Vascular lecture Bicknell Flashcards
General Vasc inspection
Smoking Inhalers Diabetic med Walking stick body habitus
Examine the hands quickly
- stained
- fistula
Supra-Aortic Pulses
Radial
- rate
- rhythm
- radio/radio
Brachial
BP
Subclavian
Carotid
- listen for bruits
Top half statement
The patient appears comfortable at rest, no peripheral stigmata of chronic disease. His fingers are….
He is not tachycardic with a regular rhythm, no radio radial delay
You have indicated his BP is (normatensive)
There is a full complement of supra-aortic pulses, with no bruits
I would also like to complte with examination by examining the pre-cordium
Abdo examine
nipple to knee exposure
Scars around the sides
Palpate for aneurysm
listen for bruits centrally and over renal vessels
Lower limbs
Inspect - feel the temperature in lower legs only
Femorals - feel together then for radiofemoral delay (coarctation)
Popliteal - if feel it may be aneurysm - do pulsatile and expansile
Pedal arteries
Listen for bruits - iliacs, CFA, adductor hiatus
Arterial Anomalies - Dominant Peroneal artery
5% of pop.
absent doralis pedis but there is one lateral to malleolus and supplied by peroneal vessel
Buergers Angle
angle of the test
lie flat and lift 45 degrees. When it goes white is the Buergers angle
Buergers Test
From buergers angle swing leg round onto the floor.
Goes brick red.
Why brick red i nBuergers Test
Ischaemia makes Co2 and lactic acid so get reactive vasodilatation
What does buergers test signifyt?
Significant lower limb arterial disease
ABPI
Screening test for peripheral artery disease
Significance of ABPI in DM or renal disease
may have incompreesible calcified vessels
ABPI values
- 8 - 1 normal
- 6 - 08 claudication
below 0.6 may be critical ischamia
Claudicants and ABPI
May have any value but drops with exercise
How to present lower limbs
On exam there was no signs of scars or ulceration
no difference in temperature
pt had bilateral and equal fem pulses and no radio femoral delay
there were palpable popliteal pulses
No bruits on auscultation
Buergers tes was negative
I would like ABPIS on both sides
Midline laprotomy
Aorta
Midline and up to shoulder
Thoracolaporotomy
Rooftop incision
aorta and abdomen
left flank
Iliac artery or renal tranplant
Vertical groin incision
Common femoral artery
if blockage go around it two ways
anatomically or extra antomically
if unfit pt
axillo bifemoral bipass
Long saphernous vein
infront of medial malleolus
to behind the pubic tubercle
used in CABG or arterial graft in leg (fem pop)
vein left in situ (get pulse) or taken out and put somewhere else
Claudication History
No pain at rest
cramping pain on certain distance - repeatable
Stop and gets better
ICE them
