The Vascular Examination

As with any examination

•I•P•E•E•P

•Introduce•Permission•Explanation•Exposure•PAIN

Varicose vein examination

Inspection•With patient standing, comment on:

•Distribution - “The patient has tortuous varicosities in the distribution of the long/short saphenous vein"

•Signs of poor skin nutrition• Venous stars (venulectasias).

• Superficial thrombophlebitis, which shows as a red, painful lump

• The brown pigmentation of haemosiderin deposition characteristic of increased venous pressure

• Venous eczema

• Ulceration and scarring from previous ulceration, especially in the gaiter area

• Lipodermatosclerosis

• Scars from previous vein surgery

Palpation

•Run hand up veins feeling for increased warmth

•Palpate varicosities to assess • Hard/soft

• Tenderness

Percussion

•Tap top of vein and feel how far down you can feel repercussions

Saphenofemoral junction

•Trendelenberg• Lie patient down and empty veins

• place 2 fingers on SFJ

• Ask patient to stand

• If varicosities dont fill, SFJ incompetent

• If varicosities fill, incompetence lower down

• on releasing fingers, veins fill quickly = SFJ incompetent

•Can also do tourniquet test• Similar to Trendelenberg

• Place tourniquet around leg

• If veins fill, incompetence is lower

• Move tourniquet down until filling controlled

To complete examination

•“To complete my examination I would like to...”

• Doppler ultrasound - duplex

Examination of the Chronically

Ischaemic Limb

Inspection•Pale•Atrophic skin - shiny/red/dry•Ulcers - punched out, distal toes, in

between toes•Missing parts!

Palpation

•Run back of hand from toes to groin•Feel warm/cold•Palpate pulses

Femoral

•Midway between pubis symphysis and anterior superior iliac spine

•Midpoint of the inguinal canal

Popliteal

•Place thumbs on tibial tuberosity•part heads of gastrocnemius with

finger of both hands•press against back of tibia

Posterior Tibial

•Midway between medial malleolus and tip of calcaneus

Dorsalis Pedis

•Lateral to tendon of extensor hallucis longus

Buerger’s Angle/Test

•Should not do!•If asked:

• elevate leg

• estimate angle at which leg becomes pale - Buerger’s angle (<45∘)

• Re-elevate to 45∘ for 1-2 minutes until pale

• Hang leg off end of bed

• If becomes blue then red (reactive hyperaemia) Buergers test is positive

To complete examination

•“To complete my examination I would like to........”

•ABPI• BP in brachial artery

• BP in dorsalis pedis using ultrasonic probe• 1= normal

• 0.6-0.9 = claudication

• 0.3-0.6 = Rest pain

• <0.3 = critical ischaemia

Practice makes perfect

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