
What are the pulses in the lower limbs?
Remember to auscultate over femoral and popliteal for bruits
1. Aorta
2. Femoral – at midinguinal point (1/2 way between ASIS + PS)
3. Popliteal – at popliteal fossa
4. Posterior tibial – 2cm below and behind medial malloeous
5. Dorsalis pedis – lateral to extensor hallucis longus, over 2nd/3rd cuneiform bones
How do you assess the lower limb sensation in the peripheral vascular exam
- Assess crudely by light touch
- Distal → proximal
What are the special tests in the peripheral vascular exam
Buerger’s angle
Buerger’s test
How do you test for Buerger’s angle
Give interpretation
. With the patient positioned supine, stand at the bottom of the bed and raise both of the patient’s feet to 45º for 1-2 minutes.
- Observe the colour of the limbs:
The development of pallor indicates that peripheral arterial pressure is unable to overcome the effects of gravity, resulting in loss of limb perfusion. If a limb develops pallor, note at what angle this occurs (e.g. 25º), this is known as Buerger’s angle.
In a healthy individual, the entire leg should remain pink, even at an angle of 90º.
A Buerger’s angle of less than 20º indicates severe limb ischaemia.
What is Buerger’s test
Sit the patient up and ask them to hang their legs down over the side of the bed:
Gravity should now aid reperfusion of the leg, resulting in the return of colour to the patient’s limb.
The leg will initially turn a bluish colour due to the passage of deoxygenated blood through the ischaemic tissue. Then the leg will become red due to reactive hyperaemia secondary to post-hypoxic arteriolar dilatation (driven by anaerobic metabolic waste products).
What further tests should you do after the peripheral vascular exam
- Cardiovascular examination
- LL neuro examination
- Doppler pulses (if not found)
- ABPI measurement
What pulses do you assess in the upper limbs in the peripheral vascular exam
What should you do after this? And after this?
Radial - assess rate and rhythm
Radio-radial delay
Brachial - assess volume and character
Offer blood pressure then Carotid pulse (auscultate and palpate)
Then move to the abodmen
What do you do on the abdomen in the peripheral vascular exam
Inspect (TCPS)
Palpate - aorta
Auscultate - aorta and renal arteries
What is a difference in BP between arms suggestive of
A more than 20 mmHg difference in BP between arms is abnormal and is associated with aortic dissection.
What is a wide pulse pressure suggestive of
Wide pulse pressure (more than 100 mmHg of difference between systolic and diastolic blood pressure) can be associated with aortic regurgitation and aortic dissection.
What is a radio-radial delay suggestive of
Causes of radio-radial delay include:
Subclavian artery stenosis (e.g. compression by a cervical rib)
Aortic dissection
