Peripheral vascular system

Question 1

What do you look for on inspection?

Answer 1

General bed area for clues
General - colour, build, comfort, position etc
Hands - colour (pallor or peripheral cyanosis), cap refill, yellow nicotine staining
Eyes - subconjunctival pallor (anaemia), corneal arcus (white/blue ring around iris, hyperlipidaemia)
Lips/tonge - dehydration, central cyanosis
Abdomen - scars, mass, pulsation
Legs/feet/toes - symmetry, colour, temperature, oedema, trophic changes (hair loss, shiny skin, wasting), varicose eczema, venous guttering, ulceration (describe characteristics)

Question 2

What pulses should be taken?

Answer 2

Pulses should be compared between left and right where possible
Radial - rate, rhythm, volume, radioradial delay
Ulnar - volume
Brachial - volume and character
Carotids - character and volume (do one at a time)
Abdominal aorta
Femoral - mid point between pubic symphysis and ASIS, below inguinal ligament
Popliteal - keep leg straight on bed, place thumbs inferior to patella and curl fingers into popliteal fossa, raise leg slightly to aid in finding
Dorsalis pedis - dorsum of the foot next to the hallux tendon
Posterior tibial - inferior to the medial malleolus

Question 3

What should be auscultated for bruits?

Answer 3

Carotids
Subclavians
Aorta (bruits may occur in healthy thin people)
Femoral
- there is no bruit over an occluded vessel and severe stenosis can present without an audible bruit

Question 4

What else should be examined?

Answer 4

Allen’s test
Blood pressure taken in both arms
Light touch and cap refill in the toes
Ankle-Brachial pressure index (ABPI) - highest systolic BP in the arteries in the ankle by the higher of the two systolic BPs in the arms, a ratio of <0.8 indicates significant arterial disease

Question 5

What is Buerger’s test?

Answer 5

Performed to assess the adequacy of arterial supply to a limb
Patient supine, elevate both legs to 45 degrees and hold for 1-2 mins, pallor of the feet indicates ischaemia. The poorer the supply the lower the angle needed to produce this reaction
Then get the patient to dangle their legs over the side of the bed, gravity aids in blood flow and colour will return - first blue (blood is deoxygenated on its passing through ischemic tissue) then red (due to reactive hyperaemia) from post toxic vasodilation