Vascular Examination Component What to do/look for and rationale Hand hygiene Vitals Mobility aids Amputations Ulcers Trophic changes General Inspection Erythema Varicosities Atrophy Scars Discolouration e.g. venous straining. Loss of hair Examine the hands Palpate the arms and look for: Note any changes in temperature Compare to the other side Test for capillary refill Test for venous filling Necrosis of distal fingers -> burger’s disease Feel for radial and ulnar pulses. Look for signs of acute arterial occlusion: Pain Reduced pulses. Cool peripheries. Arms Paralysis Paraesthesia (examined when examining for sensations). Causes: Embolism Thrombosis Injury Secondary causes for embolism: Arterial fibrillation Myocardial infarction Dilated cardiomyopathy Infective endocarditis Blood pressure Carotid pulses Neck Auscultate for carotid bruits. Heart Heart auscultation Abdominal bruits Abdominal Renal bruits. Palpate and feel for: Note any changes in skin temperature Compare to the other side Signs of inflammation. Look for evidence of edema -> pitting vs non-pitting. Test for the capillary refill at the toenail Test for femoral pulses -> palpate them and then auscultate them. Palpate for the veins: Hard leg veins -> suggest thrombosis. Tender veins indicate thrombophlebitis. Test for popliteal, posterior, and dorsalis pedis pulses. Look for signs of acute arterial occlusion: Pain Reduced pulses. Cool peripheries. Paralysis Paraesthesia (examined when examining for sensations). Causes: Embolism Thrombosis Injury Secondary causes for embolism: Arterial fibrillation Myocardial infarction Dilated cardiomyopathy Infective endocarditis Examine varicose veins. Legs If present, ask the patient to stand with legs fully exposed. Inspect in front of the legs for tortuous dilated branches of the ling saphenous vein (vein below the femoral vein). Inspect the back of the lower limb by looking for varicosities of the short saphenous vein (located at the back of the calf and lateral to the popliteal /fossa) Examine for lower DVT Sensory changes Diabetic neuropathy Trendelenburg Test: Ask the patient ot lay down and elevate the leg. Apply firm pressure on the saphenous vein in the groin and ask the patient to stand. The sign is positive if the veins fill despite groin pressure -> the incompetence is at the valves in the thigh or calf -> if positive perform Perthes’ test. Perthes’ Test: Complementary tests Repeat the Trendelenburg test but when the patient is standing. Allow for some blood to be released and then get them stand up and down on the toes a few times. The veins will become less tense if the perforating calf veins are patent and have a competent valve -> muscle pump is functioning well. Unusual, affected vein patterns: E.g. public varices -> exclude secondary causes to varicose veins. These may be due an intrapelvic neoplasms that has obstructed deep venous return. Rectal and pelvic examinations should then be performed.