Vascular Exam (venous)

Question 1

What do you inspect?

Answer 1

Skin changes

1. Lipodermatosclerosis
2. Venous eczema
3. Malleolar flare

Non-pitting oedema

Varicose veins and Saphena Varix

Scars relating to varicose vein surgery

Venous Ulcers

Question 2

What do you palpate?

Answer 2

Varicose veins

Temperature and tenderness

Pittong oedema

SFJ incompetence - check for cough impulse

Tap test - tap the vein above, feel below - assesses valvular competence

Question 3

How do you perform trendelenberg’s test?

Answer 3

You are looking for incompetent perforators

Milk the legs

Apply tourniquet at the SFJ high in the thigh (whilst lying down)

Ask the patient to stand

If veins refill then the distal perforators are incompetent

Question 4

How might the examination be completed?

Answer 4

Abdominal examination - abdominal masses may be causeing the lower limb venous disease

Venous DUplex - looking for reversal of blood flow indicating valvular incompetence