PERIPHERAL VASCULAR DISEASE PROTOCOL

Hx:
Age: Old: Atherosclerosis, Young: Buerger’s disease, hyperlipidemia
syndrome, middle: diabetic arteriopathy
Sex: Male: Buerger’s disease: upper limb, Raynaud’s disease: upper limb
Occupation: Vibrating tools
Residence: Frost bite at high altitude

Hx:
1. Limbs affected: -upper  Raynaud’s; Lower: Buerger’s & Atherosclerosis
2. Uni or Bilateral: B& R: bil
Atheroma: Unilateral
Unilateral: Traumatic, tumor
3. Pain
Duration
Character
Intermittent: sites*
Vascular: - On standing still (IV disc lesion)
● On first step (OA specific)
● Distance
● Relieved on taking rest
● Progression by decrease in claudication
distance (in meters)
● Numbness, pins & pricks
Boyd’s Classification: Grade I  Continuous walk sweeps away
substance
Grade II  Pain continuous but can walk
with effects
Grade III  Compels pt to take rest

6. Systemic:
Chest: Pain  Angina Pectoris, palpitation, dyspnea
H/o TIA  Fainting, Ameurosis Fugax, Weakness or
paresthesia in upper limbs

Past Hx:
● CAD
● Stroke
● Previous episodes of claudication in lower
limbs
● H/O amputation
● H/O DM, HTN
Personal Hx: Smoking, Life style (exercise, sedentary)
Family Hx: Atherosclerosis, DM
Drugs: Ergotamines (Migraine), Thiopentone, Aspirin
EXAMINATION
GPE
Build: Obese
Vital Signs:
Pulse  vessel wall status
BP  HTN
Other signs:
Xanthomas  At pressure sites eg: elbows
Xanthelasma  Eyelids
Arcus senilis (junvenilis)
Edema

Local Examinaiton
Exposure: Umblicus to toes (pt can keep on underwear)

Inspection:
Asses level of involvement or findings
Always compare both limbs

Skin:
Color: Pale or Dusky
Trophic changes: Thickening of nails, loss of hair, shinny skin
Gangrene, Skip lesions, pallor, ulceration at the tip of toes
Note: See webspace (in b/w toes) & post surface of heel and pressure areas
(maleoli & head of 5th metatarsal) as well
Muscle atrophy

Buerger’s Test:
Must be carried out in broad day light

Ask the pt to raise both legs straight up slowly with knees extended,
supported by examiner. Watch for cadaveric pallor, emptying & guttering of
veins. If no change at 30 degree then ask the pt to extend & flex ankle & toes
to the point of fatigue & note changes. Normally it remains pink coloured till 90
degree. Ask the pt to sit down look for cyanotic change which is present only
in ischemic limbs.
Capillary Filling Time: Foot turns pale to pink & then to dusky red. The time
taken by the foot to become pink is CFT. It may be prolonged by 15-30 sec.

PALPATION
Ask the pt to lie down
Ask for pain

Temp & tenderness (level of coolness)

Capillary filling
Pulses: (both sides comparison), start palpating from below
● Femoral
● Poplitial
 Methods of palpation
1. Flex the knee to 135 degree with heels resting on the bed, place
thumbs on tibial tuberosity & fingers on the lower part of poplitial
tissue. The neurovascular bundle feels like a taut rubbery cord. Feel
the pulse against the poplitial surface of tibia (condyle).
2. Legs straight, place one hand behind the knee in the midline of
politital fossa and hyperextend the knee against this hand then
couch
3. Position prone with slightly flexed knee with one hand and with
second hand, palpation of artery with the finger tips of the other
hadn
4. Fuchsig’s Test: Ask the pt to sit leg crossed, oscillatory movements
of foot occurs synchrnonously with the poplitial artery if patent.
Dorsalis Pedis
Support the toes with one hand and the fingers of the other hand are
slid along the groove b/w 1st & 2nd metatarsal bone upwards towards ankle.
The pulps of fingers being slightly directed towards 1st metatarsal bone.
Usually pulse is felt lateral to external hallucis longus at the proximal end of
groove. In 10% the artery is congenitally absent. Therefore significant only if
other ischemic changes are present.
Post Tibial Artery:
Midway b/w back of medial maleolus & medial border of tendo Achilles
Ant Tibial Artery: Midway ant b/w the two maleoli against the lower part of tibia
just above the ankle joint lat to the ext haulacis longus.
Aorta
Carotid
Temporal
Brachial
Radial

MUSCULOSKELETAL & NEUROLOGICAL EXAMINATION of Lower Limb

Examination of lymph nodes if ulcer/ infection present
Auscultation:
Heart
Abdomen (Aorta)
Femoral
Poplitial