CHAPTER 15 Peripheral vascular disease
Arterial
Examination
The patient’s limb should be examined in a warm room.
Palpation
Check the skin temperature. Check the capillary refilling time, i.e. press the tip of the nail or pulp of the toe or finger for 2 s and observe the time taken for the blanched area to turn pink. In the normal digit this should occur immediately. Delay (>2 s) will occur in the ischaemic digit. Palpate and record all the pulses. They should be assessed for strength (assessed as normal, weak or absent). Pulses should be recorded as shown in Table 15.1 and the presence of any aneurysmal dilatation noted.
Pulses | R | L |
---|---|---|
Radial | ++ | ++ |
Brachial | ++ | ++ |
Subclavian | ++ | ++ |
Carotid | ++ (bruit) | ++ |
Femoral | ++ | ++ (bruit) |
Popliteal | + | − |
Posterior tibial | − | − |
Dorsalis pedis | − | − |
Arterial occlusive disease
Acute arterial occlusion
Investigations
Treatment
The further management depends on the clinical condition of the limb. Options include:
Chronic arterial occlusion
Lower limb (aorto-ilio-femoral disease)
Investigations
Treatment
Medical
Surgical
Cerebrovascular disease
Symptoms and signs
These may be classed as carotid (anterior circulation) or vertebrobasilar (posterior circulation).