Peripheral Vascular Examination Flashcards
What may missing limbs or digits suggest?
Missing limbs/digits: may be due to amputation secondary to critical ischaemia.
What may scars suggest?
Scars: may indicate previous surgical procedures (e.g. bypass surgery) or healed ulcers.
What is the following clinical sign and what does it suggest?
Peripheral cyanosis: bluish discolouration of the skin associated with low SpO2 in the affected tissues (e.g. may be present in the peripheries in PVD due to poor perfusion).
What is the following clinical sign and what does it suggest?
Peripheral pallor: a pale colour of the skin that can suggest poor perfusion (e.g. PVD).
What is the following clinical sign and what does it suggest?
Tar staining: caused by smoking, a significant risk factor for cardiovascular disease (e.g. PVD, coronary artery disease, hypertension).
What is the following clinical sign and what does it suggest?
Xanthomata: raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow. Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), another important risk factor for cardiovascular disease.
What is the following clinical sign and what does it suggest?
Gangrene: tissue necrosis secondary to inadequate perfusion. Typical appearances include a change in skin colour (e.g. red, black) and breakdown of the associated tissue.
What may a cool pale limb and prolonged CRT suggest?
A cool and pale limb is indicative of poor arterial perfusion.
A CRT that is greater than two seconds suggests poor peripheral perfusion.
What may radio radial delay indicate?
Causes of radio-radial delay include:
- Subclavian artery stenosis (e.g. compression by a cervical rib)
- Aortic dissection
What is a wide blood pressure and what does it suggest?
Wide pulse pressure (more than 100 mmHg of difference between systolic and diastolic blood pressure) can be associated with aortic regurgitation and aortic dissection.
A more than 20 mmHg difference in BP between arms is abnormal and is associated with aortic dissection.
What does a bruit in the carotid artery suggest?
The presence of a bruit suggests underlying carotid stenosis, making palpation of the vessel potentially dangerous due to the risk of dislodging a carotid plaque and causing an ischaemic stroke.
Be aware that at this point in the examination, the presence of a ‘carotid bruit’ may, in fact, be a radiating cardiac murmur (e.g. aortic stenosis).
When assessing abdominal pulse your hands move outwards, what are you concerned about?
In healthy individuals, your hands should begin to move superiorly with each pulsation of the aorta.
If your hands move outwards, it suggests the presence of an expansile mass (e.g. abdominal aortic aneurysm).
What may cause an abdominal and renal bruit?
Aortic bruits: auscultate 1-2 cm superior to the umbilicus, a bruit here may be associated with an abdominal aortic aneurysm.
Renal bruits: auscultate 1-2 cm superior to the umbilicus and slightly lateral to the midline on each side. A bruit in this location may be associated with renal artery stenosis.
What is the following clinical sign and what does it suggest?
Ischaemic rubour: a dusky-red discolouration of the leg that typically develops when the limb is dependent. Ischaemic rubour occurs due to the loss of capillary tone associated with PVD.
What is the following clinical sign and what does it suggest?
Venous ulcers: typically large and shallow ulcers with irregular borders that are only mildly painful. These ulcers most commonly develop over the medial aspect of the ankle.
What is the following clinical sign and what does it suggest?
Arterial ulcers: typically small, well-defined, deep ulcers that are very painful. These ulcers most commonly develop in the most peripheral regions of a limb (e.g. the ends of digits).
What is the following clinical sign and what does it suggest?
Gangrene: tissue necrosis secondary to inadequate perfusion. Typical appearances include a change in skin colour (e.g. red, black) and breakdown of the associated tissue.
What is the following clinical sign and what does it suggest?
Muscle wasting: associated with chronic peripheral vascular disease.
What is the following clinical sign and what does it suggest?
Xanthomata: raised yellow cholesterol-rich deposits that may be present over the knee or ankle. Xanthomata are associated with hyperlipidaemia (typically familial hypercholesterolaemia), another important risk factor for cardiovascular disease.
