SPECIAL TESTS FOR PERIPHERAL VASCULAR DISEASE

SPECIAL TESTS FOR PERIPHERAL VASCULAR DISEASE

 1. Test for disease of arteries

i. Venous filling time:

·         It is to test both arterial and venous systems

·         Patient in supine lying and affected extremity is elevated to empty blood from superficial veins

·         The patient then hangs the extremity over the edge of the table

·         Time is recorded when the veins have been refilled

·         Normal filling time: Approximate 15 sec

·         Venous insufficiency: <15 sec

ii. Rubor of dependency:

·         It is used for both arterial and venous disease

·         Patient is positional in supine lying and the color of both feet are examined

·         The affected limb is elevated for several seconds and is lowered back to the original position

·         Time is recorded for the color of involved foot to match with the uninvolved foot

·         For arterial disease time taken is more than 20-30 seconds to return to normal (usually red)

·         For venous disease: Color returns back immediately

iii. Claudication test:

·         It is mainly used for arterial disease

·         A treadmill is used for walking

·         For Grade- I: Patient feels pain n walking and on further walking the pain subsides

·         Grade II: Pain on walking and on further walking the pain increases

·         Grade II: Pain at rest – The time and distance at which the painful claudication occurs is thus recorded

iv. Buerger’s test:

·         It is used for Buerger‘s disease

·         If the leg of a normal individual is raised by 900 then the skin color remains pink

·         But in case of patient with ischemic limb, on elevation will cause marked pallor of the foot

·         The angle between the limb at which the pallor appears and the horizontal plane is known as Buerger‘s angle or vascular angle

·         If this angle is less than 300 then it indicates severe arterial occlusion

2. Tests for diseases of veins

i. Moses sign:

·         Squeezing of the calf muscles form side-side is painful in case of DVT

ii. Homan’s sign:

·         Passive dorsiflexion of the ankle with knee in extension will elicit pain in the calf muscles

iii. Cuff test:

·         Place a pressure cuff around the lower aspect of the affected leg and inflate the cuff

·         If the patient is unable to bear the cuff pressure greater than 40 mm of Hg then it indicates possibility of DVT

iv. Trendlenberg’s test:

·         It is used to assess the functioning of the valves especially I case of perforating veins

·         It is positioned in supine lying with lower extremity elevated to 450 to empty the venous veins

·         A tourniquet is tied along the thigh to prevent superficial venous back flow

·         Then placed the lower limb back to normal position and observe the venous refilling time

·         On releasing the tourniquet if the superficial veins fills quickly then the valves have become incompetent

·         The normal venous filling time is 25-30 secs

v. Perthes test:

·         It is to test the competency of deep veins

·         A tourniquet is tied around the thigh to prevent back flow of blood

·         The patient is then asked to walk quickly

·         If the communicating veins and deep veins are normal then varicose veins will shrink

·         If the communicating veins and deep veins are blocked then the varicose veins will get distended