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CLINICAL EXAMINATION
OF PERIPHERAL
VASCULAR DISEASES
What is PVD?
Definition:
• Also known as PAD or
PAOD.
• Occlusive disease of the
arteries of the extremity.
charac. by a r...
Pathophysiology:
• Arterial narrowing  Decreased blood
flow = Pain
• Pain results from an imbalance between
supply and de...
Factors that can contribute to the development
of peripheral vascular disorders :
atherosclerotic changes
thrombus forma...
CAUSES OF ISCHEAMIA
LARGE ARTERY OCCLUSION
-Atherosclerosis
-Embolism.
SMALL ARTERY OCCLUSION
-Buerger`s disease
-Raynaud`...
ATHEROSCLEROSIS
AGE- above 50yrs
Vessels involved– medium sized & large vessels
aorta,femoral,carotids.
Nature of vessel- ...
TAO (BUERGER`S DISEASE)
Age -20-40 yrs
Sex – Exclusively males
Vessel involved –Small & medium sized arteries.
Nature of v...
RAYNAUD`S DISEASE
(PRIMARY RAYNAUD`S PHENOMENON)
-Occur in young females.
-Upper limbs more involved than lower limbs.
- I...
Atherosclerosis
Thromboangitis Obliterans
CLINICAL EXAMINATION
HISTORY
1. AGE & SEX
 Atherosclerosis – Older AGE M~ F
 BURGER`S Disease - Mostly men
age 20-40yrs
...
2. LIMBS AFFECTED
 Lower limbs –Buergers`s disease
- Atherosclerotic
-gangrene
Upper limbs- Raynaud`s disease
Superfici...
3.BILATERAL & UNILATERAL
 BILATERAL –BURGER`S
-Raynaud`s disease.
 Atherosclerotic – intially UL later B/L.
 UNILATRAL ...
4.MODE OF ONSET
Spontaneously & gradually
-Atherosclerosis gangrene
- Raynaud`s disease
-Buerger`s disease
Suddenly
- embo...
5.PAIN
-site
-charcter
-radiation
TYPES
-Intermittent claudication.
claudication distance
Grades I,II,II (boyd`s classific...
5.EFFECTS OF HEAT & COLD
Raynaud`s phenomenon
Raynaud`s disease
-local syncope
- local asphyxia
- local recovery ----- loc...
6. PARAESTHESIA
- Numbness.
- pins and needles sensation.
7.HISTORY OF SUPERFICAIL PHLEBITIS:
8.INVOLVMENT OF OTHER ARTERI...
HISTORY IMPOTENCE
B/L internal iliac artey occlusion.
PAST HISTORY
cardiac attacks, embolic, frost bite.
PERSONAL HISTORY:...
PHYSICAL EXAMINATION
LOCAL EXAMINATION
1.INSPECTION
Change in colour
Pallor
– sudden occlusion of arteries
- spasm of arte...
2.SIGNS OF ISCHEMIA
1.Thinning of skin
2.Diminished growth of hair,
3.Loss of subcutaneous fat,
4.Trophic changes in nails...
3.BUERGER`S POSTURAL TEST:
Bauerger angle (vascular angle)
-normal indiviual legs will be pink raised
above 90degree
-seve...
IN GANGRENE
- Extent & color of gangrene.
-TYPE
dry (mummified) .
wet (putrefying).
-LINE OF DEMARCATION.
- SKIP LESIONS
PALPATION
1. Skin temperature.
2.capillary filling time.
3.venous filling time.
4.crossed leg test (fuchsig test):
oscilla...
TEST FOR UPPER LIMBS:
-Elevated arm test.
-Allen`s test.
-Costoclavicular compressive manoeurve.
-Hyperabduction manoeurve...
PALPATION OF BLOOD VESSELS.
LOWE LIMBS
-Dorsalis pedis
-posterior tibial
-anterior tibial
-popliteal
-femoral
UPPER LIMB
-...
Examination of arterial wall
-PIulse
-condition of wall
- thrombosis of vessel.
CERVICAL RIB
-Adson`s test.
NEUROLOGICAL E...
Differential diagnosis of limb pain
– Arteritis
– Ischemic intermittent claudication
– Nerve root pain, sciatica, neurogen...
INVESTIGATION:
complte blood picture.
blood sugar.
blood lipid profile.
-Doppler ultrasound blood flow detector.
-Duplex s...
1.Modification factors
a)Smoking Cessation
b)Rigorous BSL con
c)BP reduction
d)Lipid Lowering Therapy
• 2EXERCISE:
a)Claud...
3.MEDICAL MANAGEMENT:
a)Antiplatelet therapy e.g.
Aspirin/Clopidogrel
b)Phosphodiesterase Inhibitor e.g. Cilostazol
c)Foot...
PCI / SURGERY
Indications/Considerations:
• Poor response to exercise rehabilitation + pharmacologic
therapy.
• Significan...
• Bypass Surgery:
• Reverse the saphenous vein for femoro-
popliteal bypass
• Synthetic prosthesis for aorto-iliac or ilio...
ACUTE ARTERIAL DISEASE
sudden occlusion of major peripheral artery.
due to:
-Arterial embolus
-Trauma
-Acute arterial thro...
FEATURES OF ACUTE LIMB
ISCHEAMIA
1.PAIN
2.PALLOR
3.PULSELESNESS
4.PERISHING COLD
(POIKILOTHERMIA)
5.PARASTHESIAS
6.PARALYS...
INVESTIGATION
-Angiography
TREATMENT
- THRMOBOLYSIS
SURGICAL
-embolectomy
GANGRENE
• Gangrene implies death of macroscopic
portions of tissue; the term necrosis
may be used synonymously.
• It ofte...
TYPES
- Dry gangrene
- Wet gangrene.
Signs of gangrene.
1.change of colour
pale,bluish purple and finally black.
2. loss o...
DRY GANGRENE
Wet gangrene
Causes of ischaemia
-Large vessel occlusion.
- Small vessel occlusion.
CAUSES OF GANGRENE.
cardiovascular
-traumatic .
-In...
TREATMENT
- amputation.
THANK YOU
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Clinical examination peripheral vascular disease

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Clinical examination peripheral vascular disease

  1. 1. CLINICAL EXAMINATION OF PERIPHERAL VASCULAR DISEASES
  2. 2. What is PVD? Definition: • Also known as PAD or PAOD. • Occlusive disease of the arteries of the extremity. charac. by a reduction in blood flow and hence 02 through the peripheral vessels when the need of the tissues for 02 exceeds the supply, areas of ischemia and necrosis will develop
  3. 3. Pathophysiology: • Arterial narrowing  Decreased blood flow = Pain • Pain results from an imbalance between supply and demand of blood flow that fails to satisfy ongoing metabolic requirements.
  4. 4. Factors that can contribute to the development of peripheral vascular disorders : atherosclerotic changes thrombus formation embolization  coagulability of blood  hypertension  inflammatory process/infection
  5. 5. CAUSES OF ISCHEAMIA LARGE ARTERY OCCLUSION -Atherosclerosis -Embolism. SMALL ARTERY OCCLUSION -Buerger`s disease -Raynaud`s disease -embolism -scleroderma -physical agents –Trauma,radiation,electric burns,pressure necrosis
  6. 6. ATHEROSCLEROSIS AGE- above 50yrs Vessels involved– medium sized & large vessels aorta,femoral,carotids. Nature of vessel- Thickned Pathology – Deposition of atheromatous plaque in the intima. Risk factors – smoking, diabetes,hypertensive, obesity,hypercholesterolaemia.
  7. 7. TAO (BUERGER`S DISEASE) Age -20-40 yrs Sex – Exclusively males Vessel involved –Small & medium sized arteries. Nature of vessel –Not thickned. Pathology – Diffusion inflammatory reaction involving all coats of vessels results obliterans. Risk factors – Smoking, hypercoagulable, autonomic hyperactivity, low socioeconomic.
  8. 8. RAYNAUD`S DISEASE (PRIMARY RAYNAUD`S PHENOMENON) -Occur in young females. -Upper limbs more involved than lower limbs. - Its episodic digital ischeamia on exposure to cold - Peripheral pulses are normal. - Recurrent attacks.
  9. 9. Atherosclerosis
  10. 10. Thromboangitis Obliterans
  11. 11. CLINICAL EXAMINATION HISTORY 1. AGE & SEX  Atherosclerosis – Older AGE M~ F  BURGER`S Disease - Mostly men age 20-40yrs  RAYNAUD`S DISEASE – Young women  Diabetic arteriopathy - middle age
  12. 12. 2. LIMBS AFFECTED  Lower limbs –Buergers`s disease - Atherosclerotic -gangrene Upper limbs- Raynaud`s disease Superficial gangrene of fingers -Raynauds disease - cervical rib -scalenus anticus syndrome
  13. 13. 3.BILATERAL & UNILATERAL  BILATERAL –BURGER`S -Raynaud`s disease.  Atherosclerotic – intially UL later B/L.  UNILATRAL – Embolus.  Diabetic gangrenous – U/L or B/L.
  14. 14. 4.MODE OF ONSET Spontaneously & gradually -Atherosclerosis gangrene - Raynaud`s disease -Buerger`s disease Suddenly - embolic gangrene Traumatic & infection - Diabetic
  15. 15. 5.PAIN -site -charcter -radiation TYPES -Intermittent claudication. claudication distance Grades I,II,II (boyd`s classification) - Rest pain
  16. 16. 5.EFFECTS OF HEAT & COLD Raynaud`s phenomenon Raynaud`s disease -local syncope - local asphyxia - local recovery ----- local gangrene
  17. 17. 6. PARAESTHESIA - Numbness. - pins and needles sensation. 7.HISTORY OF SUPERFICAIL PHLEBITIS: 8.INVOLVMENT OF OTHER ARTERIES -Transient attack, fainting .(stroke) - chest pain (coronary arteries) - abdominal pain (mesentric arteries) - blurred vision (retinal areteries)
  18. 18. HISTORY IMPOTENCE B/L internal iliac artey occlusion. PAST HISTORY cardiac attacks, embolic, frost bite. PERSONAL HISTORY: Smoking. FAMILY HISTORY:
  19. 19. PHYSICAL EXAMINATION LOCAL EXAMINATION 1.INSPECTION Change in colour Pallor – sudden occlusion of arteries - spasm of arteries in raynaud`s. Congestion& cyanosed -severe ischemia & pre gangrenous stage
  20. 20. 2.SIGNS OF ISCHEMIA 1.Thinning of skin 2.Diminished growth of hair, 3.Loss of subcutaneous fat, 4.Trophic changes in nails 5.Muscle wasting 6.Minor ulceration over pressure area
  21. 21. 3.BUERGER`S POSTURAL TEST: Bauerger angle (vascular angle) -normal indiviual legs will be pink raised above 90degree -severe ischemia buerger angle less than 30 degree 4.CAPILLARY FILLING TIME -severe ischaemic it take 20-30 sec. 5.VENOUS FILLING TIME -Noramal 5 sec. -In ischaemic limb veins collapsed.
  22. 22. IN GANGRENE - Extent & color of gangrene. -TYPE dry (mummified) . wet (putrefying). -LINE OF DEMARCATION. - SKIP LESIONS
  23. 23. PALPATION 1. Skin temperature. 2.capillary filling time. 3.venous filling time. 4.crossed leg test (fuchsig test): oscillatory movements obsent popliteal block. 5.Cold and warm water test.
  24. 24. TEST FOR UPPER LIMBS: -Elevated arm test. -Allen`s test. -Costoclavicular compressive manoeurve. -Hyperabduction manoeurve -GANGREANGENOUS AREA. -CREPITUS. -LIMB ABOVE GANGRENOUS AREA.
  25. 25. PALPATION OF BLOOD VESSELS. LOWE LIMBS -Dorsalis pedis -posterior tibial -anterior tibial -popliteal -femoral UPPER LIMB -radial & ulnar -brachial subclavian common carotid. Superficaial temporal.
  26. 26. Examination of arterial wall -PIulse -condition of wall - thrombosis of vessel. CERVICAL RIB -Adson`s test. NEUROLOGICAL EXAMINATION: AUSCULTATION systolic bruit. In occlusion -Blood pressure of both arms. -Ankle brachial pressure index. -Heart for murmur etc.
  27. 27. Differential diagnosis of limb pain – Arteritis – Ischemic intermittent claudication – Nerve root pain, sciatica, neurogenic – pseudoclaudication (spinal stenosis) – Peripheral nerve pain (eg, diabetic neuropathy) – Phlebitic syndrome after deep venous thrombosis – Thromboangiitis obliterans (Buerger disease) – Venous claudication
  28. 28. INVESTIGATION: complte blood picture. blood sugar. blood lipid profile. -Doppler ultrasound blood flow detector. -Duplex scan. -Plethysmography. - Angiography
  29. 29. 1.Modification factors a)Smoking Cessation b)Rigorous BSL con c)BP reduction d)Lipid Lowering Therapy • 2EXERCISE: a)Claudication exercise rehabilitation program b)45-60mins 3x weekly for 12 weeks c)6 months later +6.5mins walking time (before pain)
  30. 30. 3.MEDICAL MANAGEMENT: a)Antiplatelet therapy e.g. Aspirin/Clopidogrel b)Phosphodiesterase Inhibitor e.g. Cilostazol c)Foot Care
  31. 31. PCI / SURGERY Indications/Considerations: • Poor response to exercise rehabilitation + pharmacologic therapy. • Significantly disabled by claudication, poor QOL • The patient is able to benefit from an improvement in claudication • The individual’s anticipated natural hx and prognosis • Morphology of the lesion (low risk + high probabilty of operation success) • PCI: • Angioplasty and Stenting • Should be offered first to patients with significant comorbidities who are not expected to live more than 1-2 years
  32. 32. • Bypass Surgery: • Reverse the saphenous vein for femoro- popliteal bypass • Synthetic prosthesis for aorto-iliac or ilio- femoral bypass • Others = iliac endarterectomy & thrombolysis • Current Cochrane review = not enough evidence for Bypass>PCI • Amputation: Last Resort
  33. 33. ACUTE ARTERIAL DISEASE sudden occlusion of major peripheral artery. due to: -Arterial embolus -Trauma -Acute arterial thrombosis
  34. 34. FEATURES OF ACUTE LIMB ISCHEAMIA 1.PAIN 2.PALLOR 3.PULSELESNESS 4.PERISHING COLD (POIKILOTHERMIA) 5.PARASTHESIAS 6.PARALYSIS
  35. 35. INVESTIGATION -Angiography TREATMENT - THRMOBOLYSIS SURGICAL -embolectomy
  36. 36. GANGRENE • Gangrene implies death of macroscopic portions of tissue; the term necrosis may be used synonymously. • It often affects the distal part of a limb because of arterial obstruction (from thrombosis, embolus or arteritis).
  37. 37. TYPES - Dry gangrene - Wet gangrene. Signs of gangrene. 1.change of colour pale,bluish purple and finally black. 2. loss of temperture. 3.loss of sensation. 4.loss of pulsation. 5.loss of function.
  38. 38. DRY GANGRENE
  39. 39. Wet gangrene
  40. 40. Causes of ischaemia -Large vessel occlusion. - Small vessel occlusion. CAUSES OF GANGRENE. cardiovascular -traumatic . -Infective. -Diabetic -Nervous diseases -Physical gangrene . Frost bite
  41. 41. TREATMENT - amputation.
  42. 42. THANK YOU
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