Arterial Disease Examination

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Arterial diseases

andExamination of Arterial system

By

Dr. Mohammad NaumanFRCS


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Common terminology used in arterialdisease

Claudication intermittent

Ischaemia Acute chronic

Critical ischemiagangrene


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Common disease processes of arterialdisease

ThrombosisEmbolismAtherosclerosisArteritis (angiitis)Endartritis obliterans (buergers disease)Arterial spasm

AneurysmArterio-venous fistulaTraumatic arterial injury


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G angreneIt is the death of the tissues with superadded

putrefactionPoints to note in established G angreneExtent & colour G as gangrene G as, crepitus, odour of

hydrogen sulphideMuscle colour Brick red green black

T ype of gangreneD ry Parts become mummifiedWet Putrifaction as In diabetic gangrene

Line of demarcationL ine between living & dead

L imb above the gangrenous areacongested, oedematous, paleBlack patches indicate skip lesion


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Arterial walls


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Aneurysms


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Mesenteric ischemia


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Arteriovenous fistula Athroma removal


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G angreneG angrene of fingers

R aynaud, cervical rib, scalene anticussyndrome,Morvans disease painless syringomyelia

U inlateral / Bilateral

AtherosclerosisU

nilateral first BilateralBuergers & R aynauds disease Bilateral

Embolic G angrene U nilateral-- mostly

D iabetic U nilateral / bilateral


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H istory

Age & Sex> men than womenOld age AtherosclerosisYoung men 20-40 years Buergers diseaseYoung women R aynauds diseaseMiddle age D iabetic arteriopathy

L imb affectedLower limb Buergers diseaseU pper limb R aynaud disease

Mode of Onset

G radual & spontaneousBuerger, R aynaudSudden EmbolicTrauma or infection D iabetic G angrene


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symptoms

PainTwo types

Claudication

Intermittent pain Claudio L impPain in calf on walking accumulation of P Substance

Rest painContinuous aching pain Cry of dying nervesPain worse at night, on elevationPain relieved hanging down below heart level


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Site of painD epends on level of obstruction

FootTibial / planter aretries Buergersdisease

Calf Occlusion Femoral-Popliteal Junction

T highSuperficial femoral artery

ButtockOcclusion at bifurcation Iliacartery/Aorta

Claudication distanceD istance walked when pain starts


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symptomsEffects of cold and warmth

warmth increases symptomsRaynaudL ocal syncope digits become cold & white +

Tingling & numbness spasm of arteriesL ocal asphyxia digits become blue with burning

sensation slow circulation + accumulation of reduced HbL ocal recovery release of spasm normal

colour


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P araesthesia

Tingling, numbness, pins and needles in foot--blood is shunted from skin to musclesSuperficial phlebitis

Swelling, redness, pain Buergers diseaseInvolvement of other arteries

T ake H/OFainting, transient blackouts (cranial),chest pain, (angina, heart),weakness, paraesthesia in upper limb,blurred vision, (ophthalmic),abdominal pain (mesenteric),

Impotenceabdominal aortaBilateral Iliac artery occlusion


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Physical ExaminationInspection

Colour changeMarked pallor sudden occlusion Embolism,

R aynaud diseaseP urple blue cyanosed Severe ischaemia, pregangrene stage

Elevation of limb leads to Pallor.

Signs of IschaemiaThinning of skin,D iminished hair growth

Loss of subcutaneous fat,ShininessBrittle nails with transverse ridgesMinor ulcers in pressure areas

``heel, malleoli, ball of foot, tips of toes


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Buergers T estBroad day lightPatient lying on his back

NormalR aise straight legs to 90 0 colour of skin

remains pinkIschaemic limb

Marked pallor on elevation

Veins collapsed and guttered Angle between limb and horizontal planeBuergers

AnglePallor at Angle < 30 0 Severe ischaemiaLegs elevated (doctor hold limbs)

Ankle Exercised till fatigue Pallor at H eelindicates Occlusive diseaseFeet now lowered to sitting posture in 2-3

min. Cyanosed


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Ischaemia (cond)Capillary filling time

Elevated pallor leg when becomes pinkon bringing down the time taken iscalled Capillary filling time

Severe ischaemia Takes 2030 sec.

Again limb changes colour to purplereddue to skin filling with deoxygenatedblood

V enous filling

Normal Elevated limb when put down Veins fill within

5 sec.

Ischaemic limb take more time


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PalpationSkin temperature

With back of fingersCompare with other limb

Capillary fillingPress the nail see blanching

V enous refillingTwo finger testvenous filling poor in ischaemic limb

H arveys signCross leg test

shows oscillatory movements of kneedue to popliteal artery pulsationsMovements absent in blocked artery


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Examination of vesselsDorsalis pedis aretry

Just lateral to tendon Extensor hallucis longus

P osterior tibialMid way between med. Malleolus & Tendo -

Achillis

Ant.tibail arteryMidway between malleioli anteriorly lateral to

tendon Exten. hallucis longus

P opletial arteryK nee 40 0 flexion to relax the fossa Palpate inupper part of popletial fossa


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Auscultation

L isten along the course of major arterysystolic bruit due to turbulence of blood flowrenal artery stenosis

Continuous machinery murmur arteriovenous fistula

Check BP in both arms

Reactive hyperaemiaInflate sphygmomanometer above

250mmH

g & then releaseH

yperaemiain 1-2 sec in normal limbD elayed in arterial occlusive disease


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Neurological examinationSensation

lost in gangrenous areaBorder line of gangrene skin is hyperaesthetic

U lcers exclude/ find underlying causeH emiplegia, transvesre myelitis,

syringomyelia, tabes dorsalis

Adsons testPositive in cervical rib, scalene syndromepatient sits on stoolTurn face to other sideR adial pulse obliterated due to compression

Examination of LN


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T he End

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Arterial Disease Examination