Arterial insufficiency- Diagnosis

Tests and Measurements of Arterial sufficiency

1. Palpation of Pulses

1. Compare the pulses in the involved and 

2. Detection of pulses in the distal portion of the extremities.

3. Pulses are describe as normal, diminished, or absent.

4. Pulselessness is a sign of severe arterial insufficiency.

5. Palpate the femoral, popliteal, dorsalis pedis, posterior tibial, radial, ulnar, and Brachial pulses.

2. Skin Temperature

1. A limb with diminished arterial blood flow will be cool to the touch.

2. If a discrepancy exists between an involved and uninvolved extremity, then a quantitative measurement of skin temperature should be assessed by an electronic thermometer.

3. Skin Integrity and Pigmentation

1. Diminished and absent arterial blood flow to a limb cause trophic changes in the skin.

2. The patient's skin is dry, pallor.

3. Hair loss and skin ulceration may be present.

4. Tests for Reactive Hyperemia (Rubor of Dependency)

1. Changes in skin color that occur with elevation and dependency of the limb as a result of altered blood flow.

2. Procedure;

1. The legs are elevated for several minutes above the level of the heart while the patient is lying supine.

2. Pallor (skin color is diminished) of skin will occur in feet within 1 minute or less if arterial circulation is poor.

3. The time for a change in skin color is noted.

4. The legs are then placed in a dependent position, and the color of the feet is noted.

3. Alternate procedure

1. Reactive hyperemia can be evaluated by temporarily restricting blood flow to the distal portion of the extremity with a BP cuff.

2. This restriction causes an accumulation of CO2 and lactic acid in the distal extremity. 

3. These metabolites are vasodilators and affect the vascular bed of blood flow deprived area.

4. When the cuff is removed and blood flow resumes to the distal extremity, normal hyperemia (flushing) of the extremity should occur within 10 seconds.

5. In arteriosclerotic vascular disease, the time for flushing is 1 to 2 minutes but in vasospastic arterial disease, flushing will occur within the normal time.

6. This method is painful in normal individuals or patients with occlusive arterial disease.

5. Claudication Time

1. Assessment of intermittent claudication is performed to determine the amount of time a patient can exercise before experiencing cramping and pain in the distal musculature.

2. Measurement should be taken to create a baseline for exercise tolerance before initiating an exercise program.

6. Doppler Ultrasonography

1. A noninvasive assessment to determine the relative velocity of blood flow in the arteries and veins.

2. 👉 Doppler Ultrasonic evaluations are not commonly performed by therapists.

7. Transcutaneous Oximetry

1. Transcutaneous Oximetry provides information about the oxygen saturation of blood by use of a pulse oximeter.

8. Arteriography

1. An invasive procedure involves the injection of radiopaque dye (contrast medium) directly into the artery (Fig. 1).

   

   Fig. 1: Arteriography of leg
   

   
   

2. Then the arteries are radiographically visualized to detect any restriction in the movement of dye in arterial vessels.

3. 👉This is an invasive procedure that gives a very accurate picture of the location of Arterial obstruction. 

9. Magnetic Resonance Angiography

1. A non-invasive procedure that provides radiographically visualization of arteries without the use of contrast medium.