Vascular Exam

Question 1

Inspection

Answer 1

Around the bed: walking aids, medications

At patient: fistula, BMI, scars, swellings, deformity (amputations,ulcers, gangrene, hair loss, fistulas)

Venous: varicose veins, skin changes (venous eczema, haemosiderin deposition, swelling, ulcers, lipodermosclerosis like red inverted champagne bottles)

Redness colour

Question 2

Palpation

Answer 2

Temperature

Capillary refill time

Palpation of peripheral pulses:

• upper (radial, brachial, carotid, subclavian)
• abdominal aorta
• lower (femoral - midinguinal point), popliteal, posterior tibial- posterior to medial malleolus, dorsalis pedis - medial to extensor hallucinus longus )

Radio-radial delay: subclavian artery stenosis, aortic dissection
Radio- femoral delay: Aortic coarctation

Any varicose veins
Sapheno femoral junction for varices

Question 3

Auscultation

Answer 3

Bruits:
Carotid
Renal

Also auscultation any varicose veins

Question 4

Offer

Answer 4

Buergers test:
-Raise feet t angle that they tom white is the Buerger’s angle

• When feet are white, swing legs over side of bed
• lschaemic foot will go red = significant arterial disease

Assess sensation

Venous: Tao test, tourniquet test

Question 5

Complete exam

Answer 5

Cardiovascular exam, ABPI Artery or venous doppler ,? CT scan, perhaps abdominal exam for any masses that could be stopping draining

Question 6

How do you measure ABPI? What is the significance Of the results?

Answer 6

Screening test for arterial disease

Measure Brachial BP & measure ankle pressure (sphygmomanometer around ankle + doppler on posterior tibia 1)

More than 1.2 = Calcified vessel
1-1.2 = normal
Less than 0.8 = claudication
Less than 0.6 = critical Ischaemia