Peripheral Vascular Disease & Gangrene

HISTORY

• • Age & Sex-

  • Limbs affected-

  • Bilateral or unilateral-

  • Mode of onset-

  • Pain-

    • Intermittent Claudication-

    • Rest Pain-

  • Effects of heat & cold-

  • Paraesthesia-

  • History of superficial phlebitis-

  • Involvement of other arteries-

  • Impotence-

  • Past history-

  • Personal history-

  • Family history-

PHYSICAL EXAMINATION

LOCAL EXAMINATION

• • INSPECTION-

    • Change in Colour-

    • Signs of Ischaemia-

    • Buerger's postural test- This test must be carried out in broad day light. The patient lies on his back on the examining table. The patient is asked to raise his legs one after the other keeping the knees straight. The legs of a normal individual remain pink even if they are raised to 90 degree. But in case of an ischaemic limb elevation to a certain degree will cause marked pallor and the veins will be empty and 'guttered'. The angle (between the limb and the horizontal plane) at which such pallor appears is called 'Burger's angle' or the 'vascular angle'. A vascular angle of less than 30 degree indicates severe ischeamia.

    • Capillary filling time- After elevating the legs, the patient is asked to sit up and hang his legs down by the side of the table. A normal leg will remain pink as it was during elevated position. But an ischaemic leg will first become pallor when elevated & gradually become pink in horizontal position. This change of colour takes place slowly & is called 'the capillary filling time'. In severe ischeamia it takes about 20 to 30 seconds to become pink. Then the ischaemic limb again changes colour & becomes purple-red quickly. This is due to the filling of the dilated skin capillaries with deoxygenated blood.

    • Venous refilling-

    • In established gangrene-

      • Extent & Colour-

      • Type-

      • Line of demarcation-

      • Limb above-

• • PALPATION-

    • Skin temperature-

    • Capillary refilling-

    • Venous refilling-

    • Crossed leg test (Fuchsig's test)-

    • Cold & Warm water test-

    • Elevated arms test-

    • Allen's test-

    • Branham's sign or Nicoladonis sign-

    • Costoclavicular compressive manoeuvre or test-

    • Hyperabduction manoeuvre-

    • Gangrenous area-

    • Crepitus-

    • Limb above the gangrenous area-

    • Palpation of the blood vessels-

      • Dorsalis pedis artery-

      • Posterior tibial artery-

      • Anterior tibial artery-

      • Popliteal artery-

      • Femoral artery-

      • Radial & Ulnar arteries-

      • Brachial artery-

      • Subclavian artery-

      • Common carotid artery-

      • Superficial temporal artery-

    • Neurologic examination-

    • Adson's test-

    • Examination of the lymph nodes-

  • AUSCULTATION-

Special investigations for Peripheral Vascular Disease & Gangrene

Vascular Trauma

Evaluation of peripheral vascular disease