Peripheral vascular examination
medicine, the peripheral vascular examination is a series of maneuvers to elicit signs of peripheral vascular pathology. It is performed as part of a physical examination, or when a patient presents with leg painsuggestive of a cardiovascular pathology.
The exam includes several parts:
Position - patient should be lying in the
supine positionand the bed or examination table should be flat. The patient's hands should remain at her sides with her head resting on a pillow.
Lighting - adjusted so that it is ideal.
Draping - the legs should be exposed, the private groin and thigh covered. Drapes are usually placed between the legs.
On inspection the physician looks for signs of:
* previous surgery (
* muscle wasting/muscle asymmetry
* edema (swelling)
ulcers - arterial ulcers tend to be on the borders / sides of the foot, neuropathic ulcers on the plantar surface of the foot, venous ulcers tend on be on the medial aspect of the leg superior to the medial malleolus.
* hair - hair is absent in
peripheral vascular disease(PVD)
* shiny skin - seen in PVD
Temperature- cool suggest poor circulation, sides should be compared
Pitting edema- should be tested for in dependent locations - dorsum of foot, if present then on the shins. If the patient has been in bed for a longer period of time one should check the sacrum.
Capillary refill(should be less than 3 seconds)(the time it takes to say capillary return)
Dorsalis pedis artery pulse- on dorsal surface of the foot, running lateral to the tendon of the first toe
Posterior tibial arterypulse - posterior and inferior to the medial malleolus
Popliteal arterypulse - behind the knee, typically done with both hands
Femoral arterypulse - in the femoral triangle / halfway between the ASIS and pubic symphysis
femoral artery bruits
Ankle-brachial pressure index(ABPI) assesses peripheral vascular disease
* Venous refill with dependency (should be less than 30 seconds) - the vein should bulge outward with in 30 seconds of elevation for one minute.
* Buerger's Test (assessment of arterial sufficiency):With the patient supine, note the colour of the feet soles. They should be pink. Then elevate both legs to 45 degrees for more than 1 minute. Observe the soles. If there is marked pallor (whiteness, ischemia should be suspected. Next check for rubor on dependency. Sit the patient upright and observe the feet. In normal patients, the feet quickly turn pink. If, more slowly, they turn red like a cooked
lobster, suspect ischemia.
* Brodie-Trendelenberg Test (assessment of valvular competence if
varicose veinsare present):One leg at a time. With the patient supine, empty the superficial veins by 'milking' the leg in the distal to proximal direction. Now press with your thumb over the saphenofemoral junction (2cm below and 2cm lateral to the pubic tubercle) and ask the patient to stand while you maintain pressure. If the leg veins now refill rapidly, the incompentence is located below the saphenofemoral junction, and visa versa. This test can be repeated using pressure at any point along the leg until the incompetence has been mapped out.
Peripheral vascular disease
* [http://www.fpnotebook.com/SUR3.htm Peripheral Arterial Occlusive Disease] - fpnotebook.com
Wikimedia Foundation. 2010.
Look at other dictionaries:
Peripheral vascular disease — Classification and external resources ICD 10 I73.9 … Wikipedia
Peripheral neuropathy — Neuropathy redirects here. For other uses, see Neuropathy (disambiguation). Not to be confused with Nephropathy. Peripheral neuropathy Classification and external resources … Wikipedia
Neurological examination — Intervention The human nervous system ICD 9 CM … Wikipedia
Physical examination — Intervention Examination room in Washington, DC, period of WWI. ICD 9 CM … Wikipedia
Mini–mental state examination — Not to be confused with Mini international neuropsychiatric interview. The mini–mental state examination (MMSE) or Folstein test is a brief 30 point questionnaire test that is used to screen for cognitive impairment. It is commonly used in… … Wikipedia
Mental status examination — Intervention ICD 9 CM 94.09, 94.11 The mental status examination in the USA or mental state … Wikipedia
Rectal examination — Intervention Digital rectal exam: side view of the male reproductive and urinary anatomy, including the prostate, rectum, and bladder. ICD 9 CM 89.34 … Wikipedia
Cranial nerve examination — The cranial nerve exam is part of the neurological examination. It is used to identify problems with the cranial nerves by physical examination. Contents 1 Components 2 See also 3 References 4 … Wikipedia
Ankle brachial pressure index — The Ankle Brachial Pressure Index (ABPI) is a measure of the reduction in arterial blood pressure of the legs and as such is used to detect evidence of blockages (peripheral vascular disease). It is calculated by dividing the highest systolic… … Wikipedia
Invasiveness of surgical procedures — Invasive (medical) redirects here. For invasive as related to abnormal tissue growth, see Cancer. There are three main categories which describe the invasiveness of surgical procedures. These are: non invasive procedures, minimally invasive… … Wikipedia