The assessment and investigation of the patient with PVD is aimed at establishing whether or not the symptoms warrant further interventional treatment, as well as assessing the patient’s cardiorespiratory fitness for invasive management.
Clinical History and Examination
A full cardiovascular and respiratory history should be taken to assess fitness to withstand treatment (particularly if invasive).
Documentation of the claudication distance and its evolution.
Documentation of any rest pain and tissue loss or gangrene.
Palpate and document all pulses. Pedal pulses present at rest should be palpated post-exercise (patient may have significant in-flow disease).
Measure Buerger’s angle and perform Buerger’s test.
Full peripheral neurological examination.
Laboratory Investigations
Ankle Brachial Pressure Index (ABPI)
Should be performed in a rested patient in a warm environment.
The highest pedal pressure (DP or PT) is divided by the highest brachial pressure and gives an objective measurement of ischaemia.
ABPI <0.7 → claudication, <0.3 → rest pain.
The Doppler signal should be used in conjunction with Buerger’s test. The angle of signal disappearance corresponds to the ischaemic angle!
Exercise ABPI
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