Clinical assessment of the arterial circulation of limb

 1.      Inspection

Ø      Colour,

Ø      vascular angle,

Ø      capillary filling,

Ø      venous filling,

Ø      pressure areas

 

2.      Palpation 

Ø      Temp,

Ø      capillary refilling ,

Ø       pulses

 

3.      Auscultation

Ø      Along the course of all major vessels,

Ø       ABI.

 

Note:

Ø  Examine the patient in a warm room

Ø  Palpate the legs after exposing both legs.

Ø  Don’t press too hard with the sthetoscope while listening for a bruit-pressure can dent the artery and cause a bruit.

Inspection: 

Ø    Colour : pallor

Ø    Vascular angle/Burger’s  angle :                                                                                        

       *In ischemic leg, elevation to 15 – 30 degree may case pallor

*It is directly comparable to the pressure in the small vessels

       *It gives an idea about the level of the distal perfusion.

 

Ø      Capillary filing time: Ask the patient to sit up and hang his legs over the side of the couch.    White => pink=> purple.  It is caused by the blood filling dilated skin capillaries.

Ø      Venous filling: Guttering of the veins (veins collapsed).

Ø      Pressure areas and muscle wasting.

Palpation:

Ø      Temperature.

Ø      Capillary refilling press the tip of the nail for 2 seconds.

Ø      Feel the pulses.

Ø        Femoral

Ø        Dorsalis paeds

Ø        Posterior tibial

Ø        Popliteal.

Ø      Muscle atrophy and parasthesia.  

Auscultation:

Ø      Bruit

Ø      ABI      

Ø      0.7-1 normal   

Ø      0.5-0.7 claudication

Ø      > 0.3 rest pain, ulcer,  gangrene

Ø      Doppler

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